INDIGESTION

INDIGESTION:
Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen. Indigestion is not a disease, but rather some symptoms you experience, including abdominal pain and a feeling of fullness soon after you start eating. Although indigestion is common, how you experience indigestion may differ from other people. Symptoms of indigestion may be felt occasionally or as often as daily.
Indigestion can be a symptom of another digestive disease. Indigestion that isn't caused by an underlying disease may be eased with lifestyle changes and medication.

SYMPTOMS:
People with indigestion may have one or more of the following symptoms:

• Early fullness during a meal. You haven't eaten much of your meal, but you already feel full and may not be able to finish eating.
• Uncomfortable fullness after a meal. Fullness lasts longer than it should.
• Discomfort in the upper abdomen. You feel a mild to severe pain in the area between the bottom of your breastbone (sternum) and your navel.
• Burning in the upper abdomen. You feel an uncomfortable heat or burning sensation between the bottom of the breastbone and navel.
• Bloating in the upper abdomen. You feel an uncomfortable sensation of tightness.
• Nausea.

Less frequent symptoms include vomiting and belching.
Sometimes people with indigestion also experience heartburn, but heartburn and indigestion are two separate conditions. Heartburn is a pain or burning feeling in the center of your chest that may radiate into your neck or back during or after eating.

When to see a doctor

Mild indigestion is usually nothing to worry about. Consult your doctor if discomfort persists for more than two weeks. Contact your doctor right away if pain is severe or accompanied by:

• Unintentional weight loss or loss of appetite
• Repeated vomiting or vomiting with blood
• Black, tarry stools
• Trouble swallowing that gets progressively worse
• Fatigue or weakness, which may be symptoms of anemia

Seek immediate medical attention if you have:

• Shortness of breath, sweating or chest pain radiating to the jaw, neck or arm
• Chest pain on exertion or with stress 

CAUSES:
Indigestion has many possible causes. Often, indigestion is related to lifestyle and may be triggered by food, drink or medication. Common causes of indigestion include:

• Overeating or eating too quickly
• Fatty, greasy or spicy foods
• Too much caffeine, alcohol, chocolate or carbonated beverages
• Smoking
• Anxiety
• Certain antibiotics, pain relievers and iron supplements

Sometimes indigestion is caused by other digestive conditions, including:

• Gastritis
• Peptic ulcers
• Celiac disease
• Gallstones
• Constipation
• Pancreas inflammation (pancreatitis)
• Stomach cancer
• Intestinal blockage
• Reduced blood flow in the intestine (intestinal ischemia)

Indigestion with no obvious cause is known as functional dyspepsia or nonulcer stomach pain.

COMPLICATIONS:
Although indigestion doesn't usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. When indigestion is caused by an underlying condition, that condition can also have its own complications.

PREPARING FOR YOUR APPOINTMENT:
You're likely to start by seeing your family doctor, or you may be referred to a doctor who specializes in digestive diseases (gastroenterologist). Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
• Write down your symptoms, including when they started and how they may have changed or worsened over time.
• Take a list of all your medications, vitamins or supplements.
• Write down your key medical information, including other diagnosed conditions.
• Write down key personal information, including any recent changes or stressors in your life, as well as a detailed description of your typical daily diet.
• Write down questions to ask your doctor.

Some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Do you think my condition is temporary or chronic?
• What kinds of tests do I need?
• What treatments can help?
• Are there any dietary restrictions that I need to follow?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Be ready to answer questions your doctor may ask:

• When did you first begin experiencing symptoms, and how severe are they?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve or worsen your symptoms?
• What medications and pain relievers do you take?
• What do you eat and drink, including alcohol, in a typical day?
• How have you been feeling emotionally?
• Do you use tobacco? If so, do you smoke, chew or both?
• Are your symptoms better or worse on an empty stomach?
• Have you vomited blood or black material?

Have you had any changes in your bowel habits, including stools turning black?

TESTS AND DIAGNOSIS:
Your doctor is likely to start with a health history and a thorough physical exam. Those evaluations may be sufficient if your indigestion is mild and you're not experiencing certain symptoms, such as weight loss and repeated vomiting.
But if your indigestion began suddenly, and you are experiencing severe symptoms or are older than age 50, your doctor may recommend:

• Laboratory tests, to check for thyroid problems or other metabolic disorders.
• Breath and stool tests, to check for Helicobacter pylori (H. pylori), the bacteria associated with peptic ulcers, which can cause indigestion. H. pylori testing is controversial because studies suggest limited benefit from treating the bacterium.
• Endoscopy, to check for abnormalities in your upper digestive tract. A tissue sample (biopsy) may be taken for analysis.
• Imaging tests (X-ray or CT scan), to check for intestinal obstruction.

If initial testing fails to provide a cause, your doctor may diagnose functional dyspepsia.

TREATMENT AND DRUGS:
Lifestyle changes may help ease indigestion. Your doctor may recommend:

• Avoiding foods that trigger indigestion
• Eating five or six small meals a day instead of three large meals
• Reducing or eliminating the use of alcohol and caffeine
• Avoiding certain pain relievers, such as aspirin, ibuprofen and naproxen
• Finding alternatives for medications that trigger indigestion
• Controlling stress and anxiety

If your indigestion persists, medications may help. Over-the-counter antacids are generally the first choice. Other options include:

• Proton pump inhibitors (PPIs), which can reduce stomach acid. PPIs may be recommended if you experience heartburn along with indigestion.
• H-2-receptor antagonists (H2RAs), which also can reduce stomach acid.
• Prokinetics, which may be helpful if your stomach empties slowly.
• Antibiotics, if H. pylori bacteria are causing your indigestion.
• Antidepressants or anti-anxiety medications, which may ease the discomfort from indigestion by decreasing your sensation of pain.

LIFESTYLE AND HOME REMEDIES:
Mild indigestion can often be helped with lifestyle changes, including:

• Eating smaller, more frequent meals. Chew your food slowly and thoroughly.
• Avoiding triggers. Fatty and spicy foods, processed foods, carbonated beverages, caffeine, alcohol and smoking can trigger indigestion.
• Maintaining a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
• Exercising regularly. Exercise helps you keep off extra weight and promotes better digestion.
• Managing stress. Create a calm environment at mealtime. Practice relaxation techniques, such as deep breathing, meditation or yoga. Spend time doing things you enjoy. Get plenty of sleep.
• Changing your medications. With your doctor's approval, stop or cut back on pain relievers or other medications that may irritate your stomach lining. If that's not an option, be sure to take these medications with food. 

ALTERNATIVE MEDICINE:
Alternative and complementary treatments may help ease indigestion, although none of these treatments has been well studied. These treatments include:

• Herbal tea with peppermint.
• STW5 (iberogast), a liquid supplement that contains extracts of herbs including bitter candytuft, peppermint leaves, caraway and licorice root. STW5 may work by reducing the production of gastric acid.
• Artichoke leaf extract, available as a supplement. Artichoke leaf extract may work by stimulating the flow of bile from the liver to improve digestion. Some people may experience flatulence or an allergic reaction.
• Psychological treatment, including behavior modification, relaxation techniques, cognitive behavioral therapy and hypnotherapy.
• Acupuncture, which may work by blocking the pathways of nerves that carry sensations of pain to the brain.

Always check with your doctor before taking any supplements to be sure you are taking a safe dose and that the supplement won't adversely interact with any medications you're taking.