When you are in middle school it may might be a mark of honor to let out a good belch, but for the rest of your life, burping, gas and bloating are not really great assets. What should you do if you find yourself constantly battling indigestion, heartburn and abdominal pain after you eat?

Everyone has had a dinner that didn't agree with them now and then, but some of us suffer from frequent and ongoing episodes of gas, pain, and pressure in the upper abdomen. All of these common symptoms of dyspepsia, commonly known as indigestion, can be treated once you find out the underlying cause of your discomfort. 

What is Dyspepsia?

Dyspepsia, or indigestion, is a broad term used to describe a range of complaints related to your stomach and the upper part of your digestive tract.  Bloating, gas, belching, stomach pain, and discomfort in the upper abdomen, particularly after eating, are all signs of dyspepsia. These symptoms of indigestion may be mild or quite severe and are shared by a range of medical conditions affecting the digestive tract.

Rather than food sensitivities such as celiac disease or gastritis, dyspepsia is a symptom rather than a condition in its own right. Since this is the case, it is important to diagnose and treat the underlying cause of your dyspepsia rather than simply managing the symptoms. While antacids can help calm an upset stomach, it is also important to investigate what may be causing your discomfort, especially if you are suffering from chronic dyspepsia.

The most common form of chronic indigestion is called functional dyspepsia. This term is used when there is no obvious underlying cause for your dyspeptic symptoms. You should be careful, though, as more serious conditions also produce these symptoms. The symptoms of indigestion are common to many other serious digestive diseases such as stomach cancer, gastroesophageal reflux disease or GERD, irritable bowel syndrome, or even liver disease. 

Despite not being a lethal condition, dyspepsia is still responsible for a large portion of the healthcare costs in the United States. It can also seriously affect your quality of life, especially your dyspepsia is caused by a chronic or severe underlying condition. Some studies suggest dyspepsia occurs in more than 20% of the population, but many people do not seek treatment. Though functional dyspepsia is common, and is typically treated with over-the-counter antacids or proton pump inhibitors, you should still get a confirmed diagnosis. 

What Causes Dyspepsia?

At the mild end of causes, dyspepsia can be caused by simply eating too much. Indigestion can also be caused by eating large amounts of greasy or spicy food. In these cases, simply modifying your diet or changing lifestyle habits to alter the frequency and size of your meals can bring very rapid relief. 

Stress and unresolved emotional trauma are also common causes of indigestion. In these situations, the ongoing emotional or mental stress can cause your body to excrete more stomach acid and pepsin, eventually resulting in irritation of the lining of the stomach and the formation of peptic ulcers. These mental stresses can be related to money, relationship pressures such as the loss of a significant relationship or marriage, and emotional trauma of many kinds from your past. 

Drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids also increase the amount of acid in your stomach. This unwelcome side effect can eventually lead to irritation and stomach pain. Long term usage of over-the-counter painkillers such as ibuprofen is often discouraged for this very reason. 

Helicobacter pylori is a bacterial infection that is one of the most common causes of stomach and upper gastrointestinal irritation. This bacteria, like the drugs mentioned above, will increase the amount of pepsin and stomach acid you produce, resulting in discomfort and potential damage to the lining of the stomach. This damage can lead to gastritis, a condition where the lining of the stomach becomes inflamed and can become damaged. If the condition is left untreated for too long you may be at increased risk of stomach cancer. 

Chronic indigestion can be caused by physiological problems as well. In the case of a hiatal hernia, part of the stomach can escape upward through your diaphragm, causing it to bulge into the chest cavity. This condition is closely related to acid reflux and typically requires careful dietary and lifestyle changes to relieve symptoms. 

Preventing Dyspepsia 

Managing or preventing dyspepsia is something you can often achieve with simple lifestyle changes. In some cases, more serious issues are contributing to your indigestion, but even if more aggressive treatment is required, small changes in your eating habits can go a long way to helping manage your symptoms. 

A few of the many things you can do to help reduce the severity of your dyspepsia are listed below. If you need more solutions, talking to your healthcare provider or dietitian can be a great resource for helping you take control of your symptoms.

  • Eat more slowly. This will allow you to achieve the feeling of fullness (also called satiety) before you have eaten too much 
  • Eat smaller meals. If you are still hungry, eat more frequently rather than eating a few large meals
  • Quit smoking, which can irritate the lining of the stomach.
  • Avoid acidic foods like citrus fruits and tomatoes.
  • Don't lie down right after eating. Eat your last meal of the day earlier in the evening and leave at least three hours between the last time you eat and when you go to bed.
  • Wear loose-fitting clothing, especially around the abdomen. This will prevent the stomach from being compressed, which can cause food to back up into the esophagus.
  • Cut out caffeine by removing coffee, tea, and other beverages.
  • Reduce your consumption of alcohol, as alcoholic drinks can irritate your stomach lining.
  • If your indigestion is related to stress, work on meditation, biofeedback and other techniques to relieve or lower your stress.
  • Use pillows to prop your head and torso up while you sleep. By keeping your head at least six inches above your feet, gastric juices will flow into the intestines more easily rather than into the esophagus.
  • Avoid exercising on a full stomach by waiting at least one hour after eating a meal or exercising before you eat.

How is Dyspepsia Diagnosed? 

When you talk to your doctor about dyspepsia, he or she will begin by asking you a series of questions about your lifestyle and diet. These can include asking if you experience frequent heartburn, as this can be an indicator of gastroesophageal reflux disease (GERD). Your doctor will also run a series of tests to determine what might be wrong. Breath tests can sometimes be used to identify conditions like lactose intolerance or bacterial overgrowth by looking for a surplus of hydrogen in your breath. Breath samples, blood tests, and stool samples can only tell your doctor so much. You may also have x-rays or possibly a CT scan done of your abdomen in an attempt to identify particular causes of your symptoms.  

Typically if you are suffering from some of the more severe symptoms of dyspepsia, your doctor will order an upper endoscopy to visually inspect your stomach. This procedure involves inserting a small tube containing a camera through the esophagus and into the stomach. This will give your doctor a chance to see what is going on inside your stomach, as well as collect a tissue sample for a biopsy. 

How do I Treat Dyspepsia?

For some people who have functional dyspepsia, taking over-the-counter (or OTC) antacids such as Zantac can be enough to eliminate the burping, bloating, and burning of indigestion. Depending on the severity of your symptoms, your doctor may prescribe drugs to lower your overall level of acid in your stomach. These drugs, known as proton-pump inhibitors (PPIs) work by blocking the chemical pathways that trigger acid production in the stomach. PPIs can be effective against h. pylori infections and other conditions such as GERD or gastritis. 

Since dyspepsia is often a collection of symptoms and not a disease in its own right, treating your dyspepsia will mean treating other conditions as well. This means the actual treatment will differ depending on the cause of your indigestion. Almost regardless of the condition, you can take an active roll in your own healing by making diet and lifestyle changes that will help manage your symptoms. From relieving stress to changing when and how much you eat, there are many things you can do to free you from the pain of chronic dyspepsia.

When Should I Talk to My Doctor About Indigestion?

Like many medical conditions, a few episodes of discomfort are not a cause for concern. If your symptoms continue to manifest or you are beginning to experience more serious complications, it may be time to talk to your doctor.

With gastrointestinal issues, it is always better to be safe than sorry. You may discover your abdominal pain was just a dinner that didn’t agree with you, but it is worth risking a little embarrassment given how dangerous and even life-threatening some digestive maladies can quickly become.

If you are experiencing shortness of breath, chest pain or you have pain that is radiating into the arm, neck, back or shoulder, you should call 911 or seek emergency medical attention immediately. Some other signs you should immediately seek medical treatment include the following:

  • Vomiting containing blood or a substance that looks like coffee grounds
  • Unexplained loss of appetite
  • Unintended weight loss
  • Difficulty swallowing that gets worse over time
  • Blood visible in the stool or tarry, black stools
  • Abdominal pressure or discomfort that is not related to eating
  • Pain centered in the lower right of the abdomen
  • Severe pain in the upper right abdomen

Even if your symptoms do not indicate a life-threatening condition, it is always best to see your doctor if you are having to take medication to manage indigestion. Your symptoms may indicate a deeper, more serious illness. Even if they don’t, there is no need to live with the ongoing pain and discomfort of indigestion.  Getting a diagnosis is only part of the picture. Learning to live with and manage your dyspepsia is the rest of the story. 

Our expert team at Cary Gastroenterology can provide you with resources and ideas to help you manage your symptoms and reclaim your life from chronic indigestion.