Indigestion (Dyspepsia)

What indigestion is

Dyspepsia is a symptom complex centered on the epigastrium, the area between the bottom of the breastbone and the belly button. Doctors recognize four main symptoms:

• Epigastric pain: a gnawing or aching pain in the upper middle belly
• Epigastric burning: a hot, burning feeling in the same area
• Postprandial fullness: feeling uncomfortably full long after a normal meal
• Early satiety: feeling full after only a few bites

Other common features are bloating, belching, nausea and a sour taste.

Indigestion vs heartburn

These often overlap but are not the same:

Heartburn that is the main symptom suggests GERD and is treated as reflux.

Causes of indigestion

Functional dyspepsia (most common)

In about 3 out of 4 people tested, no ulcer, inflammation or cancer is found. This is functional dyspepsia, a disorder of gut-brain interaction. The stomach may not relax properly to accommodate food, may empty slowly, or may be oversensitive to normal stretching and acid. It often follows a bout of gastroenteritis and is linked to stress and anxiety. It has two main patterns: post-meal fullness and early satiety, or epigastric pain and burning.

Peptic ulcers

Peptic ulcers are open sores in the stomach or duodenum. Duodenal ulcer pain often improves briefly with food and wakes people at night. The two main causes are H. pylori infection and NSAIDs.

H. pylori infection

Helicobacter pylori is a common stomach bacterium that causes chronic gastritis, ulcers and, over decades, raises the risk of stomach cancer. Clearing it can cure ulcer-related dyspepsia and helps some people with functional dyspepsia.

Medicines

• NSAIDs: ibuprofen, naproxen, aspirin (even low-dose)
• Iron and potassium supplements
• Some antibiotics (such as erythromycin and doxycycline)
• Bisphosphonates for osteoporosis
• Metformin, steroids, and GLP-1 medicines for diabetes and weight loss

Food, drink and lifestyle

Large, fatty or spicy meals, eating quickly, eating late, alcohol, coffee, carbonated drinks, smoking and stress commonly trigger symptoms. Pregnancy causes indigestion through hormonal relaxation of the stomach and pressure from the growing uterus.

Less common causes

• Gallstones: attacks of pain under the right ribs, often after fatty meals, lasting 30 minutes to several hours.
• Gastroparesis: delayed stomach emptying, often from diabetes, causing nausea, vomiting and early fullness.
• Celiac disease and food intolerances.
• Pancreatitis: severe upper belly pain spreading to the back.
• Stomach cancer or esophageal cancer: uncommon, but more likely with age over 60, weight loss, difficulty swallowing and anemia.
• Heart disease: angina and heart attacks can feel like indigestion, especially in women, older adults and people with diabetes.

How indigestion is diagnosed

Your doctor will ask what your symptoms feel like, how they relate to meals, your medicines (including over-the-counter painkillers), alcohol and smoking, and about warning signs. They will examine your belly.

Current US and Canadian guidance recommends:

• Age 60 or over with new dyspepsia: an upper endoscopy (a thin camera passed through the mouth into the stomach and duodenum) to look for ulcers and cancer.
• Under 60 without red flags: a H. pylori test (breath test, stool antigen test or blood test), treating it if positive. If negative or symptoms persist, a trial of a proton pump inhibitor (PPI).
• Other tests as needed: a blood count for anemia, celiac blood test, liver tests, an ultrasound for gallstones, or a gastric emptying study for suspected gastroparesis.

Stop PPIs for 2 weeks before a breath or stool H. pylori test, because they can cause false negative results.

Treatment and relief

Lifestyle changes

• Eat smaller meals more often, and eat slowly.
• Stop eating 2 to 3 hours before bed.
• Cut back on foods that clearly trigger your symptoms. Common ones are fatty or fried food, spicy food, chocolate, coffee, alcohol and fizzy drinks.
• Stop smoking.
• Lose weight if you are overweight, which reduces pressure on the stomach.
• Raise the head of the bed by 10 to 20 cm (4 to 8 in) if symptoms are worse at night.

Over-the-counter medicines

• Antacids (calcium carbonate, magnesium or aluminum compounds) neutralize acid for quick, short-lived relief.
• Alginates form a raft on top of stomach contents that reduces reflux.
• H2 blockers (famotidine) reduce acid for several hours.
• PPIs (omeprazole, esomeprazole, lansoprazole) are the most effective acid reducers. Take them 30 to 60 minutes before breakfast, as the label directs. Over-the-counter courses are 14 days. See a doctor if you need them longer.
• Simethicone may ease bloating.

Avoid using NSAIDs for pain if you have indigestion. Acetaminophen (paracetamol) is gentler on the stomach.

Prescription treatment

• H. pylori eradication: a combination of antibiotics and a PPI for 10 to 14 days, followed by a test to confirm it has cleared.
• Longer PPI courses for ulcers or reflux.
• For functional dyspepsia: low-dose tricyclic antidepressants, which calm gut nerve sensitivity rather than treat depression; prokinetic medicines to speed stomach emptying; and psychological therapies such as cognitive behavioral therapy or gut-directed hypnotherapy.

Complications

Most indigestion causes no harm. Complications come from the underlying cause: ulcers can bleed or perforate, untreated reflux can narrow or damage the esophagus, and H. pylori raises long-term stomach cancer risk.

Frequently asked questions

What is the fastest way to relieve indigestion?

An antacid or alginate usually works within minutes. Sitting upright, loosening tight clothing and sipping water can help. Avoid lying down after eating. If you need relief more than twice a week, see a doctor to find and treat the cause.

What causes indigestion every day?

Daily indigestion is most often functional dyspepsia, but it can also be caused by H. pylori infection, ulcers, reflux, regular NSAID use or alcohol. A doctor can test for H. pylori and decide whether you need an endoscopy, especially if you are over 60 or have warning signs.

Can indigestion be a sign of a heart attack?

Yes. Heart attacks can feel like indigestion, particularly in women, older adults and people with diabetes. Call 911 or your local emergency number if "indigestion" comes with chest pressure, pain in the arm, jaw or back, breathlessness, sweating or lightheadedness.

How long does indigestion last?

An episode after a meal usually lasts from 30 minutes to a few hours. Functional dyspepsia can come and go for months or years. Symptoms lasting more than 4 weeks despite treatment need medical review.

Can stress cause indigestion?

Yes. Stress and anxiety change stomach movement and increase sensitivity to normal digestion, which can trigger pain, burning and fullness. They are especially linked to functional dyspepsia. Stress management, regular meals and therapy can reduce symptoms.

What foods help indigestion?

No food cures indigestion, but smaller portions of plain, low-fat foods such as oatmeal, bananas, rice, lean protein and vegetables are usually easier to digest. Keep a food diary to identify your personal triggers instead of cutting out many foods.