Dyspepsia, or indigestion, may arise on its own, or it may be a symptom of a more serious underlying condition. How is it diagnosed, treated, and managed? Read on to find out.
What is Dyspepsia?
Dyspepsia is the technical term for indigestion. People with dyspepsia may experience a feeling of fullness (or feeling bloated), heartburn, nausea, or belching. Dyspepsia is itself a common symptom or complication of other digestive conditions like gastritis and gastroesophageal reflux disease (GERD) .
If dyspepsia arises suddenly, especially in older people, it is considered a potential sign of more serious diseases. If you have unexplained indigestion, especially if it arose suddenly, we strongly recommend talking to your doctor as soon as possible .
Functional dyspepsia (or functional indigestion) is dyspepsia without evidence of an underlying disease or condition. Researchers are currently investigating possible causes of functional dyspepsia; some studies have found evidence of increased immune cell activity in the digestive tissue of people with this condition, but the implications of this activity are unknown [2, 3, 4, 5, 6].
There is also disagreement about the appropriate treatment strategy for functional dyspepsia. Treatments for this condition range from herbal remedies to prokinetics (drugs that speed up the emptying of the stomach) to antidepressants for psychological symptoms [3, 5].
How is Dyspepsia Diagnosed?
Most cases of dyspepsia are diagnosed by a doctor reviewing the medical history and symptoms of their patient. Dyspepsia may be caused by certain medications or by cigarette smoke, and these risk factors will be taken into account. A doctor will likely also conduct a physical exam, during which they may check for bloating, unusual sounds in the gut, tenderness, and yellowing of the eyes or skin .
If your doctor suspects an H. pylori infection, they will likely order blood tests, urea breath tests, or stool tests. A breath test with higher CO2 concentration than normal indicates H. pylori infection, while a stool sample is directly tested for the presence of the bacteria [9, 10].
Upper GI Endoscopy
Endoscopic procedures use a tiny camera and light to visually inspect diseased tissues. To check for gastritis, endoscopy is typically performed by feeding the camera down the esophagus and into the stomach [9, 10].
Upper GI Series
This procedure uses a chalky liquid containing barium to coat the upper digestive tract and make it more visible to an X-ray. The patient typically fasts and stops drinking water before the procedure (your doctor will tell you how long you must be fasted) and drinks the barium liquid while sitting or standing in front of the X-ray machine [9, 10].
How is Dyspepsia Treated?
Be sure to follow any and all prescriptions and recommendations from your doctor, which may or may not include therapies and strategies described here. Never use any of the following strategies in place of what your doctor recommends or prescribes.
Depending on your particular situation, your doctor may recommend changes to your diet. Before making any significant or sweeping changes yourself, make sure to check in with your doctor to avoid nutritional deficiencies or other unexpected consequences.
Avoiding Trigger Foods
Many people report that certain foods either aggravate or alleviate their dyspepsia symptoms. If you experience symptoms after eating certain foods, we recommend discussing these foods with your doctor. You may then be advised to avoid them, or at least to keep a meal diary to track the intensity of your symptoms relative to the foods you eat .
Some reported trigger foods include :
- Carbonated beverages (soft drinks)
- Legumes (beans, lentils)
- Processed meat (sausage, cured meat)
- Whole grains
Simply removing foods from your diet without guidance from a doctor or dietitian is not recommended due to a risk of nutritional deficiencies. Work with a medical professional for best results!
Dyspepsia patients are often advised to eat many small meals per day (five or six) rather than two or three large meals. When you consume less food, you are less likely to put undue pressure on your stomach, which may reduce the intensity and frequency of gastric pain and other symptoms .
It is broadly recognized that psychological stress and digestive disease are linked, and some researchers believe that stress may directly cause or worsen dyspepsia. As such, one important element of treating almost any case of dyspepsia is to minimize stress [12, 13, 14].
A study of 30 people with functional dyspepsia found that increased cooperation between medical and psychological practitioners and treatment plans led to better outcomes for the patients. If your doctor believes you are at risk of mental health issues like anxiety or depression, they may recommend a therapist or psychiatrist who can help with cognitive behavioral therapy or prescribe appropriate medications .
Supplements for Dyspepsia
The FDA has not approved any natural substances for medical use in dyspepsia, and supplements generally lack solid clinical research. Speak with your doctor before using any of these substances, and never use them in place of something your doctor recommends or prescribes.
Anise or Aniseed (Pimpinella anisum), is an aromatic flowering plant with many culinary and medicinal uses. It has been used in traditional medicine to relieve menopause symptoms, increase milk production, enhance libido, improve digestion, improve depression symptoms, and freshen breath [15, 16].
In a trial of 107 patients, taking anise powder (9 g daily for 4 weeks) improved symptoms of functional dyspepsia (indigestion) compared to placebo. Anise improved all symptoms except for nausea and vomiting .
In 2 clinical trials on over 700 people with indigestion, oral globe artichoke leaf extract improved the symptoms and quality of life. The extract was especially effective in easing fullness and reducing flatulence. However, it was barely more effective than the placebo in reducing pain and nausea caused by indigestion [19, 20].
A commercial mixture of artichoke leaf extract, chlorogenic acid, dandelion root extract, inulin, turmeric rhizome, and rosemary bud essential oil also relieved indigestion symptoms in a clinical trial on over 300 people .
3) Mastic Gum
Mastic gum is a type of resin obtained from the trunk and stems of an evergreen shrub (Pistacia lentiscus var. chia). Traditionally, mastic gum has been used for thousands of years in the Mediterranean as a natural remedy for wound healing, pain relief, and various gut disorders.
In a clinical trial of 148 people with indigestion, 350 mg of mastic gum, taken 3x/day, reduced symptoms of indigestion such as stomach pain (both in general and from anxiety), heartburn, and dull upper-stomach ache .
4) Plant-Based Enzymes
Digestive enzymes are a group of proteins that break down large nutrients into smaller, more easily absorbed compounds. The human body produces many digestive enzymes in the pancreas, and for the most part, these are all we need to break down and absorb our food. However, some people use supplemental enzymes to improve digestion, relieve inflammation, gut infections, pain, and more [25, 26, 27, 28].
In clinical studies with over 80 people with increased protein intake, fungal proteases supplements (extracted from Aspergillus) increased protein absorption and improved the blood fat levels [30, 31].
5) Herbal Bitters
Digestive bitters broadly include all herbs or supplements with a bitter taste. Their bitterness stimulates digestive juices to help the body overcome gut problems such as indigestion, bloating, heartburn, nausea, and more. A number of bitters have been used for hundreds of years across the world to promote digestive health.
Iberogast is a well-known blend of herbal bitters advertised as a remedy for indigestion. It contains extracts from angelica (dong quai), caraway, clown’s mustard, German chamomile, greater celandine, licorice, milk thistle, peppermint leaf, and lemon balm. An analysis of six clinical trials found that Iberogast significantly reduced symptoms of indigestion .
Insufficient Evidence For
The following substances have shown promise against dyspepsia in limited, low-quality clinical studies; there is currently insufficient evidence to support their use in this context, and they should never replace what your doctor prescribes. Remember to talk to your doctor before starting any new supplement or making significant changes to your diet.
Amla, or Indian gooseberry, is a plant often used as part of Ayurvedic traditional medicine. Although all parts of the plant were used, the fruit was used the most and believed to have the highest medicinal power. Limited studies support this traditional stance, as the fruit has been found to contain the most active compounds .
A double-blind randomized controlled trial found that amla reduced the severity of dyspepsia. Larger-scale studies are required, however .
At birth, the sterile human gut is immediately colonized with several types of microorganisms from both the mother and the environment. By the time they reach one year of age, each individual develops a unique bacterial profile. These beneficial bacteria help digest our food, support our immune systems, and even regulate inflammation. Probiotic supplements are popular additions to digestive management strategies for this reason .
In a study of 124 patients, S. boulardii decreased dyspepsia symptoms after anti-H. pylori therapy. It is unclear whether probiotic treatment could help with dyspepsia not associated with H. pylori .
8) Banana Powder
In a study of 46 patients with non-ulcer (functional) dyspepsia, banana powder supplements significantly improved symptoms in 75% of those given the supplement. The authors suggested that banana powder has some protective activity against ulcers, but additional studies are required to investigate this hypothesis [37, 38].
In a study of 116 people with dyspepsia, turmeric supplements significantly improved symptoms in 87% of those given the supplement. The authors suggested that curcumin, the best-studied active compound in turmeric, may have improved symptoms by increasing the secretion of bile. However, additional studies are required to investigate this hypothesis [37, 39].
10) Peppermint & Caraway
In a very small study of 6 volunteers with dyspepsia, a combination of peppermint and caraway oils significantly reduced the intensity of stomach pain. Clearly, this is nowhere near enough evidence to recommend peppermint or caraway oil, either together or in combination; additional studies are required [37, 40].
11) Red Peppers
Spicy food is often on the list of potential triggers of indigestion and other digestive complaints. However, peppers themselves may be useful for some. In a small study, red pepper powder (Capsicum annuum) improved symptoms in twice as many dyspepsia patients than the placebo .
If your doctor diagnoses dyspepsia and determines that it has a more severe underlying cause (such as H. pylori infection, gastritis, or GERD), they may prescribe medication to resolve these issues. It is very important to follow any prescription very carefully, and never start or stop medication without a doctor’s instructions.
As antacids, calcium carbonate and magnesium hydroxide are considered effective for non-ulcer (functional) dyspepsia. However, it is strongly recommended to talk to your doctor before taking them, to avoid adverse effects or unexpected interactions [42, 43].
The FDA has also approved aluminum phosphate as an ingredient for antacids. Aluminum phosphate may only make up 25% of the total active ingredients of an antacid, and people are advised not to consume more than 8 g of aluminum phosphate per day .
- Antibiotics, if you test positive for H. pylori
- Proton pump inhibitors, to reduce stomach acid production
- H2 histamine blockers, to reduce stomach acid production
- Prokinetics, to help the stomach empty more quickly
- Antidepressants or anti-anxiety medication, in cases of mental illness
Dyspepsia is the technical term for indigestion; it may emerge on its own or as a symptom of an underlying condition like gastritis, GERD, or even (rarely) cancer. It is typically diagnosed with a physical exam and symptom history, but if a doctor suspects a serious underlying cause, lab tests, endoscopy, and imaging may be used.
Dyspepsia is treated and managed with a combination of diet and lifestyle changes; your doctor may or may not also prescribe medications such as antacids, PPIs, H2 blockers, or antibiotics, depending on the underlying cause of the condition. Many doctors also recommend mental health intervention, as dyspepsia may arise from psychological stress.
Some supplements are currently under investigation for potential usefulness in dyspepsia. The most promising of these include anise, artichoke extract, mastic gum, plant-based enzymes, and blends of herbal bitters.