Dyspepsia
What is Dyspepsia?
Dyspepsia (Indigestion) is a general term used to describe discomfort or a burning sensation in the upper abdomen.
Indigestion may be characterized by, or associated with other symptoms, such as early satiety (feeling full early into a meal), bloating or nausea and vomiting.
Bouts of dyspepsia often occur after a meal. However, medications and certain medical conditions can also cause indigestion. Dyspepsia usually passes within a few hours, sometimes without treatment. Some people experience chronic indigestion that is not caused by foods, medications or medical conditions. This type of indigestion is called functional or non-ulcer dyspepsia. It is believed that this type of indigestion may be caused by a problem in the muscle movement that propels food through the intestinal tract. Muscle problems may delay the emptying of the stomach and cause indigestion.
Patients with indigestion often experience other symptoms, such as vomiting, belching, flatulence, abdominal pain and abdominal cramping. Indigestion is often confused with heartburn, a burning sensation in the upper abdominal or chest area that is caused by acid reflux of the stomach contents. However, heartburn is a different symptom and may indicate a different problem. In some cases, people experiencing a heart attack may confuse their heart symptoms for indigestion.
People of any age, even children, can experience dyspepsia. Men and women are affected equally by indigestion. About 25 percent of the population experience indigestion at least once a year, according to the American Academy of Family Physicians.
Although dyspepsia is common, less than half of the people who experience it seek medical treatment.
Potential causes of dyspepsia
There are many possible causes of indigestion. They include:
- Gastritis. Inflammation or irritation of the stomach lining. Both acute (short-term) and chronic (long-term) gastritis can cause indigestion.
- Peptic ulcer. An open sore, or ulcer, in the lining of the esophagus, stomach or duodenum.
- Infection. Stomach infections caused by the microorganism Helicobacter pylori (H. pylori) can sometimes lead to gastritis or ulcers, both of which may lead to indigestion.
- Gastroesophageal reflux disease (GERD). A backflow of acid from the stomach into the esophagus.
- Motility disorders. People who experience delayed emptying of the stomach after eating frequently experience dyspepsia.
- Pancreatitis. Inflammation or irritation of the pancreas, often due to gallstones or alcohol abuse.
- Gallstones. Hard, stone-like concretions formed from substances in bile such as cholesterol or bilirubin that develop in the gallbladder or bile ducts.
- Cholecystitis. Inflammation of the gallbladder that causes episodes of severe abdominal pain.
- Cancer. Certain types of gastrointestinal cancer, including esophageal cancer and pancreatic cancer, may cause dyspepsia.
How is Dyspepsia treated?
Indigestion often goes away within a few hours without treatment. However, it can often be prevented or treated by making the following lifestyle modifications:
- Avoid foods, such as fatty or spicy foods, that trigger bouts of dyspepsia. Carbonated beverages, caffeine and alcohol can also cause indigestion.
- Eat smaller meals more frequently throughout the day. Eat slowly and chew thoroughly. Restrict intake of fluids during meals. To avoid swallowing excessive air, do not chew with the mouth open or talk while eating.
- Exercise regularly. Getting 30 to 60 minutes of exercise a day improves digestion. However, exercising immediately after eating is not advised.
- Limit stress. Relaxation techniques, such as deep breathing and yoga, can help relieve stress.
- Maintain a healthy body weight. Excess weight can increase pressure on the abdomen and make indigestion worse.
Depending on their cause, some cases of indigestion may be treated with medications, including:
- Antacids. Medications that work by neutralizing stomach acid. They are available without a prescription.
- Acid blockers. Medications that work by decreasing the amount of acid the stomach produces. They are available without a prescription.
- Proton pump inhibitors. Medications that reduce the amount of stomach acid by inhibiting its production. They are available with and without a prescription.
- Prokinetics. Prescription medications that act on the muscles in the gastrointestinal tract to help move food through the digestive system.
- Tegaserod (Zelnorm) was recently removed from the market due to adverse cardiovascular side effects. However, metoclopropamide may still be used to treat indigestion despite its frequent side effects.
- Antispasmodics. Medications that work by relaxing the smooth muscles in the intestines. They are available by prescription.
- Acid suppressors. Medications to help protect the tissues that line the stomach and small intestine. They are available by prescription.
- Low-dose antidepressants. In a few cases, tricyclic antidepressants and selective serotonin reuptake inhibitors (another type of antidepressant) are sometimes prescribed in low doses to treat dyspepsia. They work by inhibiting the activity of neurons that control the intestines.
- Antibiotics. Dyspepsia caused by the microorganism Helicobacter pylori (H. pylori) may be treated with prescription antibiotics.
Most types of dyspepsia can be treated at home. However, patients should consult a physician if:
- Symptoms are persistent or severe.
- Symptoms are accompanied by weight loss, appetite loss or vomiting.
- Stools are black or bloody.
- Severe pain is experienced in the upper right abdomen. This may indicate another serious condition, such as gallstones or pancreatitis.
- Symptoms are accompanied by shortness of breath, sweating or pain in the jaw, neck or arm. These symptoms may indicate a heart attack.
- Discomfort is experienced that is unrelated to eating.
Medications
- For minor discomfort, you may use non-prescription antacids.
- For serious discomfort, H-2 blockers, antispasmodics or tranquilizers to relieve tension may be prescribed.
Aciphex (Rabeprazole), Pepcid (Famotidine), Prevacid (Lansoprazole), Prilosec (Omeprazole), Protonix (Pantoprazole), Zantac (Ranitidine), Reglan (Metoclopramide)
What might complicate it?
Dyspepsia may be complicated by the underlying condition causing it. Taking antacid drugs may initially mask the underlying disease or disorder, delaying diagnosis and treatment.
Predicted outcome
Since dyspepsia is not a disease in itself, but rather a symptom of other diseases or disorders, the predicted outcome depends on the underlying cause.
Alternatives
Dyspepsia is a symptom of many other diseases and disorders including gastrointestinal tract dysfunction, pancreatic disease, biliary tract disease, thyroid disease, coronary ischemia, pregnancy, side effects of certain drugs, and excessive alcohol consumption.
Appropriate specialists
Gastroenterologist, general practitioner, internist.
Notify your physician if
- The pattern of indigestion symptoms changes markedly.
- Any of the following occur:
- Vomiting, weight loss or appetite loss.
- Black, tarry stool or vomiting of blood.
- Fever.
- Severe pain in the upper right abdomen.
- Discomfort that continues unrelated to eating or chewing gum.
- Indigestion is accompanied by:
- Shortness of breath.
- Sweating.
- Pain radiating to the jaw, neck or arm.
Last updated 6 July 2015