Indigestion

Indigestion (Dyspepsia)

Overview
Indigestion, medically termed dyspepsia, refers to a set of symptoms affecting the upper digestive tract. It is characterized by discomfort or pain in the upper abdomen, bloating, early satiety, belching, nausea, or a burning sensation after eating. It can be episodic or chronic and may be functional (without a clear structural cause) or secondary to underlying gastrointestinal diseases.

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Causes

• Dietary and Lifestyle Factors

  • Overeating, eating too quickly, or consuming fatty, spicy, or acidic foods

  • Excessive alcohol, caffeine, or carbonated drinks

  • Smoking

• Medical Conditions

  • Gastroesophageal reflux disease (GERD)

  • Peptic ulcer disease

  • Gastritis (inflammation of the stomach lining)

  • Gallstones or gallbladder disease

  • Pancreatic disorders

  • Functional dyspepsia (no structural abnormality detected)

• Medications

  • NSAIDs (ibuprofen, diclofenac, naproxen)

  • Certain antibiotics

  • Bisphosphonates

  • Corticosteroids

• Other Factors

  • Stress and anxiety

  • Helicobacter pylori infection

  • Pregnancy-related hormonal changes

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Symptoms

• Upper abdominal pain or burning (epigastric discomfort)

• Early fullness while eating (early satiety)

• Bloating or distension

• Belching or excessive gas

• Nausea, sometimes with vomiting

• Acidic taste or mild reflux symptoms

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Diagnosis

• Clinical evaluation based on history and symptoms

• Investigations (if persistent or severe):

  • Endoscopy (to rule out ulcer, gastritis, or malignancy)

  • H. pylori testing (urea breath test, stool antigen test)

  • Blood tests (anemia, liver, pancreatic enzymes)

  • Imaging (ultrasound, CT scan if gallstones or other pathology suspected)

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Treatment

Lifestyle Modifications

• Eat smaller, more frequent meals

• Avoid high-fat, spicy, or acidic foods

• Reduce alcohol and caffeine intake

• Quit smoking

• Do not lie down immediately after meals

• Manage stress through relaxation techniques

Pharmacological Treatments

• Antacids (aluminum hydroxide, magnesium hydroxide, calcium carbonate): for rapid but short-term relief

• H2 receptor antagonists (ranitidine – withdrawn in many countries, famotidine 20–40 mg once or twice daily)

• Proton Pump Inhibitors (PPIs) (omeprazole 20 mg once daily, esomeprazole 20–40 mg once daily, lansoprazole 15–30 mg once daily): reduce stomach acid, useful in GERD or ulcer-related dyspepsia

• Prokinetic agents (domperidone 10 mg before meals, metoclopramide 10 mg up to 3 times daily): enhance gastric emptying, reserved for functional dyspepsia

• Antibiotics for H. pylori (clarithromycin, amoxicillin or metronidazole, with PPI – triple therapy for 7–14 days)

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Red Flag Symptoms (Require Urgent Evaluation)

• Unexplained weight loss

• Persistent vomiting

• Difficulty swallowing (dysphagia)

• Vomiting blood (hematemesis) or black stools (melena)

• Family history of gastrointestinal cancer

• Age >45–50 with new-onset symptoms

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Precautions

• Avoid long-term NSAID use if prone to indigestion

• Monitor for adverse effects of PPIs (long-term use linked to vitamin B12 deficiency, osteoporosis, kidney issues)

• Stress management is important, as psychological factors often worsen symptoms

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Drug Interactions

• PPIs: can reduce absorption of drugs needing acidic pH (ketoconazole, atazanavir, iron supplements)

• H2 blockers: may interfere with certain antiretroviral or antifungal drugs

• Metoclopramide/domperidone: risk of extrapyramidal side effects when combined with antipsychotics; may prolong QT interval with certain antibiotics or antifungals

• Antacids: interfere with absorption of tetracyclines, fluoroquinolones, and levothyroxine