If you suffer from indigestion, you've got company. By some estimates, up to 40 percent of people in Western countries experience it.
Every year Americans spend millions of dollars on medications for indigestion, also referred to as dyspepsia or sour stomach. These catch-all terms are used to describe an assortment of upper abdominal symptoms that may include pain, bloating, burping, loss of appetite, feeling full too soon (early satiety), nausea, and heartburn.
Although most people who suffer from indigestion do not seek medical help, up to 40 percent of them do. Many who seek assistance for indigestion are worried that they may have a life-threatening disorder—in particular, stomach, pancreatic, or esophageal cancer. In reality, such malignancies are the culprit in less than 1 percent of cases.
Indigestion is far more likely to be caused by one of a host of less-serious problems, such as gallbladder disease, peptic ulcer disease, esophagitis or gastritis.
These conditions can be treated—preventing complications, relieving discomfort, and improving your quality of life. Fortunately, the proper treatment—often combined with lifestyle measures—usually is helpful.
Sometimes indigestion does not have an identifiable cause, in which case it is classified as functional dyspepsia. This diagnosis should be made only after a careful evaluation for other causes. Even though the basis for functional dyspepsia is unknown, effective treatments can reduce the impact of this condition, too.
Symptoms provide clues to the cause
Doctors recognize indigestion when a patient reports persistent or recurrent pain or discomfort in the middle to upper abdomen, feeling full quickly when eating, or both symptoms. Most people who have indigestion experience it following a meal, sometimes only with specific foods.
This can be a clue to the cause. For example, intolerance to fatty foods suggests gallbladder disease. Nausea and heartburn (a burning sensation just under the breastbone that sometimes radiates to the neck) also may be present, but frequent vomiting is not typical. Heartburn suggests that esophagitis may be present.
Stomach ulcers cause periodic episodes of upper abdominal pain that get worse with hunger and improve after eating or taking antacids. Gastritis may be associated with pain soon after eating, whereas pancreatitis causes pain that gets worse sometime after eating.
Irritable bowel syndrome (IBS) may cause upper abdominal discomfort instead of the more-typical lower abdominal pain; in either case IBS pain is associated with diarrhea or constipation and is relieved after a bowel movement. Indigestion associated with unexpected weight loss may be associated with cancer or eating disorders.
Dysmotility disorders, such as esophageal spasms or weak esophageal contractions (achalasia), and gastroparesis (delayed gastric emptying) are less common possibilities. These problems are due to peristaltic impairment of the esophagus or stomach. Symptoms may include upper abdominal discomfort, bloating, early satiety, loss of appetite, nausea, retching, regurgitation, and vomiting.
Indigestion is also a potential side effect of many medications. Among the more likely culprits are aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, theophylline, digitalis, corticosteroids, iron, niacin, chemotherapy drugs, and narcotics.
Finally, indigestion may be associated with psychological disorders, particularly anxiety. In some people anxiety is a problem before they experience stomach problems, and in others it occurs after they start suffering from indigestion.
No matter what the cause of indigestion, stress and other psychological factors can clearly trigger or worsen symptoms.
When to see a doctor
Anyone can experience occasional indigestion after a big meal; simple over-the-counter remedies like antacid tablets usually are a sufficient treatment. But recurrent or persistent symptoms require medical attention.
When you see your doctor, be specific about your symptoms. Describe the location and severity of the pain. Explain whether it is sharp or dull, concentrated or diffuse, burning or stabbing.
Note whether you feel better or worse after eating or when you are hungry; if over-the-counter medications help; if you feel very full after eating a small meal; and if you are plagued by bloating, nausea, or burping. You also should note any changes in bowel function or weight. Be sure to bring a current list of your medications.
Because indigestion can be due to many different disorders, diagnostic tests usually are needed. Endoscopy (direct examination of the esophagus using a flexible, illuminated tube) often is recommended for people who experience recurrent indigestion, especially older individuals in whom gastrointestinal cancer is more of a consideration.
Other diagnostic exams that may be recommended include sonography or CT scans, other X-rays, blood work, and testing for Helicobacter pylori (the bacterium responsible for most stomach ulcers). In some individuals, the doctor may request gastric emptying tests or motility studies.
If a specific cause of indigestion is identified, specific therapy usually relieves symptoms. For example, if gallstones are found, cholecystectomy can cure the problem. If no specific diagnosis is discovered, various strategies often can provide relief.
Because gastric acid-related diseases are common and sometimes cause indigestion, acid-reducing strategies are tried by many doctors, either before doing any testing or if diagnostic tests are negative.
An antacid is usually the first strategy for people seeking relief from indigestion. Proton pump inhibitors and H2 blockers—medications used to treat GERD—may be more helpful because they decrease the amount of acid produced by the stomach. Recent research, however, suggests their effects are modest at best for dyspepsia.
In the past, some doctors used antibiotics for Helicobacter pylori (the ulcer germ) before doing any testing for dyspepsia—meaning treatment was given without knowing the exact cause of the problem.
This made sense when the prevalence of Helicobacter in the population was very high and antibiotics were almost always effective in eradicating Helicobacter infection. Neither proposition is true today, and now most gastroenterologists support a “test and treat” strategy (only treating patients who have evidence of infection) instead.
In the last 10 years, researchers have focused on antidepressant drugs as a possible treatment for functional dyspepsia when other therapies fail. These drugs are thought to mitigate symptoms by affecting the enteric nervous system and spinal cord, not by their antidepressant effects.
Though some antidepressants have fared no better than placebo in clinical trials, others appear to be more effective. Specifically, tricyclic antidepressants, such as amytriptiline (Elavil), appear to be more effective in reducing symptoms than selective serotonin reuptake inhibitors, such as fluoxetine (Prozac).
Serotonin-norepinephrine reuptake inhibitors also may be of some use. Buspirone (Buspar), used primarily to treat anxiety and depression, also relaxes the fundus (the top portion of the stomach); it has been shown to reduce bloating and feelings of fullness after eating.
Frustrated with a lack of options, many people with indigestion consider alternative or complementary medications. While there is little evidence to support the use of acupuncture, homeopathy or probiotics, some herbal supplements may be helpful.
The nine-herb combination iberogast (STW5) appears to relax the fundus, and capsaicin may help reduce symptoms. Peppermint and lemongrass teas are of value for some individuals.
There are certain lifestyle measures that some people with indigestion find helpful, such as not eating large, rich meals late at night, stopping smoking, and avoiding caffeinated and alcoholic beverages.
When NSAIDs or other medications are the cause of indigestion, it is necessary to stop using the offending drug. Other alternatives, such as acetaminophen (Tylenol) for short-term, over-the-counter pain relief, are usually tolerated—but consult your doctor before adjusting any prescription medications.
Investigators have tried to learn more about the cause of functional dyspepsia in the hope that better therapies can be developed. In about one-third of patients with functional dyspepsia, solids leave the stomach more slowly than normal, a condition called impaired gastric emptying. In others, the amount of food the stomach can comfortably hold may be limited, a condition called postprandial accommodation impairment.
Finally, the stomach may be unusually sensitive to stimulation, a condition called gastric hypersensitivity. Exactly what causes these abnormalities, how they contribute to dyspepsia, and whether or how they should be treated, is unknown.
Scientists are developing new drugs that affect gastrointestinal function and some of these may—in time—be available for treatment. In the meantime, many patients can be helped by existing strategies.