What to know about indigestion or dyspepsia

Dyspepsia is a common problem, affecting up to 30% of the population. Common symptoms include bloating, discomfort, feeling too full, nausea, and gas.

In most cases, it happens after eating or drinking. Lifestyle changes can often help.

Other causes include medical conditions, such as gastroesophageal reflux disease (GERD) and the use of certain medications.

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A doctor will diagnose dyspepsia if a person has one or more of the following symptoms:

• pain relating to the digestive system
• a burning sensation in the digestive tract
• feeling too full after eating
• feeling full too quickly during eating

A person may also experience bloating and nausea.

A person can have symptoms even if they have not eaten a large amount.

Treatment for dyspepsia depends on the cause and severity. Often, treating an underlying condition or changing a person’s medication will reduce dyspepsia.

Lifestyle treatments

For mild and infrequent symptoms, lifestyle changes may help. These include:

• avoiding or limiting the intake of trigger foods, such as fried foods, chocolate, onion, and garlic
• drinking water instead of soda
• limiting the intake of caffeine and alcohol
• eating smaller meals more often
• eating slowly
• maintaining a moderate weight
• avoiding tight-fitting clothing
• waiting 3 hours or more before going to bed
• raising the head of the bed
• avoiding or quitting smoking, if a smoker

Medications

For severe or frequent symptoms, a doctor may recommend medication. People should speak to their doctor about suitable options and possible side effects.

There are various medications and treatments available, depending on the cause of dyspepsia.

Medication options include:

Antacids

These counter the effects of stomach acid. Examples include Alka-Seltzer, Maalox, Rolaids, Riopan, and Mylanta. These are over-the-counter (OTC) medicines that do not need a prescription. A doctor will usually recommend an antacid medication as one of the first treatments for dyspepsia.

H-2-receptor antagonists

These reduce stomach acid levels and are more effective than antacids. Examples include Tagamet and Pepcid. Some are available OTC, while others are by prescription only. Some may carry a risk of adverse effects. A doctor can help a person choose a suitable option.

Proton pump inhibitors (PPIs)

PPIs reduce stomach acid and are stronger than H-2-receptor antagonists. Examples are Aciphex, Nexium, Prevacid, Prilosec, Protonix, and Zegerid.

Prokinetics

These can help boost the movement of food through the stomach. Examples include metoclopramide (Reglan). Side effects may include tiredness, depression, anxiety, and muscle spasms.

Antibiotics

If a Helicobacter pylori infection is causing peptic ulcers that result in indigestion, a doctor may prescribe an antibiotic. Side effects may include an upset stomach, diarrhea, and fungal infections.

Antidepressants

Sometimes, a problem with the central nervous system can lead to digestive problems. A low dose of an antidepressant may help resolve it.

Counseling

Chronic indigestion can affect a person’s quality of life and overall well-being. Counseling may help some people manage these issues.

Options may include:

• cognitive behavioral therapy
• biofeedback
• hypnotherapy
• relaxation therapy

Drug interactions

If a person’s medication appears to be a trigger for indigestion, a doctor may recommend adjusting the drug dose or type.

It is important to change medications only under the supervision of a doctor.

Dietary choices may help manage indigestion.

Tips include:

• following a healthful, balanced diet
• limiting the intake of spicy and fatty foods
• limiting caffeine and alcohol consumption
• drinking water instead of sodas
• avoiding acidic foods, such as tomatoes and oranges

Consuming four or five smaller meals per day instead of three larger ones can also help.

Indigestion can result from lifestyle or dietary habits, a medical condition, or the use of some drugs.

Common causes of indigestion include:

• dietary factors
• smoking
• obesity
• stress

If there is no identifiable structural or metabolic cause, a doctor will diagnose functional dyspepsia.

Dyspepsia can also be a symptom of a wide range of health conditions, including:

• GERD
• peptic ulcer disease
• stomach cancer or another type of cancer
• medications, such as antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs)
• obesity
• pancreatitis
• gallstones
• liver disease
• gastritis, or inflammation of the stomach
• hiatal hernia
• infection, especially with H. pylori
• celiac disease
• irritable bowel disease
• irritable bowel syndrome

In pregnancy

Dyspepsia is common during pregnancy, especially in the last trimester. This is due to hormonal changes and the way the fetus presses against the stomach.

A doctor or pharmacist can recommend safe ways to manage indigestion during pregnancy.

Many people experience mild dyspepsia from time to time and manage it with lifestyle changes or OTC medication.

However, anyone who has frequent indigestion or worsening symptoms should seek medical help.

People should see a doctor if they have the following symptoms alongside indigestion:

• severe stomach pain
• changes in bowel movements
• frequent vomiting, especially with traces of blood
• blood in the stools or black stools
• a lump in the abdominal area
• unexplained weight loss
• anemia
• generally feeling unwell
• difficulty swallowing food
• yellow coloring in the eyes and skin
• shortness of breath
• sweating
• chest pain that spreads to the jaw, arm, or neck

A doctor will ask the person about:

• their symptoms
• their personal and family medical history
• any other health conditions and medications that they are taking
• their dietary habits

They may also examine the chest and stomach. This may involve pressing down on different parts of the abdomen to check for areas that may be sensitive, tender, or painful under pressure.

In some cases, a doctor may use the following tests to rule out an underlying health condition:

• Blood test: This can assess for anemia, liver problems, and other conditions.
• Tests for H. pylori infection: In addition to a blood test, these tests may include a urea breath test and a stool antigen test.
• Endoscopy: The doctor will use a long, thin tube with a camera to take images of the gastrointestinal tract. They may also take a tissue sample for a biopsy. This can help them diagnose an ulcer or a tumor.

In rare cases, severe and persistent indigestion can lead to complications. These include:

Esophageal stricture

Persistent exposure to stomach acid can cause scarring in the upper gastrointestinal tract. The tract can become narrow and constricted, causing difficulty with swallowing and chest pain. Surgery may be necessary to widen the esophagus.

Pyloric stenosis

In some cases, stomach acid can cause long-term irritation of the pylorus, the passage between the stomach and the small intestine. If the pylorus becomes scarred, it can narrow. If that happens, a person may not be able to digest food properly, and they may need surgery.

Peritonitis

Over time, stomach acid can cause the lining of the digestive system to break down, leading to an infection called peritonitis. Medication or surgery may be necessary.

Dyspepsia is often mild, and people can make dietary and lifestyle changes to help manage it. If these do not work, a doctor can prescribe medications.

In some cases, there may be a more serious underlying cause. Anyone who has concerns about new, severe, or ongoing dyspepsia should seek medical advice.

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• antacids
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