Dyspepsia, also known as indigestion or upset stomach, is a term that describes discomfort or pain in the upper abdomen. It is not a disease. Dyspepsia is a group of symptoms which often include bloating, nausea and burping.
Indigestion is usually caused by stomach acid coming into contact with the mucosa of the digestive system - the sensitive protective lining of the digestive system. Stomach acids break down the mucosa, causing irritation and inflammation, which trigger the symptoms of indigestion.
In the majority of cases indigestion is linked to eating and/or drinking. Sometimes it may be caused by infection or some medications.
Common symptoms of dyspepsia / indigestion
Belching, nausea and a bloated feeling are common symptoms of dyspepsia.
Most people with indigestion feel pain and discomfort in the stomach or chest area. The sensation generally appears soon after consuming food or drink. In some cases symptoms may appear some time after a meal. Some people feel full during a meal, even if they have not eaten much.
Heartburn and indigestion are two separate conditions. Heartburn is a burning feeling behind the breastbone, usually after eating.
The following symptoms of dyspepsia are also common:
- Feeling bloated (very full)
In very rare cases indigestion may be a symptom of stomach cancer.
Mild indigestion is rarely anything to worry about. You should see your doctor if symptoms continue for more than two weeks. See your doctor immediately if pain is severe, and the following also occur:
- Loss of appetite or weight loss
- Black stools
- Jaundice (yellow coloring of eyes and skin)
- Chest pain when your exert yourself
- Shortness of breath
- Chest pain radiation to the jaw, arm or neck
Causes of dyspepsia / indigestion
Indigestion is usually related to lifestyle and what we eat and drink. It may also be caused by infection or some other digestive conditions.
Common causes of indigestion include:
- Eating too much
- Eating too rapidly
- Consuming fatty or greasy foods
- Consuming spicy foods
- Consuming too much caffeine
- Consuming too much alcohol
- Consuming too much chocolate
- Consuming too many fizzy drinks
- Emotional trauma
- Gastritis (inflammation of the stomach)
- Hiatus hernia
- Infection, especially with bacteria known as Helicobacter pylori
- Obesity - caused by more pressure inside the abdomen
- Pancreatitis (inflammation of the pancreas)
- Peptic ulcers
- Some medications, such as antibiotics and NSAIDs (non-steroidal anti-inflammatory drugs)
- Stomach cancer
When a doctor cannot find a cause for indigestion the patient may have functional dyspepsia - a type of indigestion that may undermine the stomach's ability to accept and digest food and then pass that food on to the small intestine.
Diagnosis of indigestion
For the majority of patients indigestion is mild and does not occur very often. In such cases no treatment from a doctor is required. People who experience indigestion regularly should see their GP (general practitioner, primary care physician). You should also see your doctor if you experience severe discomfort or pain.
A doctor will ask the patient about symptoms, his/her medical and possibly family history, and examine the chest and stomach. This may involve pressing different areas of the abdomen to find out whether any are sensitive or tender.
- Blood test - if the patient has any symptoms of anemia the doctor may order a blood test.
- Endoscopy - patients who have not responded to treatment, or those with certain signs and symptoms, may be advised to have their abdomen examined in more detail. An endoscopy takes place in hospital. A long thin tube with a camera at the end - an endoscope - goes through the patient's throat and into the stomach. The surgeon can see images of the inside of the abdomen on an external monitor.
- Tests to diagnose Helicobacter pylori infection - this may include a urea breath test, a stool antigen test, and a blood test. Peptic ulcers are often cause by this bacterium.
- Liver function test - if the doctor thinks the patient may have a biliary condition, which affects the bile ducts in the liver. This involves a blood test that determines how the liver is working.
- X-rays - usually an upper-gastrointestinal and small bowel series. X-rays are taken of the esophagus, stomach and small intestine.
- Abdominal ultrasound - high-frequency sound waves make images that show movement, structure and blood flow. A gel is applied to the patient's abdomen and a hand-held device is pressed against the skin. The device emits sound waves and the doctor can see the insides of the abdomen in detail on a monitor.
- Abdominal CT (computed tomography) scan - this may involve injecting a dye into the patient's veins. The dye shows up on the monitor. The CT scan takes a series of X-ray images to produce a 3-dimensional image of the inside of the abdomen.
Treatments for dyspepsia/indigestion
Treatment for indigestion depends on what is causing it and how severe symptoms are.
- Diet and lifestyle changes - if symptoms are mild and your indigestion is not occurring often, some lifestyle changes will probably ease symptoms. This usually involves consuming less fatty foods, less caffeine, alcohol and chocolates, sleeping at least 7 hours every night, and avoiding spicy foods.
Medications for dyspepsia
Alka-Seltzer is a common OTC medicine for indigestion.
- Antacids - examples include Alka-Seltzer, Maalox, Rolaids, Riopan, and Mylanta. These are OTC (over-the-counter, no prescription needed) medicines. These are usually the first medications doctors recommend.
- H-2-receptor antagonists - examples include Zantac, Tagamet, Pepcid and Axid. Some of these are OTC while others are prescription drugs. They reduce levels of stomach acids and last longer than antacids. However, antacids are effective faster. Some patients may experience nausea, vomiting, constipation, diarrhea, and headaches. Other side-effects may include bruising or bleeding.
- PPIs (proton pump inhibitors) - examples include Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid. PPIs are very effective for patients who also have GERD (gastroesophageal reflux disease). They reduce stomach acid and are stronger than H-2-receptor antagonists. Side effects may include cough, headache, dizziness, back pain, abdominal pain, wind, nausea and/or vomiting, constipation and diarrhea. Some studies suggest that there is a link between chronic kidney disease and the use of PPIs. In very rare cases long-term use can lead to bone fractures.
- Prokinetics - an example includes Reglan. This medication is helpful if the stomach empties slowly. Side effects may include tiredness, depression, sleepiness, anxiety and muscle spasms.
- Antibiotics - if Helicobacter pylori is causing peptic ulcers which result in indigestion an antibiotic will be prescribed. Side effects may include upset stomach, diarrhea and fungal infections.
- Antidepressants - if no causes for indigestion are found after a thorough evaluation and the patient has not responded to treatments, the doctor may prescribe antidepressants. Antidepressants sometimes ease the discomfort by reducing the patient's sensation of pain. Side effects may include nausea, headaches, agitation, constipation, and night sweats.
The doctor may also recommend making changes to the patient's current medication if it is thought that it could be contributing to the indigestion. Sometimes aspirin or ibuprofen may be discontinued and alternative medications sought. It is important to change medications under the supervision of your doctor, and not to do this on your own.
Complications of indigestion
In the vast majority of cases indigestion is mild and does not happen frequently. Severe indigestion can occasionally cause the following complications:
- Esophageal stricture - if the indigestion is caused by acid reflux, when stomach acids leak back up into the esophagus and irritate the mucosa, the esophagus can become scarred. The esophagus can eventually become narrow and constricted. Patients with esophageal stricture may have swallowing difficulties; food can get stuck in the throat, causing chest pain. Surgery is sometimes needed to widen the esophagus.
- Pyloric stenosis - this is caused by long-term irritation of the lining of the digestive system from stomach acid. The Pylorus - the passage between the stomach and the small intestine - becomes scarred and narrowed. Food is not properly digested. Surgery may be required to widen the pylorus.
- Peritonitis - inflammation of the peritoneum (the tissue layer of cells lining the inner wall of the abdomen and pelvis). Surgery can repair damage to the peritoneum, and antibiotics are sometimes prescribed to deal with infection.