Dyspepsia

What is dyspepsia?

Dyspepsia is discomfort or pain in the abdomen above the navel or in the lower chest and is related to drinking or eating. It is also known as indigestion and is very common. It may be accompanied by loss of appetite, nausea, vomiting, flatulence (discomfort relieved by belching or passing wind) and heartburn.

What causes dyspepsia and who is at risk?

Most people have experienced dyspepsia. It often has no clear cause but risk factors seem to be:

• Eating too much
• Eating too quickly
• Eating spicy or fatty foods
• Drinking too much alcohol
• Taking certain types of medicines such as aspirin and ibuprofen for headache and arthritis
• Being stressed and worried

Many abdominal disorders can cause dyspepsia, and occasionally the initial symptoms of a heart attack are similar to dyspepsia. The most common known causes of dyspepsia are:

• Back flow (reflux) of stomach contents into the oesophagus, which is the tube that passes through the chest and links the mouth with the stomach. Usually a valve between the stomach and oesophagus prevents reflux but sometimes this valve does not work very effectively. This may happen if there is a hiatus hernia, a common disorder associated with increasing age in which part of the stomach rises and protrudes into the lower chest
• Gallstones
• Peptic ulcer, a break in the lining of the stomach or duodenum, the first part of the intestine (bowel).

What are the common symptoms and complications of dyspepsia?

Dyspepsia is itself a symptom. It may be accompanied by a variety of other symptoms, and be associated with a number of complications, depending on its cause. These include:

• Heartburn due to reflux of stomach contents. Reflux can also cause ulceration (damage to the inner lining) and narrowing of the oesophagus, leading to difficulty and pain on swallowing
• Loss of appetite, nausea, flatulence or vomiting due to a variety of abdominal conditions
• Severe abdominal pain, vomiting and a fever due to gallstones (see other factsheet)
• Pain in the upper abdomen two or three hours after going to bed, due to peptic ulcer (see other factsheet)

Dyspepsia of unknown cause has no complications.

How do doctors recognise dyspepsia?

A variety of investigations can be used to find out the cause of dyspepsia but are only necessary if the symptoms are severe or if the suspected cause needs to be treated (eg, peptic ulcer, gallstones).

Endoscopy, in which a long flexible tube is passed down the throat, will show the lining of the oesophagus, stomach and duodenum. If there is reflux or an ulcer, these can be seen and inspected.

Barium X-rays involve swallowing a solution of barium, and then X-rays are taken of the chest and abdomen. The barium, which shows up on X-rays, will reveal any reflux or ulcer.

An ultrasound test can be used to diagnose gallstones and some other causes of dyspepsia

What is the treatment for dyspepsia?

Self-care action plan

A self-care action plan to help prevent dyspepsia involves:

• Avoiding large meals
• Eating slowly
• Avoiding spicy and fatty foods
• Reducing alcohol intake
• Checking with the doctor if certain medicines may be causing dyspepsia

Medicines

Simple antacid tablets can be bought at chemists and supermarkets and act to neutralise stomach acid. Other types of tablet, including anti-ulcer tablets, may also be helpful and these can also be bought at the chemist or be prescribed by the doctor. It is important to follow any instructions on the packets. If there are severe symptoms a doctor should be consulted.

If stress and anxiety are severe, anti-anxiety medicines (tranquillisers) may be prescribed.

Complementary therapy

A variety of complementary medical treatments is used for dyspepsia. However, there is no conclusive research evidence to prove that any complementary medicine is beneficial or does not have harmful effects. Therapies such as the Alexander technique, reflexology, relaxation and visualisation, yoga and tai chi may help promote a sense of well-being and reduce stress.

What is the outcome of dyspepsia?

Most dyspepsia can be prevented with good self care, and if it does occur can be relieved with antacids bought from the chemist. Treatment of causes of dyspepsia such as peptic ulcer and gallstones will be followed by a complete recovery.

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