Editing Indigestion

{{short description|Upset stomach}}
{{redirect|Dyspepsia|the Negativland album|Dispepsi}}
{{Infobox medical condition
| name            =
| synonyms        = Dyspepsia
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| field            = [[Gastroenterology]]
| symptoms        = Upper abdominal pain<ref name=Eu2019/>
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| frequency       = Common<ref name=Eu2019/>
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'''Indigestion''', also known as '''dyspepsia''' or '''upset stomach''', is a condition of impaired [[digestion]].<ref>{{DorlandsDict|three/000033170|dyspepsia}}</ref> Symptoms may include upper [[bloating|abdominal fullness]], [[heartburn]], [[nausea]], [[belching]], or upper [[abdominal pain]].<ref>{{cite book|last1=Duvnjak|first1=Marko|title=Dyspepsia in clinical practice|date=2011|publisher=Springer|location=New York|isbn=9781441917300|page=2|edition=1. Aufl.|url=https://books.google.com/books?id=UGpATfS5-T8C&pg=PA2}}</ref> People may also experience [[Satiety|feeling full]] earlier than expected when eating.<ref>{{cite journal |vauthors=Talley NJ, Vakil N |title=Guidelines for the management of dyspepsia |journal=Am. J. Gastroenterol. |volume=100 |issue=10 |pages=2324–37 |date=October 2005 |doi=10.1111/j.1572-0241.2005.00225.x |pmid=16181387 |s2cid=16499689 |doi-access=free }}</ref> Indigestion is relatively common, affecting 20% of people at some point during their life, and is frequently caused by [[gastroesophageal reflux disease]] (GERD) or [[gastritis]].<ref name="Eu2019">{{cite journal|last1=Eusebi|first1=Leonardo H|last2=Black|first2=Christopher J|last3=Howden|first3=Colin W|last4=Ford|first4=Alexander C|date=11 December 2019|title=Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis|journal=BMJ|volume=367|pages=l6483|doi=10.1136/bmj.l6483|pmc=7190054|pmid=31826881|doi-access=free}}</ref><ref name="Overview">{{cite journal|last1=Zajac|first1=P|last2=Holbrook|first2=A|last3=Super|first3=ME|last4=Vogt|first4=M |title=An overview: Current clinical guidelines for the evaluation, diagnosis, treatment, and management of dyspepsia|journal=Osteopathic Family Physician |volume=5 |issue=2 |pages=79–85 |date=March–April 2013 |doi=10.1016/j.osfp.2012.10.005}}</ref>

Indigestion is subcategorized as either "organic" or "[[functional dyspepsia]]", but making the diagnosis can prove challenging for physicians.<ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/925478002|title=Current diagnosis & treatment. Gastroenterology, hepatology, and endoscopy|date=2016|last1=Greenberger|first1=Norton|last2=Blumberg|first2=R.S.|last3=Burakoff|first3=Robert|isbn=978-1-259-25097-2|edition=3|location=New York|oclc=925478002}}</ref> '''Organic indigestion''' is the result of an underlying disease, such as [[gastritis]], [[peptic ulcer disease]] (an ulcer of the stomach or [[duodenum]]), or [[cancer]].<ref name=":0" /> Functional indigestion (previously called non-ulcer dyspepsia)<ref name="Saad&Chey2006">{{cite journal|vauthors=Saad RJ, Chey WD|date=August 2006|title=Review article: current and emerging therapies for functional dyspepsia|url=https://deepblue.lib.umich.edu/bitstream/2027.42/74835/1/j.1365-2036.2006.03005.x.pdf|journal=Aliment. Pharmacol. Ther.|volume=24|issue=3|pages=475–92|doi=10.1111/j.1365-2036.2006.03005.x|pmid=16886913|doi-access=free|hdl=2027.42/74835}}</ref> is indigestion without evidence of underlying disease.<ref>{{cite journal|vauthors=van Kerkhoven LA, van Rossum LG, van Oijen MG, Tan AC, Laheij RJ, Jansen JB|date=September 2006|title=Upper gastrointestinal endoscopy does not reassure people with functional dyspepsia|url=http://www.researchcore.org/publications/docs/endo_vankerkhoven_reassurence.pdf|journal=Endoscopy|volume=38|issue=9|pages=879–85|doi=10.1055/s-2006-944661|pmid=16981103|s2cid=260135014 |archive-url=https://web.archive.org/web/20110727213028/http://www.researchcore.org/publications/docs/endo_vankerkhoven_reassurence.pdf|archive-date=2011-07-27}}</ref> Functional indigestion is estimated to affect about 15% of the general population in western countries and accounts for a majority of dyspepsia cases.<ref name="Saad&Chey2006" /><ref name=":6">{{Cite journal|last1=Ford|first1=Alexander C.|last2=Mahadeva|first2=Sanjiv|last3=Carbone|first3=M. Florencia|last4=Lacy|first4=Brian E.|last5=Talley|first5=Nicholas J.|date=2020-11-21|title=Functional dyspepsia|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30469-4/abstract|journal=The Lancet|language=English|volume=396|issue=10263|pages=1689–1702|doi=10.1016/S0140-6736(20)30469-4|issn=0140-6736|pmid=33049222|s2cid=222254300}}</ref>

In patients who are 60 or older, or who have worrisome symptoms such as trouble swallowing, weight loss, or blood loss, an [[endoscopy]] (a procedure whereby a camera attached to a flexible tube is inserted down the throat and into the stomach) is recommended to further assess and find a potential cause.<ref name=Eu2019/> In patients younger than 60 years of age, testing for the bacteria ''[[Helicobacter pylori|H. pylori]]'' and if positive, treatment of the infection is recommended.<ref name=Eu2019/>

==Signs and symptoms==

=== Symptoms ===
Patients experiencing indigestion likely report one, a combination of, or all of the following symptoms:<ref name=":0" /><ref name=":1">{{Cite web|title=Rome IV Criteria|url=https://theromefoundation.org/rome-iv/rome-iv-criteria/|access-date=2022-01-19|website=Rome Foundation|language=en-US}}</ref>
* upper abdominal pain or discomfort
* [[bloating]]
* early [[satiety]]
* [[postprandial]] fullness
* nausea with or without vomiting
* [[Anorexia (symptom)|anorexia]]
* [[Regurgitation (digestion)|regurgitation]]
* belching

=== Signs ===
There may be abdominal tenderness, but this finding is nonspecific and is not required to make a diagnosis.<ref name=":1" /> However, there are physical exam signs that may point to a different diagnosis and underlying cause for a patient's reported discomfort. A positive Carnett sign (focal tenderness that increases with abdominal wall contraction and palpation) suggests an [[etiology]] involving the abdominal wall musculature. [[Skin|Cutaneous]] dermatomal distribution of pain may suggest a [[Thorax|thoracic]] [[Radiculopathy|polyradiculopathy]]. Tenderness to palpation over the right upper quadrant, or Murphy's sign, may suggest [[cholecystitis]] or gallbladder inflammation.<ref>{{cite journal|last1=Flier|first1=SN|last2=S|first2=Rose|date=2006|title=Is functional dyspepsia of particular concern in women? A review of gender differences in epidemiology, pathophysiologic mechanism, clinical presentation and management|journal=Am J Gastroenterol|volume=101|issue=12 Suppl|pages=S644–53|doi=10.1111/j.1572-0241.2006.01015.x|pmid=17177870|s2cid=27922893}}</ref>

=== Alarm symptoms ===
Also known as ''Alarm features'', ''alert features'', ''red flags'', or ''warning signs'' in gastrointestinal (GI) literature.

Alarm features are thought to be associated with serious gastroenterologic disease and include:<ref>{{cite journal |last1=Vakil |first1=Nimish |title=Limited Value of Alarm Features in the Diagnosis of Upper Gastrointestinal Malignancy: Systematic Review and Meta-analysis |journal=Gastroenterology |date=2006 |volume=131 |issue=2 |pages=390–401 |doi=10.1053/j.gastro.2006.04.029 |pmid=16890592 |url=https://doi.org/10.1053/j.gastro.2006.04.029|url-access=subscription }}</ref>
* chronic gastrointestinal bleeding
* progressive unintentional weight loss
* [[Dysphagia|progressive difficulty swallowing (dysphagia)]]
* persistent vomiting
* [[Iron deficiency anemia]]
* [[Vitamin B12 deficiency|Vitamin B<sub>12</sub> deficiency]] ([[Pernicious anemia]])
* [[Epigastrium|epigastric]] mass

==Cause==
Indigestion is a diagnosis related to a combination of symptoms that can be attributed to "organic" or "functional" causes.<ref name=":2">{{Cite journal|last1=Barberio|first1=Brigida|last2=Mahadeva|first2=Sanjiv|last3=Black|first3=Christopher J.|last4=Savarino|first4=Edoardo V.|last5=Ford|first5=Alexander C.|date=2020-07-28|title=Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria|url=http://dx.doi.org/10.1111/apt.16006|journal=Alimentary Pharmacology & Therapeutics|volume=52|issue=5|pages=762–773|doi=10.1111/apt.16006|pmid=32852839|s2cid=221344221|issn=0269-2813|hdl=11577/3363479|hdl-access=free}}</ref> Organic dyspepsia should have pathological findings upon endoscopy, like an ulcer in the stomach lining in [[peptic ulcer disease]].<ref name=":2" /> [[Functional dyspepsia]] is unlikely to be detected on endoscopy but can be broken down into two subtypes, epigastric pain syndrome (EPS) and post-prandial distress syndrome (PDS).<ref name=":3">{{Cite journal|last1=Sayuk|first1=Gregory S.|last2=Gyawali|first2=C. Prakash|date=2020-09-01|title=Functional Dyspepsia: Diagnostic and Therapeutic Approaches|url=https://doi.org/10.1007/s40265-020-01362-4|journal=Drugs|language=en|volume=80|issue=13|pages=1319–1336|doi=10.1007/s40265-020-01362-4|pmid=32691294|s2cid=220656815|issn=1179-1950|url-access=subscription}}</ref> In addition, indigestion could be caused by medications, food, or other disease processes.

Psychosomatic and cognitive factors are important in the evaluation of people with chronic dyspepsia. Studies have shown a high occurrence of mental disorders, notably anxiety and depression, amongst patients with dyspepsia; however, there is little evidence to prove causation.<ref>{{Cite journal|last1=Holtmann|first1=Gerald|last2=Shah|first2=Ayesha|last3=Morrison|first3=Mark|date=2017|title=Pathophysiology of Functional Gastrointestinal Disorders: A Holistic Overview|url=https://www.karger.com/Article/FullText/485409|journal=Digestive Diseases|language=english|volume=35|issue=S1|pages=5–13|doi=10.1159/000485409|issn=0257-2753|pmid=29421808|s2cid=3556796|doi-access=free}}</ref>

=== Organic dyspepsia ===

====Esophagitis====
[[Esophagitis]] is an inflammation of the esophagus, most commonly caused by gastroesophageal reflux disease ([[Gastroesophageal reflux disease|GERD]]).<ref name=":0" /> It is defined by the sensation of "[[heartburn]]" or a burning sensation in the chest as a result of inappropriate relaxation of the lower esophageal sphincter at the site where the esophagus connects to the stomach. It is often treated with proton pump inhibitors. If left untreated, the chronic damage to the esophageal tissues poses a risk of developing cancer.<ref name=":0" /> A meta-analysis showed risk factors for developing GERD included age equal to or greater than 50, smoking, the use of non-steroid anti-inflammatory medications, and obesity.<ref>{{Cite journal|last1=Eusebi|first1=Leonardo H.|last2=Ratnakumaran|first2=Raguprakash|last3=Yuan|first3=Yuhong|last4=Solaymani-Dodaran|first4=Masoud|last5=Bazzoli|first5=Franco|last6=Ford|first6=Alexander C.|date=March 2018|title=Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/28232473|journal=Gut|volume=67|issue=3|pages=430–440|doi=10.1136/gutjnl-2016-313589|issn=1468-3288|pmid=28232473|s2cid=3496003}}</ref>

====Gastritis====
Common causes of [[gastritis]] include peptic ulcer disease, infection, or medications.

=====Peptic ulcer disease=====
Gastric and duodenal ulcers are the defining feature of [[peptic ulcer disease]] (PUD). PUD is most commonly caused by an infection with ''H. pylori'' or [[Nonsteroidal anti-inflammatory drug|NSAID]] use.<ref>{{Cite journal|last1=Fashner|first1=Julia|last2=Gitu|first2=Alfred C.|date=2015-02-15|title=Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection|url=https://pubmed.ncbi.nlm.nih.gov/25955624|journal=American Family Physician|volume=91|issue=4|pages=236–242|issn=1532-0650|pmid=25955624}}</ref>

====== ''Helicobacter pylori'' (''H. pylori'') infection ======
The role of ''[[Helicobacter pylori|H. pylori]]'' in [[functional dyspepsia]] is controversial, and treatment for ''H. pylori'' may not lead to complete improvement of a patient's dyspepsia.<ref name=":0" /> However, a recent systemic review and meta-analysis of 29 studies published in 2022 suggests that successful treatment of ''H. pylori'' modestly improves indigestion symptoms.<ref>{{Cite journal|last1=Ford|first1=Alexander C.|last2=Tsipotis|first2=Evangelos|last3=Yuan|first3=Yuhong|last4=Leontiadis|first4=Grigorios I.|last5=Moayyedi|first5=Paul|date=2022-01-12|title=Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/35022266|journal=Gut|volume=71 |issue=10 |pages=gutjnl–2021–326583|doi=10.1136/gutjnl-2021-326583|issn=1468-3288|pmid=35022266|s2cid=245922275}}</ref>

====Pancreatobiliary disease====
These include [[cholelithiasis]], [[chronic pancreatitis]], and [[pancreatic cancer]].

====Duodenal micro-inflammation====
[[duodenum|Duodenal]] micro-inflammation caused by an altered duodenal [[gut flora|gut microbiota]], reactions to foods (mainly [[gluten]] proteins) or infections may induce dyspepsia symptoms in a subset of people.<ref name="JungTalley2018">{{cite journal|vauthors=Jung HK, Talley NJ|year=2018|title=Role of the Duodenum in the Pathogenesis of Functional Dyspepsia: A Paradigm Shift|journal=J Neurogastroenterol Motil|type=Review|volume=24|issue=3|pages=345–354|doi=10.5056/jnm18060|pmc=6034675|pmid=29791992}}</ref>

===Functional dyspepsia===
{{main|Functional dyspepsia}}
[[Functional dyspepsia]] is a common cause of [[Chronic condition|chronic]] heartburn. More than 70% of people have no obvious organic cause for their symptoms after evaluation.<ref name=":2" />  Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying ([[gastroparesis]]) or impaired accommodation to food. Diagnostic criteria for [[functional dyspepsia]] categorize it into two subtypes by symptom: epigastric pain syndrome and post-prandial distress syndrome.<ref name=":3" /> [[Anxiety]] is also associated with [[functional dyspepsia]]. In some people, it appears before the onset of gut symptoms; in other cases, anxiety develops after onset of the disorder, which suggests that a [[gut–brain axis|gut-driven brain]] disorder may be a possible cause.<ref name=":3" />  Although benign, these symptoms may be chronic and difficult to treat.<ref name="TalleyFord2015">{{cite journal|vauthors=Talley NJ, Ford AC|title=Functional Dyspepsia|journal=N Engl J Med|volume=373|issue=19|pages=1853–63|date=Nov 5, 2015|pmid=26535514|doi=10.1056/NEJMra1501505|type=Review|url=http://eprints.whiterose.ac.uk/97326/10/nejmra1501505.pdf}}</ref>

==== Epigastric pain syndrome (EPS) ====
Defined by stomach pain and/or burning that interferes with daily life, without any evidence of organic disease.<ref name=":5">{{Cite journal|last1=Stanghellini|first1=Vincenzo|last2=Chan|first2=Francis K. L.|last3=Hasler|first3=William L.|last4=Malagelada|first4=Juan R.|last5=Suzuki|first5=Hidekazu|last6=Tack|first6=Jan|last7=Talley|first7=Nicholas J.|date=May 2016|title=Gastroduodenal Disorders|url=https://pubmed.ncbi.nlm.nih.gov/27147122|journal=Gastroenterology|volume=150|issue=6|pages=1380–1392|doi=10.1053/j.gastro.2016.02.011|issn=1528-0012|pmid=27147122}}</ref>

==== Post-prandial distress syndrome (PDS) ====
Defined by post-prandial fullness or early satiation that interferes with daily life, without any evidence of organic disease.<ref name=":5" />

===Food, herb, or drug intolerance===
Acute, self-limited dyspepsia may be caused by [[overeating]], eating too quickly, eating high-fat foods, eating during stressful situations, or drinking too much alcohol or coffee. Many medications cause dyspepsia, including [[aspirin]], [[nonsteroidal anti-inflammatory drugs]] (NSAIDs), [[antibiotics]] ([[metronidazole]], [[macrolides]]), bronchodilators (theophylline), diabetes drugs ([[acarbose]], [[metformin]], [[Alpha-glucosidase inhibitor]], [[amylin family|amylin analogs]], [[GLP-1]] receptor antagonists), antihypertensive medications (angiotensin converting enzyme [ACE] inhibitors, [[Angiotensin II receptor antagonist]]), cholesterol-lowering agents ([[Niacin (substance)|niacin]], [[fibrates]]), neuropsychiatric medications (cholinesterase inhibitors [donepezil, rivastigmine]), [[SSRIs]] ([[fluoxetine]], [[sertraline]]), [[serotonin]]-norepinephrine-reuptake inhibitors ([[venlafaxine]], [[duloxetine]]), Parkinson drugs ([[Dopamine agonist]], [[monoamine oxidase]] [MAO]-B inhibitors), weight-loss medications (orlistat), [[corticosteroids]], [[estrogen]]s, [[digoxin]], [[iron]], and [[opioids]].<ref name="Mounsey 84–88">{{Cite journal|last1=Mounsey|first1=Anne|last2=Barzin|first2=Amir|last3=Rietz|first3=Ashley|date=2020-01-15|title=Functional Dyspepsia: Evaluation and Management|url=https://pubmed.ncbi.nlm.nih.gov/31939638|journal=American Family Physician|volume=101|issue=2|pages=84–88|issn=1532-0650|pmid=31939638}}</ref><ref>{{cite journal|vauthors=Ford AC, Moayyedi P|year=2013|title=Dysepsia|url=http://pylori.org/indigestion-symptoms-signs-treatment/|journal=BMJ|volume=347|page=f5059|doi=10.1136/bmj.f5059|pmid=23990632|s2cid=220190440|access-date=2014-12-21|archive-date=2014-12-21|archive-url=https://archive.today/20141221173257/http://pylori.org/indigestion-symptoms-signs-treatment/|url-status=dead|url-access=subscription}}</ref> Common herbs have also been shown to cause indigestion, like white willow berry, [[garlic]], [[ginkgo]], chaste tree berry, [[Serenoa|saw palmetto]], and [[Tanacetum parthenium|feverfew]].<ref name="Mounsey 84–88"/> Studies have shown that wheat and dietary fats can contribute to indigestion and suggest foods high in short-chain carbohydrates ([[FODMAP]]) may be associated with dyspepsia.<ref name=":4">{{Cite journal|last1=Duncanson|first1=K. R.|last2=Talley|first2=N. J.|last3=Walker|first3=M. M.|last4=Burrows|first4=T. L.|date=June 2018|title=Food and functional dyspepsia: a systematic review|url=https://pubmed.ncbi.nlm.nih.gov/28913843|journal=Journal of Human Nutrition and Dietetics|volume=31|issue=3|pages=390–407|doi=10.1111/jhn.12506|issn=1365-277X|pmid=28913843|s2cid=22800900}}</ref> This suggests reducing or consuming a [[Gluten-free diet|gluten-free]], low-fat, and/or [[FODMAP diet]] may improve symptoms.<ref name=":4" /><ref name="DuncansonTalley2017">{{cite journal|vauthors=Duncanson KR, Talley NJ, Walker MM, Burrows TL|year=2017|title=Food and functional dyspepsia: a systematic review.|journal=J Hum Nutr Diet|type=Systematic Review|volume=31|issue=3|pages=390–407|doi=10.1111/jhn.12506|pmid=28913843|s2cid=22800900}}</ref> Additionally, some people may experience dyspepsia when eating certain spices or spicy food as well as foods like peppers, chocolate, citrus, and fish.<ref name=":0" />

===Systemic diseases===
There are a number of [[systemic disease]]s that may involve dyspepsia, including [[coronary disease]], [[congestive heart failure]], [[diabetes mellitus]], [[hyperparathyroidism]], [[thyroid disease]], and [[chronic kidney disease]].

===Post-infectious causes of dyspepsia===
[[Gastroenteritis]] increases the risk of developing chronic dyspepsia. Post-infectious dyspepsia is the term given when dyspepsia occurs after an acute gastroenteritis infection. It is believed that the underlying causes of post-infectious [[irritable bowel syndrome|IBS]] and post-infectious dyspepsia may be similar and represent different aspects of the same pathophysiology.<ref name="pmid25348873">{{cite journal|vauthors=Futagami S, Itoh T, Sakamoto C|year=2015|title=Systematic review with meta-analysis: post-infectious functional dyspepsia|journal=Aliment. Pharmacol. Ther.|volume=41|issue=2|pages=177–88|doi=10.1111/apt.13006|pmid=25348873|doi-access=free}}</ref>

==Pathophysiology==
The pathophysiology for indigestion is not well understood; however, there are many theories. For example, there are studies that suggest a gut-brain interaction, as patients who received an antibiotic saw a reduction in their indigestion symptoms.<ref>{{Cite journal|last1=Tan|first1=V. P. Y.|last2=Liu|first2=K. S. H.|last3=Lam|first3=F. Y. F.|last4=Hung|first4=I. F. N.|last5=Yuen|first5=M. F.|last6=Leung|first6=W. K.|date=2017-01-23|title=Randomised clinical trial: rifaximin versus placebo for the treatment of functional dyspepsia|journal=Alimentary Pharmacology & Therapeutics|volume=45|issue=6|pages=767–776|doi=10.1111/apt.13945|pmid=28112426|s2cid=207052951|issn=0269-2813|doi-access=free}}</ref> Other theories propose issues with gut motility, a hypersensitivity of gut viscera, and imbalance of the microbiome.<ref name=":6" /> A genetic predisposition is plausible, but there is limited evidence to support this theory.<ref>{{Cite journal|last1=Enck|first1=Paul|last2=Azpiroz|first2=Fernando|last3=Boeckxstaens|first3=Guy|last4=Elsenbruch|first4=Sigrid|last5=Feinle-Bisset|first5=Christine|last6=Holtmann|first6=Gerald|last7=Lackner|first7=Jeffrey M.|last8=Ronkainen|first8=Jukka|last9=Schemann|first9=Michael|last10=Stengel|first10=Andreas|last11=Tack|first11=Jan|date=2017-11-03|title=Functional dyspepsia|url=https://pubmed.ncbi.nlm.nih.gov/29099093|journal=Nature Reviews. Disease Primers|volume=3|pages=17081|doi=10.1038/nrdp.2017.81|issn=2056-676X|pmid=29099093|s2cid=4929427}}</ref>

==Diagnosis==
[[File:Diagnostic and Treatment Evaluation.jpg|thumb|Simplified diagram of how indigestion is diagnosed and treatment(s) determined]]
A diagnosis for indigestion is based on symptoms, with a possible need for more diagnostic tests. In younger patients (less than 60 years of age) without red flags (e.g., weight loss), it is recommended to test for H. pylori noninvasively, followed by treatment with antibiotics in those who test positively. A negative test warrants discussing additional treatments, like proton pump inhibitors, with your doctor.<ref name="Eu2019" /> An upper GI endoscopy may also be recommended.<ref name="Milivojevic Rankovic Krstic Milosavljevic p. ">{{cite journal | last1=Milivojevic | first1=Vladimir | last2=Rankovic | first2=Ivan | last3=Krstic | first3=Miodrag N. | last4=Milosavljevic | first4=Tomica | title=Dyspepsia-challenge in primary care gastroenterology | journal=Digestive Diseases | publisher=S. Karger AG | date=2021-06-14 | volume=40 | issue=3 | pages=270–275 | issn=0257-2753 | pmid=34126614 | doi=10.1159/000517668 | doi-access=free }}</ref> In older patients (60 or older), an endoscopy is often the next step in finding out the cause of newly onset indigestion regardless of the presence of alarm symptoms.<ref name="Eu2019" /> However, for all patients regardless of age, an official diagnosis requires symptoms to have started at least 6 months ago with a frequency of at least once a week over the last 3 months.<ref name=":1" />

==Treatment==
Functional and organic dyspepsia have similar treatments. Traditional therapies used for this diagnosis include lifestyle modification (e.g., diet), [[antacid]]s, [[proton-pump inhibitor]]s (PPIs), [[H2 antagonist|H<sub>2</sub>-receptor antagonists (H2-RAs)]], [[prokinetic]] agents, and [[antiflatulent]]s. PPIs and H2-RAs are often first-line therapies for treating dyspepsia, having shown to be better than placebo medications.<ref name=":7">{{Cite journal|last1=Ford|first1=Alexander C.|last2=Moayyedi|first2=Paul|last3=Black|first3=Christopher J.|last4=Yuan|first4=Yuhong|last5=Veettil|first5=Sajesh K.|last6=Mahadeva|first6=Sanjiv|last7=Kengkla|first7=Kirati|last8=Chaiyakunapruk|first8=Nathorn|last9=Lee|first9=Yeong Yeh|date=2020-09-16|title=Systematic review and network meta-analysis: efficacy of drugs for functional dyspepsia|url=https://doi.org/10.1111/apt.16072|journal=Alimentary Pharmacology & Therapeutics|volume=53|issue=1|pages=8–21|doi=10.1111/apt.16072|pmid=32936964|s2cid=221768794|issn=0269-2813}}</ref> Anti-depressants, notably tricyclic antidepressants, have been tested on patients who do not respond to traditional therapies with some benefits, though the research is of poor quality and adverse affects are noted.<ref name=":7" />

===Diet===
A lifestyle change that may help with indigestion is a change in diet, such as a stable and consistent eating schedule and slowing the pace of eating.<ref name=":8">{{Cite journal|last1=Duboc|first1=Henri|last2=Latrache|first2=Sofya|last3=Nebunu|first3=Nicoleta|last4=Coffin|first4=Benoit|date=2020|title=The Role of Diet in Functional Dyspepsia Management|journal=Frontiers in Psychiatry|volume=11|pages=23|doi=10.3389/fpsyt.2020.00023|issn=1664-0640|pmc=7012988|pmid=32116840|doi-access=free}}</ref> Additionally, there are studies that support a reduction in the consumption of fats may also alleviate dyspepsia.<ref name=":8" /> While some studies suggest a correlation between dyspepsia and celiac disease, not everyone with indigestion needs to refrain from gluten in their diet. However, a [[gluten-free diet]] can relieve the symptoms in some patients without celiac disease.<ref name="JungTalley2018" /><ref name=":8" /> Lastly, a [[FODMAP]]s diet or diet low/free from certain complex sugars and sugar alcohols has also been shown to be potentially beneficial in patients with indigestion.<ref name=":8" />

===Acid suppression===
Proton pump inhibitors (PPIs) were found to be better than placebo in a literature review, especially when looking at long-term symptom reduction.<ref name=":9">{{Cite journal|last1=Pinto-Sanchez|first1=Maria Ines|last2=Yuan|first2=Yuhong|last3=Hassan|first3=Ahmed|last4=Bercik|first4=Premysl|last5=Moayyedi|first5=Paul|date=2017-11-21|title=Proton pump inhibitors for functional dyspepsia|journal=The Cochrane Database of Systematic Reviews|volume=11|issue=3 |pages=CD011194|doi=10.1002/14651858.CD011194.pub3|issn=1469-493X|pmc=6485982|pmid=29161458}}</ref><ref>{{Cite journal|last1=Huang|first1=Xinyi|last2=Oshima|first2=Tadayuki|last3=Tomita|first3=Toshihiko|last4=Fukui|first4=Hirokazu|last5=Miwa|first5=Hiroto|date=November 2021|title=Meta-Analysis: Placebo Response and Its Determinants in Functional Dyspepsia|url=https://journals.lww.com/10.14309/ajg.0000000000001397|journal=American Journal of Gastroenterology|language=en|volume=116|issue=11|pages=2184–2196|doi=10.14309/ajg.0000000000001397|pmid=34404084|s2cid=237199057|issn=0002-9270|url-access=subscription}}</ref> H2 receptor antagonists (H2-RAs) have similar effect on symptoms reduction when compared to PPIs.<ref name=":9" /> However, there is little evidence to support prokinetic agents are an appropriate treatment for dyspepsia.<ref>{{Cite journal|last1=Pittayanon|first1=Rapat|last2=Yuan|first2=Yuhong|last3=Bollegala|first3=Natasha P|last4=Khanna|first4=Reena|last5=Leontiadis|first5=Grigorios I|last6=Moayyedi|first6=Paul|date=2018-10-18|editor-last=Cochrane Upper GI and Pancreatic Diseases Group|title=Prokinetics for functional dyspepsia|journal=Cochrane Database of Systematic Reviews|language=en|volume=2018|issue=10|pages=CD009431|doi=10.1002/14651858.CD009431.pub3|pmc=6516965|pmid=30335201}}</ref>

Currently, PPIs are FDA indicated for erosive [[esophagitis]], gastroesophageal reflux disease (GERD), [[Zollinger–Ellison syndrome]], eradication of H. pylori, duodenal and gastric ulcers, and NSAID-induced ulcer healing and prevention, but not [[functional dyspepsia]].<ref>{{Cite web|date=2015|title=Proton Pump Inhibitors: Use in Adults|url=https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/ppi-adult-factsheet11-14.pdf|access-date=2022-01-27|website=Centers for Medicare & Medicaid Services}}</ref>

===Prokinetics===
[[Prokinetic agent|Prokinetics]] (medications focused on increasing gut motility), such as [[metoclopramide]] or [[erythromycin]], has a history of use as a secondary treatment for dyspepsia.<ref name=":0" /> While multiple studies show that it is more effective than placebo, there are multiple concerns about the side effects surrounding the long-term use of these medications.<ref name=":0" />

===Alternative medicine===
A 2021 [[meta-analysis]] concluded that herbal remedies, like menthacarin (a combination of [[peppermint]] and [[caraway]] oils), [[ginger]], artichoke, [[Liquorice|licorice]], and jollab (a combination of [[rose water]], [[saffron]], and candy sugar), may be as beneficial as conventional therapies when treating dyspepsia symptoms.<ref>{{Cite journal|last1=Heiran|first1=Alireza|last2=Bagheri Lankarani|first2=Kamran|last3=Bradley|first3=Ryan|last4=Simab|first4=Alireza|last5=Pasalar|first5=Mehdi|date=2021-12-01|title=Efficacy of herbal treatments for functional dyspepsia: A systematic review and meta-analysis of randomized clinical trials|url=https://pubmed.ncbi.nlm.nih.gov/34851546|journal=Phytotherapy Research |volume=36 |issue=2 |pages=686–704 |doi=10.1002/ptr.7333|issn=1099-1573|pmid=34851546|s2cid=244774488}}</ref> However, it is important to note that herbal products are not regulated by the FDA and therefore it is difficult to assess the quality and safety of the ingredients found in alternative medications.<ref>{{Citation|last1=Kanfer|first1=Isadore|title=Chapter 7 - Regulations for the use of herbal remedies|date=2021-01-01|url=https://www.sciencedirect.com/science/article/pii/B9780128155653000072|work=Herbal Medicine in Andrology|pages=189–206|editor-last=Henkel|editor-first=Ralf|publisher=Academic Press|language=en|doi=10.1016/b978-0-12-815565-3.00007-2|isbn=978-0-12-815565-3|access-date=2022-01-27|last2=Patnala|first2=Srinivas|s2cid=234186151|editor2-last=Agarwal|editor2-first=Ashok|url-access=subscription}}</ref>

==Epidemiology==
Indigestion is a common problem and frequent reason for primary care physicians to refer patients to GI specialists.<ref>{{Cite journal|last1=Rodrigues|first1=David M|last2=Motomura|first2=Douglas I|last3=Tripp|first3=Dean A|last4=Beyak|first4=Michael J|date=2021-06-16|title=Are psychological interventions effective in treating functional dyspepsia? A systematic review and meta‐analysis|url=http://dx.doi.org/10.1111/jgh.15566|journal=Journal of Gastroenterology and Hepatology|volume=36|issue=8|pages=2047–2057|doi=10.1111/jgh.15566|pmid=34105186|s2cid=235379735|issn=0815-9319|url-access=subscription}}</ref> Worldwide, dyspepsia affects about a third of the population.<ref>{{Cite journal|last1=Esterita|first1=Tasia|last2=Dewi|first2=Sheilla|last3=Suryatenggara|first3=Felicia Grizelda|last4=Glenardi|first4=Glenardi|date=2021-06-18|title=Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review|journal=Journal of Gastrointestinal and Liver Diseases|volume=30|issue=2|pages=259–266|doi=10.15403/jgld-3325|issn=1842-1121|pmid=33951117|s2cid=233868221|doi-access=free}}</ref> It can affect a person's quality of life even if the symptoms within themselves are usually not life-threatening. Additionally, the financial burden on the patient and healthcare system is costly - patients with dyspepsia were more likely to have lower work productivity and higher healthcare costs compared to those without indigestion.<ref>{{Cite journal|last1=Esterita|first1=Tasia|last2=Dewi|first2=Sheilla|last3=Suryatenggara|first3=Felicia Grizelda|last4=Glenardi|first4=Glenardi|date=2021-06-18|title=Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review|url=https://www.jgld.ro/jgld/index.php/jgld/article/view/3325|journal=Journal of Gastrointestinal and Liver Diseases|language=en|volume=30|issue=2|pages=259–266|doi=10.15403/jgld-3325|pmid=33951117|s2cid=233868221|issn=1842-1121|doi-access=free}}</ref> Risk factors include NSAID-use, H. pylori infection, and smoking.<ref>{{Cite journal|last1=Tsukanov|first1=V. V.|last2=Vasyutin|first2=A. V.|last3=Tonkikh|first3=Ju. L.|date=2020-10-22|title=Modern aspects of the pathogenesis and treatment of dyspepsia|journal=Meditsinskiy Sovet = Medical Council|issue=15|pages=40–46|doi=10.21518/2079-701x-2020-15-40-46|s2cid=226340276|issn=2658-5790|doi-access=free}}</ref>

==See also==
* [[Functional gastrointestinal disorder|Functional bowel disorder]]

==References==
{{Reflist}}

==External links==
{{Medical resources
|  DiseasesDB      = 30831
|  ICD10           = {{ICD10|K|30||k|20}}
|  ICD9            = {{ICD9|536.8}}
|  ICDO            =
|  OMIM            =
|  MedlinePlus     = 003260
|  eMedicineSubj   =
|  eMedicineTopic  =
}}
{{wiktionary}}
{{Gastroenterology}}

[[Category:Digestive disease symptoms]]
[[Category:Diseases of oesophagus, stomach and duodenum]]