Indigestion, also known as dyspepsia, is a condition of impaired digestion. Indigestion is a term that describes chronic or recurrent pain in the upper abdomen and a feeling of discomfort or fullness earlier than expected when eating. Signs of indigestion may also include belching, heartburn, bloating, and nausea. Dyspepsia is a common problem and is frequently caused by gastro-oesophageal reflux disease (GORD) or gastritis. It may be the first symptom of peptic ulcer disease (an ulcer of the stomach or duodenum) and occasionally cancer. Hence, unexplained recent onset dyspepsia in people over 55 requires further investigation.

Heartburn or reflux happens when the contents of the stomach back up into the oesophagus, causing a burning sensation. Most healthy people experience heartburn from time to time. Pregnant women can also experience heartburn. Overweight people can suffer from constant heartburn, which often leads to complications. Frequent heartburn, also called GORD can also be caused by a hiatus hernia, diet and smoking. Antacid is a suitable treatment for healthy people, but ongoing severe heartburn requires medical attention. Some investigators suggest heartburn and indigestion are closely related, others separate these two conditions.

What are the symptoms?

Common indigestion/heartburn symptoms include:

  • abdominal pain
  • heartburn or acid indigestion (acid reflux)
  • bloating (full feeling)
  • excessive gas (belching, burping or flatulence)
  • nausea with or without vomiting
  • acidic taste in the mouth
  • gurgling, rumbling, or growling stomach discomfort
  • constipation or diarrhea
  • decreased appetite

The presence of gastrointestinal bleeding (vomit containing blood), difficulty swallowing, loss of appetite, unintentional weight loss, abdominal swelling and persistent vomiting are suggestive of peptic ulcer disease or malignancy, and would necessitate urgent investigations.

What causes Dyspepsia?

Indigestion is a symptom of many different conditions and can have many different causes. It is usually related to a functional problem (difficulty processing food or stomach acids). This dysfunction of the gastrointestinal system is caused most often by diseases, medications, and lifestyle.

Disease or conditions that may cause indigestion include:

  • ulcers (gastric or duodenal ulcer)
  • GORD (gastro-oesophageal reflux disease)
  • esophagitis
  • hiatal hernia
  • gallstones
  • diabetes
  • pregnancy (especially late term)
  • inflammation of the pancreas (acute or chronic pancreatitis)
  • inflammation of the stomach (acute or chronic gastritis)
  • stomach infections and food poisoning
  • irritable bowel syndrome (IBS)
  • thyroid disease
  • gastroparesis (a condition where the stomach doesn’t empty properly, this often occurs in people with diabetes)
  • food allergies or sensitivities (such as lactose intolerance)
  • depression
  • stomach cancer (rare)

The list of drugs causing dyspepsia is long and includes:

  • aspirin and many other painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs)
  • corticosteroids (such as prednisone, presdnisolone, methylprednisolone, cortisone
  • oestrogen and oral contraceptives
  • antibiotics (mostly macrolides, metronidazole and tetracycline)
  • thyroid medication
  • oral iron supplements
  • cardiac medications (such as digoxin, calcium channel blockers and nitrates)
  • colchicine
  • bisphosphonates
  • cholesterol medications (statin drugs)
  • pain medications (codeine and other narcotics)

Lifestyle factors that may cause indigestion include:

  • eating too much, eating too fast;
  • eating fatty, greasy or spicy foods;
  • excessive coffee and/or alcohol intake;
  • smoking;
  • stress, fatigue and anxiety;
  • obesity
  • moderate to intense exercise immediately after eating.

Treatment methods

Indigestion is typically a symptom and not a cause, therefore the treatment depends upon resolving the underlying cause. If indigestion is caused by lifestyle habits, the prognosis is good. Prevention of the lifestyle cause can often resolve the symptoms. If indigestion is caused by medications, talk to your doctor about changing medications to ones that do not cause indigestion. Never stop taking a medication without the advice of your physician. If indigestion is caused by a disease or medical condition, the prognosis is varied and dependent upon the resolution of that condition. Some conditions such as ulcers, GORD, and gastritis respond readily to acid blocking medications such as proton pump inhibitors.

Conditions such as food poisoning or pregnancy are self-limited and symptoms should decrease over time. Hernias and gallstones, for example, usually require surgery, and the associated indigestion should resolve post-operatively. Other conditions are difficult to treat or do not respond well to medication such as pancreatitis, gastroparesis, depression, and cancer. Treatment of these conditions may involve several methods including lifestyle changes, medications, specialist care and/or surgery.