Indigestion (Upset Stomach)

Picture of GERD (Upset Stomach)

• The definition of Indigestion is an uncomfortable feeling of fullness, pain, or burning in your upper abdomen.
• Symptoms of indigestion include
  • abdominal pain,
  • heartburn or acid indigestion (acid reflux),
  • bloating,
  • gas,
  • nausea,
  • acidic taste in the mouth,
  • stomach discomfort,
  • constipation or diarrhea, and
  • decreased appetite.
• Indigestion has many causes including medical conditions, medications, diet, and lifestyle. Stress and anxiety often can make indigestion worse.
• Tests to diagnose indigestion include blood tests, abdominal ultrasound, endoscopy, colonoscopy, upper GI and small bowel X-ray series, CT scan or MRI of the abdomen, and a gastric emptying study.
• The first line of treatment for many cases of indigestion is
  • lifestyle changes including eating slower, eating smaller amounts,
  • avoiding alcohol and caffeine,
  • quitting smoking,
  • avoiding trigger foods, and
  • losing weight.
• Medications to treat indigestion include antacids and acid blockers.
• Treatment of indigestion is centered on treating the underlying cause.
• The prognosis for indigestion is generally good if indigestion is caused by lifestyle factors. The outlook for indigestion caused by a disease or medical condition varies depending on the resolution of that condition.

• Indigestion is a term that describes a feeling of fullness or discomfort in the upper abdomen.
• Signs of indigestion may be vague but can also include belching, heartburn, bloating, and nausea.
• Also called dyspepsia (and non-acid dyspepsia), it is a common symptom caused by many conditions and is not a disease unto itself.
• Some investigators suggest heartburn and indigestion are closely related, others separate these two conditions.

• Indigestion is an uncomfortable feeling in your upper abdomen.
• It may feel like fullness, pain, or burning in that area.
• You may also feel bloated or nauseated.

Common indigestion symptoms and signs 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

Consult your healthcare professional if there are changes in your symptoms, or indigestion symptoms continue or worsen, or if they are accompanied by unintentional weight loss, blood in stool, difficulty in swallowing, or inability to eat due to poor appetite.

Visit your health-care professional for regular health check-ups. Some testing performed to diagnose the cause of your indigestion may be repeated in the future to gauge the response to treatment.

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

Stress and anxiety can affect the body and can aggravate symptoms of indigestion. The physiological stress due to anxiety and stress also affect indigestion. Because indigestion can be caused by anxiety, lifestyle and diet, or another medical condition, it may be difficult to know what is causing it.

Contact a doctor to find out if anxiety is causing your indigestion, and to help you manage your anxiety if it is aggravating indigestion symptoms.

Disease or conditions that may cause indigestion to include:

• Ulcers (gastric or duodenal ulcer)
• GERD (gastroesophageal reflux disease)
• Esophagitis
• Hiatal hernia
• Gallstones
• 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)
• 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)
• Heart disease, angina, heart attack
• Thyroid disease
• Depression
• Stomach cancer (rare)

Medications that may cause indigestion to include:

• Aspirin and many other painkillers such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• Steroids (such as prednisone, methylprednisolone [Medrol, Medrol Dosepak], and Decadron)
• Estrogen and oral contraceptives
• Antibiotics (such as erythromycin and tetracycline)
• Thyroid medication
• Blood pressure medication
• Cholesterol medications (statins)
• Pain medications (codeine and other narcotics)

Lifestyle factors that may cause indigestion to include:

• Eating too much, eating too fast
• Eating fatty, greasy or spicy foods
• Excessive alcohol intake
• Smoking
• Stress, fatigue and anxiety
• Caffeine
• Moderate to intense exercise immediately after eating

Indigestion symptoms are signs of other medical conditions or problems.

If indigestion symptoms are mild or resolve in a short time, talk to your doctor about how to treat it.

If you have any of the following symptoms of severe indigestion, if your symptoms last more than a few days, or if they worsen noticeably, seek medical care immediately:

• Vomiting or blood in vomit (blood can be red or dark, like coffee grounds)
• Loss of appetite
• Trouble swallowing
• Black, tarry stools or visible blood in stools
• Severe pain in the upper right abdomen
• Sudden, severe pain in the abdomen, particularly on the right side (the liver, gallbladder, and appendix are located here)
• Yellow coloring of the skin and eyes (jaundice)
• Discomfort unrelated to eating
• Lightheadedness, dizziness, or fainting due to symptoms

Heart attacks may cause symptoms often are mistaken for indigestion. If indigestion is accompanied by shortness of breath, sweating, chest pain, or pain radiating to the jaw, back, neck or arm, seek medical attention immediately.

You might first see your primary care doctor (general or family practitioner) who will diagnose your indigestion. You may be referred to a gastroenterologist, a specialist in disorders of the gastrointestinal (GI) tract.

If you have a problem that requires surgery such as a severe ulcer or gallstones you may be referred to a general surgeon.

In addition to a physical exam and questions about your symptoms, a doctor may perform the following tests:

• Blood tests
  • compete blood count (CBC)
  • liver panel, amylase and lipase (for pancreatitis)
  • kidney function test
  • guaiac test (a test for blood in the stool)
• Helicobacter pylori (H. pylori) testing, either by stool test or breath test
• Abdominal ultrasound
• Esophagogastroduodenoscopy (EGD, or endoscopy)
  • capsule endoscopy
• Colonoscopy
• Upper GI and small bowel X-ray series
• CT Scan or MRI of the abdomen
• Gastric emptying study

Indigestion is a symptom of other conditions, so treatment usually depends upon the cause. When the cause is lifestyle-related, prevention is the best way to find relief of symptoms.

Some over-the-counter medications may help relieve indigestion pain include:

• Antacids (Tums, Rolaids)
• Acid blockers (ranitidine [Zantac], omeprazole [Prilosec OTC]).

Other indigestion remedies to alleviate symptoms include:

• Avoid laying down flat, as this may worsen symptoms
• Drink milk or water to ease the acid in the stomach

If indigestion is caused by excessive stomach acid, ulcers, GERD, esophagitis, or gastritis, a doctor may prescribe potent acid blockers such as:

• omeprazole (Prilosec, Zegerid)
• lansoprazole (Prevacid)
• rabeprazole (Aciphex)
• pantoprazole (Protonix)
• esomeprazole (Nexium)
• dexlansoprazole (Dexilant)

Some of the above medications are available in over-the-counter (OTC) strengths.

A combination of antibiotics and acid blockers may be prescribed for up to several months if the underlying cause is related to Helicobacter pylori (H. pylori).

If the underlying cause is found to be gastroparesis, pro-motility drugs such as metoclopramide (Reglan) may be prescribed.

If the underlying cause of indigestion is found to be related to depression or anxiety, antidepressants may be prescribed for a short time.

If the underlying cause is found to be a medication you are currently taking, do not abruptly stop the medication. Work with your health-care professional to find alternatives that will not worsen your indigestion.

It the underlying cause is caused entirely or partially by lifestyle, medications listed above may help reduce symptoms, but changes in lifestyle (for example, eating a healthy diet, reducing stress, and quitting smoking) will produce the best results (see prevention section below).

Most episodes of indigestion go away within hours without medical attention. If indigestion symptoms worsen, consult a health-care professional.

Indigestion caused by lifestyle habits can often be prevented.

• Do not chew with your mouth open, talk while chewing, or eat quickly. This causes you to swallow air, which can aggravate indigestion.
• Chew food completely and eat slowly.
• Drink fluids after meals, rather than during.
• Avoid late-night eating.
• Avoid spicy, greasy foods.
• Quit smoking.
• Avoid alcoholic beverages.
• Avoid caffeine.
• Wait at least one hour after eating to exercise.
• Always take aspirin and NSAIDs with food.
• If you are lactose intolerant or allergic to a food, avoid the aggravating foods.
• Meditation may help if indigestion is caused by stress or anxiety.

Because indigestion is a symptom and not a cause, the outlook 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 and cure your indigestion.

If indigestion is caused by medications, talk to your health-care professional about changing medications to ones that do not cause indigestion. Never stop taking a medication without the advice of your doctor.

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, GERD, and gastritis respond readily to medications. 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.