Dyspepsia (indigestion) is a term which describes pain and sometimes other symptoms which come from your upper gut (the stomach, oesophagus or duodenum). There are various causes (described below). Treatment depends on the likely cause.
Food passes down the oesophagus (gullet) into the stomach. The stomach makes acid which is not essential, but helps to digest food. Food then passes gradually into the duodenum (the first part of the small intestine).
In the duodenum and the rest of the small intestine, food mixes with enzymes (chemicals). The enzymes come from the pancreas and from cells lining the intestine. The enzymes break down (digest) the food. Digested food is then absorbed into the body from the small intestine.
Dyspepsia is a term which includes a group of symptoms that come from a problem in your upper gut. The gut (gastrointestinal tract) is the tube that starts at the mouth, and ends at the anus. The upper gut includes the oesophagus, stomach, and duodenum.
Various conditions cause dyspepsia. The main symptom is usually pain or discomfort in the upper abdomen. In addition, other symptoms that may develop include: heartburn (a burning sensation felt in the lower chest area), bloating, belching, quickly feeling full after eating, feeling sick (nausea) or vomiting. Symptoms are often related to eating.
Symptoms tend to occur in bouts which come and go, rather than being present all the time. Most people have a bout of dyspepsia, often called indigestion, from time to time. For example, after a large spicy meal. In most cases it soon goes away and is of little concern. However, some people have frequent bouts of dyspepsia, which affects their quality of life.
Most cases of recurring dyspepsia are due to one of the following:
The bacterium (germ) H. pylori can infect the lining of the stomach and duodenum. It is one of the most common infections in the UK. More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life.
Most people with H. pylori have no symptoms and do not know that they are infected. However, H. pylori is the most common cause of duodenal and stomach ulcers. About 3 in 20 people who are infected with H. pylori develop an ulcer. It is also thought to cause some cases of non-ulcer dyspepsia, duodenitis and gastritis. The exact way H. pylori causes problems in some infected people is not totally clear. In some people this bacterium causes inflammation in the lining of the stomach or duodenum. This causes the defence mucus barrier to be disrupted in some way (and in some cases the amount of acid to be increased) which seems to allow the acid to cause inflammation and ulcers. See separate leaflet called 'Helicobacter Pylori and Stomach Pain' for more detail.
Other problems of the upper gut such as stomach cancer and oesophageal cancer can cause dyspepsia when they first develop.
There are separate leaflets which describe the above conditions in more detail. The rest of this leaflet gives an overview of what might happen if you see your doctor about dyspepsia.
Your doctor is likely to do an initial assessment by asking you about your symptoms and examining your abdomen. The examination is usually normal if you have one of the common causes of dyspepsia. Your doctor will want to review any medicines that you have taken in case one may be causing the symptoms or making them worse. Following the initial assessment, depending on your circumstances, such as the severity and frequency of symptoms, your doctor may suggest one or more of the following plans of action.
Antacids are alkali liquids or tablets that can neutralise the stomach acid. A dose may give quick relief. There are many brands which you can buy. You can also get some on prescription. If you have mild or infrequent bouts of dyspepsia you may find that antacids used as required are all that you need.
This may be possible if a medicine that your are taking is thought to be causing the symptoms or making them worse.
A test to detect H. pylori is commonly done if you have frequent bouts of dyspepsia. As mentioned, it is the underlying cause of most duodenal and stomach ulcers, and some cases of gastritis, duodenitis and non-ulcer dyspepsia. Various tests can detect H. pylori and your doctor may suggest one:
If you are found to be infected with H. pylori then treatment may cure the symptoms. Briefly, to clear H. pylori infection you need to take two antibiotics at the same time. In addition, you need to take a medicine to reduce the acid in the stomach. This allows the antibiotics to work well in the stomach. You need to take this combination therapy for a week. It is important to take all the medicines exactly as directed, and to take the full course.
Note: after combination therapy, a test may be advised to check that H. pylori has gone (has been eradicated). This test will usually be a breath test or a stool antigen test (described earlier). If a test is done, it needs to be done at least four weeks after the course of combination therapy has finished. In most cases, the test is negative meaning that the infection has gone. If it has not gone, and you still have symptoms, then a repeat course of combination therapy with a different set of antibiotics may be advised.
Some doctors say that for most situations, this confirmation of eradication test is not necessary if symptoms have gone. The logic is that if symptoms have gone it usually indicates that whatever was causing the dyspepsia has gone. But, some doctors say it is needed to play safe. Your own doctor will advise if you should have this test following treatment to clear H. pylori.
A one-month trial of full-dose medication which reduces stomach acid may be considered - in particular, if:
There are two groups of medicines which reduce stomach acid - proton pump inhibitors (PPIs) and H2-receptor antagonists. They work in different ways to block the cells in the stomach lining from making acid. There are several brands in each group. A PPI (such as omeprazole, lansoprazole, pantoprazole, rabeprazole, or esomeprazole) is usually better and is normally tried first.
Reducing acid in the stomach can help in many cases of dyspepsia, whatever the underlying cause. If acid-suppressing medication works, then symptoms should go. If symptoms return at a later date, once the medication is stopped, then further courses may be advised. Many people take acid-suppressing medication as required. That is, waiting for symptoms to develop, and then taking a short course of treatment to clear the symptoms. Some people take them regularly if symptoms occur each day. If this is the situation, you should aim to find the lowest dose of medication that keeps symptoms away.
Further tests are not needed in most cases. One or more of the above options will often sort the problem. Reasons why further tests may be advised include:
Tests advised may include:
Treatment depends on what is found or ruled out by the tests.
For all types of dyspepsia, the National Institute for Health and Clinical Excellence (NICE) recommends the following lifestyle changes:
For dyspepsia which is likely to be due to acid reflux - when heartburn is a major symptom - the following may also be worth considering: