This may include taking medicines. It may also mean making changes to your diet and managing your mental health. Experts are still learning what may cause functional dyspepsia.
The symptoms are likely from a digestive tract that is very sensitive to certain things. These may include stress and some foods and drinks. In some cases, the symptoms may start after an infection with bacteria, a virus, or parasites. You may also have symptoms of irritable bowel syndrome IBS. These can include ongoing constipation or diarrhea.
Your healthcare provider may prescribe a medicine to help ease your symptoms. Dyspepsia can also be a symptom of a wide range of health conditions, including :. Dyspepsia is common during pregnancy , especially in the last trimester. This is due to hormonal changes and the way the fetus presses against the stomach.
Many people experience mild dyspepsia from time to time and manage it with lifestyle changes or OTC medication. People should see a doctor if they have the following symptoms alongside indigestion:. They may also examine the chest and stomach. This may involve pressing down on different parts of the abdomen to check for areas that may be sensitive, tender, or painful under pressure.
In some cases, a doctor may use the following tests to rule out an underlying health condition:. In rare cases, severe and persistent indigestion can lead to complications. These include:. Persistent exposure to stomach acid can cause scarring in the upper gastrointestinal tract.
The tract can become narrow and constricted, causing difficulty with swallowing and chest pain. Surgery may be necessary to widen the esophagus. In some cases, stomach acid can cause long-term irritation of the pylorus, the passage between the stomach and the small intestine. If the pylorus becomes scarred, it can narrow.
If that happens, a person may not be able to digest food properly, and they may need surgery. Over time, stomach acid can cause the lining of the digestive system to break down, leading to an infection called peritonitis. Medication or surgery may be necessary. Dyspepsia is often mild, and people can make dietary and lifestyle changes to help manage it.
A combination of peppermint oil and caraway oil for the treatment of functional dyspepsia: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine. Masuy I, et al. Review article: Treatment options for functional dyspepsia.
Brown AY. Allscripts EPSi. Mayo Clinic. Kashyap PC expert opinion. Related Associated Procedures Hypnosis Upper endoscopy. Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.
Related Editorial. Dyspepsia, often defined as chronic or recurrent discomfort centered in the upper abdomen, can be caused by a variety of conditions. Common etiologies include peptic ulcers and gastroesophageal reflux.
Serious causes, such as gastric and pancreatic cancers, are rare but must also be considered. Symptoms of possible causes often overlap, which can make initial diagnosis difficult. In many patients, a definite cause is never established. The initial evaluation of patients with dyspepsia includes a thorough history and physical examination, with special attention given to elements that suggest the presence of serious disease.
Optimal management remains controversial in young patients who do not have alarm symptoms. Although management should be individualized, a cost-effective initial approach is to test for Helicobacter pylori and treat the infection if the test is positive.
If the H. If symptoms persist or recur after six to eight weeks of empiric therapy, endoscopy should be performed. Dyspepsia is upper abdominal pain or discomfort that is episodic or persistent and often associated with belching, bloating, heartburn, nausea or vomiting. Even though dyspepsia is a highly prevalent condition, no definitive studies have as yet established guidelines for the work-up of dyspeptic patients in the primary care setting.
It is well accepted that patients with peptic ulcer disease associated with Helicobacter pylori infection should be treated with antibiotics to eradicate the organism.
The approach to previously uninvestigated dyspepsia is more difficult. It includes differentiating the cause of dyspepsia, selecting among the available options for initial management and distinguishing between patients who require endoscopy and those who can safely receive empiric drug therapy.
The challenge is further increased by the controversy surrounding the role of H. Because the differential diagnosis of dyspepsia is broad, initial efforts should be focused on the most common etiologies Table 1. Peptic ulcer disease. Reflux esophagitis. Gastric or esophageal cancer. Biliary tract disease. Carbohydrate malabsorption lactose, sorbitol, fructose, mannitol. Medications see Table 4.
Infiltrative diseases of the stomach Crohn's disease, sarcoidosis. Metabolic disturbances hypercalcemia, hyperkalemia. Ischemic bowel disease. Systemic disorders diabetes mellitus, thyroid and parathyroid disorders, connective tissue disease. Intestinal parasites Giardia, Strongyloides. Abdominal cancer, especially pancreatic cancer. AGA technical review: evaluation of dyspepsia. Management of nonulcer dyspepsia.
N Engl J Med ;— Structural conditions commonly associated with dyspepsia include peptic ulcers and gastroesophageal reflux disease GERD. Gastric or esophageal cancers are serious causes but account for fewer than 2 percent of cases. A thorough history is important in evaluating the patient with dyspepsia, although symptoms alone may not be very useful in establishing a specific diagnosis. One group of investigators found extensive symptom overlap when they attempted to categorize patients into diagnostic groups, which included ulcer-like, dysmotility-like, reflux-like and unspecified dyspepsia.
Questions that may be useful in identifying other causes of dyspepsia-like symptoms are presented in Table 2. Is the pain abrupt, is it unbearable in severity and does it last for many hours without relief?
Does the patient have a medical history of diabetes mellitus, hypothyroidism or hyperthyroidism, or hyperparathyroidism? Is the patient currently taking medications commonly associated with dyspepsia? Patients who present with dyspepsia should be asked about risk factors associated with peptic ulcers.
If a patient has a history of ulcers, a recurrent lesion is likely. Reflux-like dyspepsia, or GERD, can be distinguished from other gastrointestinal disorders with reasonable accuracy on the basis of symptoms. Heartburn and esophageal reflux and spasm commonly occur at night or after the consumption of a large meal.
If the diagnosis of GERD is uncertain, intraesophageal pH monitoring may help in separating the disease from other causes of dyspepsia. Dysmotility-like dyspepsia, or gastroparesis, is associated with symptoms of bloating, abdominal distention, flatulence and prominent nausea.
The abdominal pain associated with irritable bowel syndrome may frequently be confused with the pain of nonulcer dyspepsia. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
Gallstones are common and often asymptomatic. When pain occurs, it is episodic and severe, and may last for hours. Patients with dyspepsia should also be asked about the presence of dark urine, jaundice and acholic stools. Fortunately, malignancies are rare in patients with dyspepsia. A complete medication history, including prescription and over-the-counter drugs, should always be obtained as part of the evaluation of patients with dyspepsia. Agents that have been associated with dyspepsia are listed in Table 4.
Because dosage reduction or discontinuation of the offending agent may relieve a patient's symptoms, questions directed at identifying medication-induced dyspepsia may avoid costly diagnostic studies. The use of herbal products, home remedies and other products e. Dietary supplements can be harmful, but patients may not consider their use important enough to mention.
Food and Drug Administration. Thus, purity and quality are difficult to ensure, and a number of products contain contaminants. Although documentation is poor, these products have been reported to cause a number of side effects, including dyspepsia Table 5.
Information from Pharmacist's letter continuing education booklet: therapeutic use of herbs Hot. Stockton, Calif. Patients with ischemic heart disease may relate their symptoms to the stomach rather than the heart.
Therefore, cardiac etiologies need to be ruled out. Unfortunately, gastrointestinal and cardiac pain may be clinically indistinguishable, posing a difficult diagnostic and therapeutic challenge.
Some historical features may help to distinguish between cardiac and gastrointestinal causes of dyspepsia. Burning pain suggests a gastrointestinal etiology, whereas pressure radiating to the left arm suggests a cardiac origin.
Pain lasting for hours tends to be gastrointestinal in origin. Positional pain is also more likely to have a gastrointestinal cause. For example, pain that occurs when a patient is lying down is more typical of GERD than of cardiac disease. Metabolic disorders are a rare cause of dyspepsia.
Other disorders to consider include malabsorption syndrome, collagen vascular disorders, Zollinger-Ellison syndrome and Crohn's disease. With the exception of epigastric tenderness, the physical examination is usually normal in patients with uncomplicated dyspepsia. In addition to evaluating the epigastric pain, it is important to assess the patient's hemodynamic status because hypotension or tachycardia may indicate significant blood loss from gastrointestinal bleeding.
The stool should also be tested for occult blood. An association between dental erosions and GERD has been found, 29 but its incidence remains unclear.
Thus, an oral examination may suggest the presence of GERD in a patient with extensive loss of enamel and exposed dentin. Jaundice or a positive Murphy's sign suggests gall bladder disease. Signs of hypothyroidism or hyperthyroidism should also be considered in the evaluation of dyspepsia.
Weight loss, a positive fecal occult blood test, a palpable mass, signal nodes Virchow's nodes and acanthosis nigricans are signs of possible malignancy. Patients with dyspepsia and any of these signs should undergo endoscopy as soon as possible.
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