Dyspepsia is a burning pain or uncomfortable feeling in the upper middle part of the abdomen.
It can be caused by a peptic ulcer, but frequently is not .
Dyspepsia is usually considered to be separate from gastro-oesophageal reflux i.e. heartburn.
About 25 percent of people suffer from dyspepsia at some point in their lives.
Avoiding certain foods, stopping smoking and relaxation may assist in the management of dyspepsia.
Dyspepsia literally means “bad digestion”. It is a burning pain or an uncomfortable feeling in the upper middle part of the abdomen. The pain can be intermittent, but some people who suffer from dyspepsia are aware of this more or less continuously.
Dyspepsia can result from a peptic ulcer or can occur in people with no evidence of ulceration (non-ulcer dyspepsia). Peptic ulcers may occur in either the stomach or in the duodenum (the first part of the small bowel).
Peptic ulcers are usually associated with an infection in the stomach (Helicobacter pylori), or with the use of certain medication, in particular aspirin and the non-steroidal anti-inflammatory drugs. Eradication of the organism (Helicobacter pylori) and avoidance of these drugs will usually prevent the ulcer from recurring. The cause of non-ulcer dyspepsia is not certain at present, but may reflect a dysmotility, similar to that seen in the irritable bowel syndrome (spastic colon).
Although medications that reduce the amount of acid in your stomach, either by neutralization (antacids), or decreased production (H2-receptor blockers or the proton pump inhibitors), may improve or relieve the symptoms, there is usually no evidence of increased gastric acid production in people with dyspepsia. Some patients find that certain foods, in particular spicy foods, may aggravate their symptoms. Symptoms may also be particularly evident during times of stress.
Dyspepsia is usually considered to be separate from gastro-oesophageal reflux, where leakage of acid from the stomach into the oesophagus results in a sensation of burning, or “heartburn” in the lower chest.
Here are some of the other symptoms of dyspepsia:
A feeling of nausea
Bloating (a feeling of uncomfortable fullness)
A burning stomach pain
Dyspepsia may be caused by a stomach ulcer. Frequently, however, there is no evidence of ulceration, and the cause of the symptoms is often unclear.
Whether dyspepsia is somehow connected to Helicobacter pylori infection is currently being studied. It has been found, however, that not all people who have non-ulcer dyspepsia have Helicobacter pylori infection, and eradication of the organism in those who do, does not always result in improvement of symptoms.
Non-ulcer dyspepsia may be related to a dysmotility of the upper gastrointestinal tract, or a heightened sensation or awareness of the normal motility. It is important to differentiate the symptoms of dyspepsia from those of gastro-oesophageal reflux.
Who gets it?
Anyone, of any age can get dyspepsia. About 25 percent of all people suffer from this condition at some time in their lives.
When presented with patients complaining of pain in the upper abdomen, doctors need to consider the possibility of peptic ulcers, gallstones or reflux disease. Occasionally, disorders of the pancreas can also cause a similar pain. Investigations may include endoscopy and ultrasound examination.
Most people take antacids to reduce the discomfort caused by dyspepsia. If you have a stomach ulcer, it can be cured. You may need to take an acid-blocking medicine. If you have an infection (Helicobacter pylori) in your stomach, you may also need to take an antibiotic for a week.
If your doctor thinks that a medicine you're taking causes your dyspepsia, something else may be prescribed.
A medicine that cuts down on the amount of acid in your stomach might help your pain. This medicine can also help if you have acid reflux disease. Taking antacids on a regular basis may control the symptoms of dyspepsia, particularly if they are not particularly severe. They, however, do not necessarily treat the cause. Doctors will usually prescribe more potent acid reducing therapy (either the H2-receptor blockers or the proton pump inhibitors).
In those people who are able to identify certain foods that aggravate their symptoms, avoidance of those foods may assist in their management.
Side effects of medication
The medications used in the management of dyspepsia are generally safe and free from side effects. Antacids may be associated with loose stools or constipation, depending on the type. The proton pump inhibitors may also result in loose stools, and this is also a fairly frequent complaint of patients taking the antibiotics prescribed for the treatment of Helicobacter pylori. Mostly side effects are only minor and go away on their own.
Certain drugs, particularly some of the H2-receptor antagonists, may interfere with your other medications (in particular asthma drugs and blood thinning tablets), and advice regarding this should be obtained from your doctor.
Stick to the instructions on taking your medication. Remember that you need to complete a course of antibiotics - stopping halfway could be harmful to you.
If taking dyspepsia medication for two to four weeks does not sort out your problem, your doctor might suggest an endoscopy exam in order to investigate for peptic ulcer or gastro-oesophageal reflux disease. The same will happen if the pain recurs after treatment.
In an endoscopy exam, a small tube with a camera inside it is put into your mouth and is gently pushed down into your stomach. This enables your doctor to see into your stomach and find out what is causing the pain.
If the endoscopy does not identify a cause of the pain, or if the doctor suspects gallstones or pancreatic problems, an ultrasound or even a CT scan of the abdomen may be required.
There is much that you can do to prevent dyspepsia.
Avoid food triggers
Avoid foods that you know have caused indigestion before. Make a note of what you have eaten in the past that made you feel uncomfortable. Remember this when you plan your meals or eat in a restaurant.
If you smoke, make plans to stop. This is not only general health advice, but smoking can, in some people, cause an increase in stomach acids, and may also aggravate gastro-oesophageal reflux.
Many people find that stress aggravates their dyspeptic symptoms. Learn to destress, whether by means of exercise, yoga or relaxation exercises.
Midnight snack disaster
Don't eat just before you go to bed. A large meal late at night is not conducive to a good night's sleep. Many people get heartburn when they lie down at night - much more so if a large or fatty meal has just been consumed.
Reviewed by Dr Ganief Adams, Gastroenterologist, MBChB (UCT), FCP (SA)