Indigestion or dyspepsia is a widespread condition, estimated to occur in 25% of the adult population of the United States. Most people with indigestion do not feel sick enough to see a doctor; nonetheless, it is a common reason for office visits. About 3% of visits to primary care doctors are for indigestion.
Causes and symptoms
The symptoms associated with indigestion have a variety of possible physical causes, ranging from commonplace food items to serious systemic disorders:
Diet. Milk, milk products, alcoholic beverages, tea, and coffee cause indigestion in some people because they stimulate the stomach’s production of acid.
- Medications. Certain prescription drugs as well as over-the-counter medications can irritate the stomach lining. These medications include nonsteroidal anti-inflammatory drugs (NSAIDs, or over-the-counter pain killers like aspirin), some antibiotics, digoxin, theophylline, corticosteroids, iron (ferrous sulfate), oral contraceptives, and tricyclic antidepressants.
- Disorders of the pancreas and gallbladder. These include inflammation of the gallbladder or pancreas, cancer of the pancreas, and gallstones.
- Intestinal parasites. Parasitic infections that cause indigestion include amebiasis, fluke and tapeworm infections, giardiasis, and strongyloidiasis.
- Systemic disorders, including diabetes, thyroid disease, and collagen vascular disease.
- Cancers of the digestive tract.
- Conditions associated with women’s reproductive organs. These conditions include menstrual cramps, pregnancy, and pelvic inflammatory disease.
Psychologic and emotional causes
Indigestion often accompanies an emotional upset, because the part of the nervous system involved in the so-called “fight-or-flight” response also affects the digestive tract. People diagnosed with anxiety or somatoform disorders frequently have problems with indigestion.
Many people in the general population, however, will also experience heartburn, “butterflies in the stomach,” or stomach cramps when they are in upsetting situations—such as school examinations, arguments with family members, crises in their workplace, and so on. Some people’s digestive systems appear to react more intensely to emotional stress due to hypersensitive nerve endings in their intestinal tract.
Specific gastrointestinal disorders
In some cases, the patient’s description of the symptoms suggests a specific digestive disorder as the cause of the indigestion. Some doctors classify these cases into three groups:
ESOPHAGITIS TYPE. Esophagitis is an inflammation of the tube that carries food from the throat to the stomach (the esophagus). The tissues of the esophagus can become irritated by the flow (reflux) of stomach acid backward into the lower part of the esophagus.
If the patient describes the indigestion in terms of frequent or intense heartburn, the doctor will consider gastroesophageal reflux disease (GERD) as a possible cause.
GERD is a common disorder in the general population, affecting about 30% of adults. In 2001, a study showed that obesity impairs the antireflux action. Those that are overweight have more severe reflux than most patients.
Nighttime GERD affects 79% of adults with heartburn and is potentially more destructive to the esophagus than daytime indigestion. Another study found that acid reflux leads to cough and wheezing problems, particularly in people with asthma.
GERD also affects some infants and children, and is a common cause of babies spitting up formula. In most cases, the condition resolves itself, but children older than one year with regularly occurring pain in the lower chest or upper abdomen should cause concern. If a child is bothered by these symptoms during sleep or activities, a physician should be consulted.
PEPTIC ULCER TYPE. Patients who smoke and are over 45 are more likely to have indigestion of the peptic ulcer type. This group also includes people who find that their indigestion is relieved by taking antacids or eating a small amount of food.
Patients in this category are often found to have Helicobacter pylori infections. H. pylori is a rod-shaped bacterium that lives in the tissues of the stomach and causes irritation of the mucous lining of the stomach walls.
Most people with H. pylori infections do not develop chronic indigestion, but the organism appears to cause peptic ulcer disease (PUD) in a vulnerable segment of the population.
NONULCER TYPE. Most cases of chronic indigestion—as many as 65%—fall into this third category. Nonulcer dyspepsia is sometimes called functional dyspepsia because it appears to be related to abnormalities in the way that the stomach empties its contents into the intestine.
In some people, the stomach empties either too slowly or too rapidly. In others, the stomach’s muscular contractions are irregular and uncoordinated. These disorders of stomach movement (motility) may be caused by hypersensitive nerve endings in the stomach tissues. Patients in this group are likely to be younger than 45 and have a history of taking medications for anxiety or depression.
Because indigestion is a nonspecific set of symptoms, patients who feel sick enough to seek medical attention are likely to go to their primary care doctor. The history does not always point to an obvious diagnosis.
The doctor can, however, use the process of history-taking to evaluate the patient’s mood or emotional state in order to assess the possibility of a psychiatric disturbance. In addition, asking about the location, intensity, timing, and recurrence of the indigestion can help the doctor weigh the different diagnostic possibilities.
An important part of the history-taking is asking about symptoms that may indicate a serious illness. These warning symptoms include:
- weight loss
- persistent vomiting
- difficulty or pain in swallowing
- vomiting blood or passing blood in the stools
If the doctor thinks that the indigestion should be investigated further, he or she will order an endoscopic examination of the stomach. An endoscope is a slender tube-shaped instrument that allows the doctor to look at the lining of the patient’s stomach.
If the patient has indigestion of the esophagitis type or nonulcer type, the stomach lining will appear normal. If the patient has PUD, the doctor will be able to see breaks or ulcerated areas in the tissue. He or she may also order ultrasound imaging of the abdomen, or a radionuclide scan to evaluate the motility of the stomach.
BLOOD TESTS. If the patient is over 45, the doctor will have the patient’s blood analyzed for a complete blood cell count, measurements of liver enzyme levels, electrolyte and serum calcium levels, and thyroid function.
TESTS FOR HELICOBACTER PYLORI. Doctors can now test patients for the presence of H. pylori without having to take a tissue sample from the stomach. One of these noninvasive tests is a blood test and the other is a breath test.
Nutritionists or naturopaths may recommend the following to improve digestion:
- Stay away from foods that may cause an upset stomach. These include spicy, fried, cured, or junk foods, cucumbers, onions, peppers, tomatoes, beans, soda pop, or beverages containing caffeine.
- Eat lighter but more frequent meals.
- Avoid smoking.
- Adopt a high-fiber diet to improve regularity and treat such digestive problems as constipation, hemorrhoids, irritable bowel disease, and colon cancer. A high-fiber diet provides such additional health benefits as boosting the immune system function and preventing heart disease, cancer, and other diseases.
- Increase water intake. Proper hydration helps the digestive system work better.
- Improve poor digestive enzyme function with hydrochloric acid and pancreatic enzyme supplements such as lipase, amylase, and protease.
- Thickening a baby’s food can help with reflux (add one tablespoon of dry rice cereal to each ounce of formula or breast milk). Hold babies upright after feedings rather than putting them down right away.
Practitioners of Chinese traditional herbal medicine might recommend medicines derived from peony (Paeonia lactiflora), hibiscus (Hibiscus sabdariffa), or hare’s ear (Bupleurum chinense) to treat indigestion.
Western herbalists are likely to prescribe fennel (Foeniculum vulgare), lemon balm (Melissa officinalis), or peppermint (Mentha piperita) to relieve stomach cramps and heartburn.
Homeopaths tailor their remedies to the patient’s overall personality profile as well as the specific symptoms. Depending on the patient’s reaction to the indigestion and some of its likely causes, the homeopath might choose Lycopodium, Carbo vegetalis, Nux vomica,or Pulsatilla.
Diet and stress management
Many patients benefit from the doctor’s reassurance that they do not have a serious or fatal disorder. Cutting out alcoholic beverages and drinks containing caffeine often helps.
The patient may also be asked to keep a record of food intake, daily schedule, and symptom severity. Food diaries sometimes reveal psychological or dietary factors that influence indigestion.
Some alternative treatments are aimed at lowering the patient’s stress level or changing attitudes and beliefs that contribute to indigestion. These therapies and practices include Reiki, reflexology, hydrotherapy, therapeutic massage, yoga, and meditation.
Since most cases of indigestion are not caused by serious disorders, many doctors prefer to try medications and other treatment measures before ordering an endoscopy. Many patients with acid reflux treat themselves with over-the-counter remedies.
For nighttime GERD, a 2001 study recommends a dose of a proton pump inhibitor before breakfast and another dose before dinner. Some medicines are also approved for use in infants and children with indigestion that doesn’t resolve itself.
Patients with the esophagitis type of indigestion are often treated with H2 antagonists. H2 antagonists are drugs that block the secretion of stomach acid. They include ranitidine (Zantac) and famotidine (Pepcid).
Patients with motility disorders may be given prokinetic drugs. Prokinetic medications such as metoclopramide (Reglan) and cisapride (Propulsid) speed up the emptying of the stomach and increase intestinal motility.
Removal of H. pylori
Antibiotic therapy may be given to wipe out H. pylori bacteria from the gastrointestinal tract.
Most cases of mild indigestion do not need medical treatment. For patients who consult a doctor and are given an endoscopic examination, 5–15% are diagnosed with GERD and 15–25% with PUD. About 1% of patients who are endoscoped have stomach cancer. Most patients with functional dyspepsia do well on either H2 antagonists or prokinetic drugs, depending on the cause of their indigestion.
Indigestion can often be prevented by attention to one’s diet, general stress level, and ways of managing stress. Specific preventive measures include:
- stopping smoking
- cutting down on or eliminating alcohol, tea, or coffee
- avoiding foods that are highly spiced or loaded with fat
- eating slowly and keeping mealtimes relaxed
- practicing yoga or meditation
- not taking aspirin or other medications on an empty stomach
- keeping one’s weight within normal limits