Dyspepsia (Indigestion)

What is dyspepsia?

Dyspepsia -- commonly known as indigestion -- is a catch-all term for pain or discomfort in the upper abdomen. Everything from stress to certain painkillers can cause indigestion, but with treatment and some basic lifestyle changes, most people find they can be free of it.

If you have persistent stomach trouble, schedule an appointment with your doctor. You can rest assured he or she has tackled this problem many times before. Every year, roughly one in four Americans has at least one bout of indigestion.

Although many people use dyspepsia interchangeably with indigestion, some specialists make a distinction between them. Indigestion, for example, is nonspecific: it's often used to describe a feeling of over-fullness, bloating, or discomfort after eating. In contrast, dyspepsia generally refers to a gnawing pain or discomfort in the upper abdomen.

What are the symptoms of dyspepsia?

The hallmark of dyspepsia is a gnawing or burning pain usually located in the stomach. The pain may be relentless, but it can also fade in and out. (It doesn't apply to discomfort caused by irritable bowel syndrome.) You may also experience bloating, nausea, vomiting, heartburn, and burping.

In very rare cases, dyspepsia may be a sign of a more serious problem. Contact your doctor promptly if you notice any of these warning signs: unintentional weight loss, trouble swallowing, severe vomiting, black stools (often a sign of intestinal bleeding), a strange lump or bulge in your abdomen, or severe pain in the upper-right abdomen.

What causes dyspepsia?

In roughly 60 percent of all cases, there's no obvious organic disease, infection, or injury that might explain the pain. But that doesn't mean the discomfort is all in your head. There's a nervous system in our gut that sends and receives messages from the brain (the brain-gut axis), and at times nerve and muscle sensations in the gut may differ in some patients with more sensitive digestive systems, translating into pain or discomfort in a certain area. Your diet may also be a factor, along with how much exercise you get.

As many as one in four people with dyspepsia have an ulcer, an open sore on the lining of the stomach or the small intestine. These sores are almost always caused by either nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, or by an infection by the bacterium Helicobacter pylori. In some cases, NSAIDs or H. pylori can cause dyspepsia without forming an ulcer.

NSAIDs aren't the only medications that can irritate your stomach and cause indigestion. Tell your doctor about every drug you take, including over-the-counter products, herbal remedies, and alcohol, as they may have side effects or interact with each other in ways that affect your stomach.

Acid reflux disease is the next most common cause of dyspepsia. In this condition, stomach acid splashes into the esophagus. People with acid reflux disease generally suffer heartburn. On occasion, they may experience stomach pain as well.

Many people blame their upset stomachs on stress. But while stress can undoubtedly make your symptoms worse, it's not likely to be the sole cause of indigestion.

In the worst-case scenario, dyspepsia may be a sign of stomach cancer. This condition is rare in the United States, especially among people under 50. People with stomach cancer usually have "alarm" symptoms such as weight loss, difficulty eating the amounts of food that one could previously handle with ease, and black stools or other symptoms that may be a sign of internal bleeding.

How is dyspepsia treated?

Doctors can take several different approaches to treating dyspepsia. Each has pros and cons, and no one strategy is right for everyone.

For many patients, treatment starts with a simple blood test for H. pylori, the bacterium that causes ulcers. If the test is positive, your doctor will prescribe a course of antibiotics to kill the germ. If the test is negative, acid-blocking medications such as lansoprazole (Prevacid) and ranitidine (Zantac) should bring quick relief. The downside to this approach is that H. pylori is often harmless, and many patients end up taking antibiotics for no good reason.

Before you take drugs, some specialists recommend that you instead take a good hard look at your lifestyle. In his book, Freedom from Digestive Distress, Dr. Gary Gitnick describes patient after patient who benefited from exercising and changing his or her diet. Gitnick, co-chief of the division of digestive diseases at University of California at Los Angeles School of Medicine, often finds that poor eating habits -- such as too much fat, caffeine, and alcohol and not enough whole grains or fruits and vegetables -- are the root cause of stomach pain.

Gitnick has patients keep a food journal to see if overeating or choosing the wrong foods affects their stomach pain. In addition to foods that may trigger indigestion, smoking can be a cause, as well as drinking coffee and alcohol. The National Digestive Diseases Information Clearinghouse, overseen by the National Institutes of Health, recommends that if you're a smoker and you're not ready to quit, at least try not to smoke before eating.

Gitnick is emphatic about exercise as a remedy for many digestive symptoms and insists that if he could give only one prescription, getting moving would be it. He advises 30 minutes of some sort of aerobic exercise each day. Just make sure your fitness routine isn't so bouncy or jarring that it aggravates your symptoms.

If lifestyle changes don't do the trick -- or if acid-blocking medications fail or their effects fade after seven to ten days of treatment -- your physician may order various tests to see if there's a more serious problem at work. If you're over 50 or show any symptoms of serious disease, your doctor may suggest an endoscopy, an exam in which a thin tube with a tiny camera on the end is slid down your throat to take pictures of your stomach.

If you're taking any medications that can upset the stomach, your doctor may be able to offer an alternative. For instance, acetaminophen (Tylenol) is generally easier on the stomach than aspirin. (Tylenol isn't generally recommended for people who drink three or more glasses or alcohol a day, though, because it can cause liver damage.)

Finally, you can take a few steps to give your stomach a break. If you smoke, stop. Smoking blocks the stomach's natural healing process and greatly raises the risk of ulcers. Also, avoid heavy drinking and try to cut back on stress. The relief you get will be well worth the effort.

References

Bytzer P and NJ Talley. Dyspepsia. Annals of Internal Medicine. Vol. 134: 815-822.

American Academy of Family Physicians. Dyspepsia -- what it is and what to do about it.

Gitnick, Gary, MD, Freedom from Digestive Distress, Three Rivers Press.

American Cancer Society. How Many People Get Stomach Cancer?

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