Dyspepsia

Dyspepsia, commonly known as indigestion, is a widespread digestive problem affecting up to one in four people at some point in their lives, causing discomfort in the upper belly that can range from mild to severe.

Table of contents

• What is dyspepsia
• Symptoms you may experience
• What causes dyspepsia
• When to see a doctor
• How dyspepsia is diagnosed
• Treatment options
• Lifestyle changes that can help
• Living with dyspepsia

What is dyspepsia

Dyspepsia is pain or discomfort that happens while your stomach digests food^[1]. The word dyspepsia comes from Greek, meaning “bad digestion”^[8]. This condition is also commonly called indigestion^[2].

If you often get a stomachache after eating, something in your digestion may not be working as it should^[1]. The discomfort typically occurs in the upper middle part of your belly, in an area called the epigastric region, which holds important digestive organs like your stomach, liver, pancreas and the first part of your small intestine^[1].

Dyspepsia is a very common problem. It affects approximately 20 to 25 percent of the population at some point during their life^[2][4]. Both men and women can get indigestion, and people of any age, even infants, can experience it^[15].

Most people have occasional indigestion, which is usually not serious^[1]. Small changes in your eating habits can often help. However, for others, it happens often enough to affect daily life. When indigestion becomes a regular problem, it may be a sign of an underlying digestive condition, or it may have no clear cause at all^[1].

Symptoms you may experience

Healthcare providers define indigestion by three main symptoms: pain in your upper belly, a burning feeling, and uncomfortable fullness^[1]. These symptoms often show up within minutes to a few hours after a meal^[1].

The most common symptoms of dyspepsia include^[1][4]:

• Pain or discomfort in your upper abdomen
• A burning feeling in your upper belly or chest
• Feeling full sooner than expected while eating (called early satiety)
• Feeling uncomfortably full long after eating (postprandial fullness)

Many people who experience indigestion also report additional symptoms^[1]:

• Belching or burping
• Bloating (a feeling of fullness or swelling in your stomach)
• Gas
• Nausea (feeling sick to your stomach)
• In some cases, vomiting

The symptoms might come and go, but they are usually present most of the time if you have chronic indigestion^[9]. It normally takes three to five hours for your stomach to digest food before passing it to your small intestine. During this time, your pancreas and gallbladder release enzymes (substances that help break down food) and bile to help break food down, right in the same area where indigestion pain tends to show up^[1].

What causes dyspepsia

The most common cause of indigestion is stomach acid, especially when there’s too much of it or when it gets where it doesn’t belong^[1]. Acid can irritate the lining of your stomach, esophagus (the tube leading from your mouth to your stomach), or small intestine, causing that familiar burning or painful sensation^[1].

Indigestion can happen for different reasons. Sometimes, indigestion is simply due to overeating or eating rich, fatty foods^[1]. These meals require more digestive effort, which means more acid and stronger contractions from your stomach, gallbladder and pancreas. This extra activity can irritate your digestive tract and cause temporary discomfort^[1].

Certain actions and habits can trigger feelings of indigestion^[15]:

• Eating too fast or too much in one sitting
• Eating high-fat, greasy or spicy foods
• Smoking
• Drinking alcohol
• Consuming too much caffeine
• Experiencing stress
• Taking certain medicines, especially anti-inflammatory drugs like aspirin or ibuprofen

When indigestion happens regularly, it may be linked to a digestive condition. The extra acid often results from underlying conditions like GERD (gastroesophageal reflux disease, also called acid reflux) or peptic ulcer disease, which are among the most common causes of chronic indigestion^[1].

GERD allows acid to escape from your stomach into your esophagus, which isn’t built to handle it^[1]. Peptic ulcers can form in your stomach or the first part of your small intestine (called the duodenum) when acid damages the protective lining^[1]. A bacterium called Helicobacter pylori (H. pylori) can cause stomach infections that lead to ulcers and inflammation^[5].

Sometimes, indigestion has no identifiable cause. This is called functional dyspepsia^[3]. About 50 to 60 percent of patients with dyspepsia symptoms fall into this category^[13]. Functional dyspepsia is diagnosed when no specific cause of symptoms can be found. It happens when the nerves in the stomach become overly sensitive, causing symptoms of pain^[5]. The gut and the brain are connected, and this connection can cause the stomach to become more sensitive to normal signals^[5].

When to see a doctor

Most indigestion isn’t usually serious^[1]. However, you should make an appointment with a healthcare professional if you experience constant symptoms that worry you^[3].

Talk to your doctor if^[15]:

• Your indigestion lasts more than two weeks
• Your symptoms change or get a lot worse
• You see blood in your stool or start vomiting blood
• You experience sudden weight loss for no reason
• You start having really bad belly pain
• You have trouble swallowing
• You experience jaundice (when your skin and the whites of your eyes turn yellow)

Seek medical attention right away if you experience^[3]:

• Bloody vomit
• Dark, tarry stools
• Shortness of breath
• Pain in your jaw, neck or arm
• Unexplained weight loss

Sometimes, a heart attack can feel like indigestion, called a silent heart attack^[1]. If you have indigestion along with a tight, clenching feeling in your chest, pain in your jaw or upper back, fatigue, shortness of breath, chest heaviness or sweating, seek emergency care immediately^[1].

How dyspepsia is diagnosed

A healthcare professional will most likely review your symptoms and do a physical exam^[10]. Several tests can help find the cause of the discomfort and rule out other disorders^[10].

Your doctor will ask about your symptoms, what and how you eat, and whether you take certain medicines^[1]. A thorough history is important in evaluating dyspepsia, although symptoms alone may not be very useful in establishing a specific diagnosis^[13].

Tests your doctor may recommend include^[10]:

• Blood tests to help rule out other diseases that can cause similar symptoms
• Tests for the bacterium H. pylori, which may involve a stool sample, a breath test, or tissue samples of the stomach taken during endoscopy
• Endoscopy, a procedure where a tiny camera on the end of a flexible tube is put into your mouth and down into your stomach, allowing the doctor to look inside your stomach and collect tissue samples to look for infection or inflammation

Endoscopy should be performed promptly in patients who have “alarm symptoms” such as black, tarry stools, trouble swallowing, vomiting blood, or unexplained weight loss^[13]. In patients who are 60 or older, or who have worrisome symptoms, an endoscopy is recommended to further assess and find a potential cause^[7].

In patients younger than 60 years of age without alarm symptoms, testing for H. pylori is recommended, and if the test is positive, treatment of the infection follows^[7]. If symptoms persist or recur after six to eight weeks of treatment, endoscopy should be performed^[13].

Treatment options

Most often, medicine can take care of indigestion^[9]. Treatment depends on your symptoms and may combine medicines and behavior therapy^[10].

If you have a stomach ulcer, it can be cured. You may need to take an acid-blocking medicine^[9]. If you have an H. pylori infection in your stomach, you will also need to take antibiotics^[9]. If your doctor thinks that a medicine you’re taking causes your dyspepsia, you might need to try another one^[9].

Several types of medicines may help manage symptoms of dyspepsia^[10]:

• Antacids that counter the effects of stomach acid (available without a prescription)
• Proton pump inhibitors (PPIs) that cut down on the amount of acid in your stomach, such as omeprazole, esomeprazole, and lansoprazole
• H2-receptor antagonists that reduce stomach acid production
• Prokinetic agents that speed up stomach emptying
• Antidepressants (such as tricyclic antidepressants) that may help when dyspepsia is thought to be due to an abnormal brain-gut interaction

Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H. pylori or who continue to have symptoms after H. pylori eradication^[23].

A medicine that cuts down on the amount of acid in your stomach might help your pain and can also help if you have acid reflux disease^[9]. When used for functional dyspepsia, antidepressants are typically prescribed at a low dose, where they do not exert any significant antidepressant effect but help modulate the abnormal brain-gut connection^[17].

The medicines for dyspepsia most often have only minor side effects that go away on their own^[9]. Some medicines can make your tongue or stools black. Some may cause headaches, nausea or diarrhea^[9]. If you have side effects that make it hard for you to take medicine for dyspepsia, talk to your family doctor^[9].

Remember to take medicines just the way your doctor tells you. If you need to take an antibiotic, take all of the pills, even when you start feeling better^[9].

Lifestyle changes that can help

For mild and infrequent symptoms, lifestyle changes may help^[2]. Small changes in your eating habits can often provide relief from indigestion^[1].

You can do quite a bit to help yourself feel better^[9]:

• If you smoke, stop smoking
• If some foods bother your stomach, try to avoid eating them
• Try to reduce the stress in your life
• If you have acid reflux, don’t eat right before bedtime. Raising the head of your bed with blocks under two legs may also help
• Unless your doctor tells you otherwise, don’t take a lot of anti-inflammatory medicines like ibuprofen, aspirin, or naproxen. Acetaminophen is a better choice for pain because it doesn’t hurt your stomach

Dietary changes can make a significant difference^[2]:

• Avoid or limit the intake of trigger foods, such as fried foods, mint, tomatoes, and some spices
• Limit the intake of milk, caffeine, and alcohol
• Avoid large portions at mealtime
• Eat smaller meals more often
• Avoid lying down for at least two hours after eating
• If you are overweight, losing weight may provide some relief to the digestive tract
• Avoid carbonated and fizzy drinks
• Avoid food containing high citric content such as oranges and tomato products
• Avoid greasy food and fatty or spicy food

During mealtimes, care should be taken to create a calm and relaxed atmosphere, eat in small quantities, and chew the food slowly and completely^[22]. Never skip meals or overeat^[22].

An important factor in causing indigestion is mental health. Anxiety and stress cause discomfort to the stomach^[22]. Feelings of anxiety make the nervous system overactive and divert valuable components from the digestive system^[22]. If the indigestion is due to depression and anxiety, talk therapy may help^[22]. Psychological therapy, such as cognitive behavioral therapy, may be effective in treating functional dyspepsia^[17].

Living with dyspepsia

Indigestion isn’t usually serious, and how often it happens and how severe it feels matter^[1]. Most people have occasional indigestion. For others, it happens often enough to affect daily life^[1].

Functional dyspepsia is a constant condition, but symptoms don’t happen all the time^[3]. The primary treatment focuses on symptom management, as this disorder can be relapsing and remitting^[4]. Initial management involves educating yourself about the diagnosis and discussing treatment expectations with your doctor^[4].

There’s no one solution that works for everyone^[11]. Living with these symptoms can reduce a person’s quality of life and may have a negative impact on mental health^[20]. However, with proper treatment and lifestyle modifications, many people find significant relief from their symptoms.

A large proportion of people with functional dyspepsia also have ongoing anxiety, depression, or other mental health conditions. Addressing these conditions, often with the help of a trained psychiatrist or psychologist, can also improve dyspepsia symptoms^[17].

If symptoms persist or recur after treatment, or if new symptoms develop, it’s important to follow up with your healthcare provider for further evaluation^[13].