Dr. Brian M. Kirsh, MD
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Dyspepsia

What is Dyspepsia?

Dyspepsia means "bad digestion" but is generally used as a label for persistent or recurring upper abdominal pain or discomfort. The term indigestion is often used synonymously with dyspepsia. The pain or discomfort is centered in the upper abdomen and is not accompanied by heartburn or regurgitation (symptoms of gastroesophageal reflux disease - GERD). It is also not generally associated with change in bowel habits. Dyspepsia is very common. It affects almost one fourth of people in the United States and affects both men and women equally. Symptoms may occur regularly for months at a time, or occur intermittently with long symptom free intervals.

In addition to the pain in the upper abdomen described above, dyspepsia may cause bloating, nausea, burping, and a feeling of fullness that occurs soon after eating.

Dyspepsia is often confused with GERD, where acid in the stomach refluxes (backs up) into the esophagus, the tube between the mouth and the stomach. Pain due to reflux is in the chest instead of the abdomen.
 

What Causes Dyspepsia?

Causes of dyspepsia may be easy to identify in some people and in other persons, no causes can be detected. Some of the causes include:
  • Ulcers - a breakdown in the lining of the stomach or duodenum
  • Medications, especially non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and naproxen
  • Helicobacter pylori (H. pylori), a stomach infection
  • Atypical GERD
  • Abnormal motility (muscle function) of the stomach
  • Cancer - dyspepsia is very rarely due to cancer

How is Dyspepsia Treated?

Your doctor will review your symptoms and determine whether or not you need any tests to check for possible problems with your lungs or heart, bleeding, or anemia. If you are at low risk for a more serious illness, you may be encouraged to stop behaviors that are known to be possible causes of dyspepsia.
 

You may be asked to:

  • Avoid foods high in fat. Fatty foods remain in the stomach longer than proteins or carbohydrates and can cause distention and pain in the stomach
  • Take note of foods that seem to bother you; avoid these foods
  • If you are overweight, consider losing weight
  • Avoid taking non-steroidal inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and others
  • Consider the possibility that other drugs you are taking may have a side effect of dyspepsia

Your physician may also prescribe histamine-2 receptor antagonists (H2RAs), such as Zantac (ranitidine), or proton pump inhibitors (PPIs) such as Prevacid (lansoprazole), Prilosec (omeprazole), Aciphex (rabeprazole), Protonix (pantoprazole), Dexilant (dexlansoprazole) or Nexium (esomeprazole).

Medications that enhance the motility of the stomach may also be used.

If these therapies do not improve your condition, your physician may order an endoscopy, a procedure in which a flexible tube is passed into your stomach. Biopsies, small samples of tissue that are then examined under a microscope, may also be taken.