Managing Indigestion (Dyspepsia)

Indigestion is generally defined as a condition characterized by a set of concurrent gastrointestinal symptoms which cause discomfort or pain under the ribs and in the upper abdomen, along with difficulty in digesting food. This condition is often referred to as dyspepsia or stomach upset.

The symptoms of indigestion include a burning sensation or discomfort or pain in the abdomen. Indigestion may be occasional (occuring once in a while), chronic (occuring regularly), or functional (occurrence of chronic symptoms with no specific cause).

Indigestion is not categorized as a disease, but may be an indication of some specific digestive conditions or disorders. Food consumption alone may not be the reason for indigestion. Digestive tract diseases such as ulcers, stomach cancer, and gastritis may result in chronic indigestion. The digestive tract diseases that result in symptoms of chronic indigestion without any overt health issues which could be responsible are termed functional dyspepsia.

Image Credit: Koldunova Anna

When to Consult a Doctor

Indigestion may result in serious health complications. However, the most compelling reason to see a doctor if symptoms similar to those of indigestion persist for over 2 weeks is that such symptoms are often associated with heart attacks. The following list includes some indications that require immediate evaluation:

• Frequent vomiting
• Tarry stools
• Vomiting blood
• Experiencing discomfort or pain while swallowing solid food
• Unusual unintended loss of weight
• Frequent irritation or pain in the chest arm, neck, or jaw
• Severe and persistent pain in the abdomen
• Breathing difficulties
• Unusual and abnormal sweating
• Frequent growling sounds (audible bowel sounds) from the stomach

Medications to Control Indigestion

Proper medication can play a vital role in treating the symptoms of heartburn and indigestion. Some of them may help neutralize acid reflux from the stomach. Commonly used medicines for this and other related conditions (indigestion, gastro-esophageal reflux, and heartburn) include:

Antacids and alginates: Antacids (such as Rennie, Mylanta, and Gastrogel) play a vital role in neutralizing acid reflux from the stomach.

Alginates (Gaviscon) work by forming a coating over the contents of the stomach, which helps in reducing acid reflux. Both antacids and alginates are utilized for immediate relief from symptoms of dyspepsia.

H2 antagonists (such as ranitidine, nizatidine, and famotidine): These tablets are more powerful in their action on reducing the secretion of gastric acid.

Proton pump inhibitors (PPIs): Proton pump inhibitors are used as the primary and effective treatment for heartburn and acid reflux. Commonly used tablets such as lansoprazole, esomeprazole, rabeprazole, pantoprazole, and omeprazole often reduce gastric acid production.

Prokinetic medicines like metoclopramide and domperidone: The role of prokinetic medicines is to hasten the progression of food through the stomach.

Anti-anxiety medications or antidepressants: Taking anti-depressants helps in managing indigestion by reducing the sensation of pain.

Antibiotics: Antibiotics help by eradicating Helicobacter pylori infection, which is one major cause for indigestion.

Alternative Therapies

Complementary and alternative treatments suggested as effective in indigestion are discussed below.

Herbal therapy: Taking peppermints and caraway seeds after meals can help in preventing indigestion. STW 5, also known as Iberogast, reduces the secretion of gastric acid. STW 5 is a liquid supplement that comprises the extracts of herbs such as licorice root, caraway, bitter candytuft, and peppermint leaves.

Psychological therapy: Psychological treatments such as hypnotherapy, cognitive behavioral therapy, behavior modification, mindfulness meditation, and relaxation approaches are also prescribed to control indigestion symptoms.

Acupuncture: Acupuncture helps in the management of indigestion by blocking the passage of nerve impulses that are involved in carrying pain sensation to the brain.

Self-Management

Stress management: A calm environment should be maintained during mealtimes. Ample sleep helps to regulate the upper esophageal sphincter pressure, swallowing rate, and salivation. The rate of primary esophageal contractions is found to be decreased while sleeping. Relaxation techniques such as meditation, yoga and deep breathing may be practiced.

Variations in medications: Self-medication often causes damage to the stomach lining and the gastrointestinal tract, which may cause symptoms of indigestion. Pain relievers or other medications that may cause irritation in the stomach lining may be stopped completely or partially with medical approval. If these medications cannot be stopped, they can be taken along with food to avoid disturbances in digestion.

Regular physical workout: Working out on a regular basis helps in improving digestion and managing weight.

More frequent meals: Thorough and slow chewing of food is important to prevent indigestion.

Maintaining proper diet: Excessive weight puts pressure on the abdomen, pushing up the stomach and causing acid to back up into the esophagus.

Right diets: Processed foods, spicy and fatty foods, greasy foods, carbonated beverages or fizzy drinks, alcoholic beverages, foods that contain large amounts of acids such as tomatoes and citric fruits, and drinks and food that contain caffeine, may be causes or contributory factors towards indigestion.

Avoiding habits such as smoking and drinking in excess is also helpful as they may result in indigestion.

References

• https://my.clevelandclinic.org/health/articles/indigestion
• http://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-managing-acid-reflux.pdf
• http://s3.gi.org/physicians/guidelines/dyspepsia.pdf
• http://www.westernsussexhospitals.nhs.uk/wp-content/uploads/2015/02/Management-of-Acid-Reflux-and-Hiatus-Hernia.pdf
• http://corecharity.org.uk/wp-content/uploads/2016/06/CORE-PATIENT-INFORMATION-INDIGESTION.pdf
• https://www.health.govt.nz/system/files/documents/publications/dyspepsia_summary.pdf
• http://www.hardingspharmacy.com.au/wp-content/uploads/2016/08/HeartburnandIndigestion-web.pdf
• http://www.mayoclinic.org/diseases-conditions/indigestion/diagnosis-treatment/treatment/txc-20209293
• https://www.ncbi.nlm.nih.gov/pubmed/12184167
• http://www.mayoclinic.org/diseases-conditions/indigestion/manage/ptc-20209309

Further Reading

• All Indigestion Content
• Indigestion – What is Indigestion?
• Indigestion Symptoms
• Lifestyle Changes for Indigestion (Dyspepsia)
• Uncommon Causes for Indigestion