Indigestion

  • Basics

    Indigestion is a common problem that causes pain/ discomfort in the upper abdomen with a feeling of fullness or bloating Figure 01. Indigestion, medically referred to as “dyspepsia,” can occur after eating a meal. While it is usually associated with eating large meals, indigestion can occur even after eating smaller ones.

    A variety of disorders can cause symptoms of indigestion, including ulcers, gastroesophageal reflux disease (GERD), and less commonly, cancer. In about half of cases brought to a doctor's attention, however, no identifiable underlying problem can be determined; doctors refer to such cases as “functional dyspepsia.” Many different medications are available to treat indigestion, even when the underlying causes cannot be identified.

    Click to enlarge: Anatomy of the Digestive System

    Figure 01. Anatomy of the Digestive System

    Recurrent indigestion accounts for about 5% of primary care doctor visits.

  • Causes

    Many different conditions can cause indigestion. The most common include:

    • Overeating
    • Eating too fast
    • Eating fatty or greasy foods
    • Overindulgence in alcohol
    • Eating spicy foods
    • Emotional trauma or nervousness
    • Gastroesophageal reflux disease (GERD), in which acidic stomach contents back up into the delicate esophagus, causing the burning pain known as “heartburn”
    • Medications including iron, nonsteroidal anti-inflammatory drugs (NSAIDS), antibiotics, corticosteroids, alendronate (Fosamax), and orlistat (Xenical)

    Other more serious conditions can also cause indigestion.Figure 02.

    • A motility disorder: either too rapid or too slow emptying of stomach contents and passage through the intestines
    • An ulcer in the stomach or the first part of the small intestine (duodenum)
    • Liver disease
    • An inflammation of the lining of the stomach that occurs suddenly and can be a result of extreme stress, medications, ingestion of corrosive material or other illnesses (acute gastritis)
    • Inflammation of the gallbladder, which can be the result of a long-term battle with gallstones (chronic cholecystits)
    • An inflammation of the lining of the stomach that occurs gradually, usually the result of long-term nonsteroidal anti-inflammatory drug (NSAID) use (chronic gastritis)
    • An inflammation of the pancreas often caused by alcohol abuse (chonic pancreatitis)
    • Cancers of the stomach, esophagus, pancreas, or ovaries

    Click to enlarge: Gastric and Duodenal Ulcers

    Figure 02. Gastric and Duodenal Ulcers

    Your indigestion could be due to an ulcer. Ulcers can occur in the stomach (gastric ulcer) or in the first part of the small intestine (duodenal ulcer).

    In up to 60% of cases, the cause cannot be determined, and doctors refer to the condition as “functional dyspepsia.” Between 30% and 60% of people with functional dyspepsia are found to carry Helicobacter pylori, a bacterium associated with ulcer disease. Many people without symptoms also carry these bacteria as part of their normal intestinal makeup, and it is not clear whether it is actually the cause of indigestion.

    Because it is not usually possible to diagnose the exact cause of functional dyspepsia, various medications may be tried to see if they bring relief.

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