Indigestion (functional dyspepsia)

Indigestion (“irritable stomach”) is one of the most common diseases of the gastrointestinal tract. Doctors also use the term “functional dyspepsia”.

Symptoms affect the upper abdomen and can vary greatly. They typically include an early feeling of satiety or fullness, stomach ache and heartburn.

The causes of indigestion are not fully understood. Many factors are probably involved.

Although there is no causal therapy, there are various treatment options, ranging from medication to psychotherapy.

Symptoms can vary greatly and can also be nonspecific. The most common symptoms include:

• Early satiety when eating
• Feeling of fullness after eating
• Stomach ache or heartburn

Some people with indigestion also report nausea, vomiting or heartburn.

The causes of indigestion are not fully understood.

Possible factors include:

• delayed emptying of the stomach
• increased sensitivity to pain in the stomach
• an infection with the bacterium Helicobacter pylori
• imbalance of bacteria in the upper gastrointestinal tract
• mental causes, e.g. persistent stress, anxiety or depression

Indigestion is a very common condition that affects approximately one in seven to one in ten people in Germany.

Women are more susceptible than men.

People with indigestion can experience symptom-free periods followed by periods of recurrence. The severity of symptoms can vary during each recurrence.

Indigestion can cause symptoms for months or even years.

In one in two people affected, the symptoms disappear after several years even without treatment.

In some people, they remain chronic, i.e. persistent.

Indigestion is diagnosed when at least one of the typical symptoms is present for 3 months during a 6-month period:

• Early satiety when eating
• Feeling of fullness after eating
• Stomach ache or heartburn

It is also important to rule out other causes of the symptoms, for example:

• a stomach ulcer or duodenal ulcer
• stomach cancer
• gastritis
• gastroesophageal reflux disease

Last but not least, taking certain medication, e.g. painkillers, can also cause stomach problems.

Doctors will ask patients about their medical history and symptoms.

They will then perform a physical examination and blood tests, and in some cases a gastroscopy. This is an endoscopic examination of the esophagus, stomach and duodenum.

A special breath test is performed to determine whether Helicobacter pylori bacteria are present in the stomach if this was not already checked using a gastroscopy.

If there is no infection with Helicobacter pylori bacteria, the doctor may prescribe a proton pump inhibitor (PPI) for treating the indigestion, for example the active substances omeprazole or pantoprazole.

These medications inhibit acid production and can help alleviate stomach pain. 

If an infection with Helicobacter pylori bacteria has been detected, the indigestion can be treated with a combination of antibiotics and proton pump inhibitors.

A further treatment option is H2 receptor antagonists, also known as H2 blockers. These medications also reduce the acid content in the stomach.

If they are not effective, antidepressants or prokinetic agents can be a further option. The latter are medications that promote gastrointestinal motility.

If none of the medications are effective, psychotherapy is another possibility.

Finally, dietary changes or avoiding certain foods may provide relief. Studies have shown that wheat, caffeine and fatty foods can trigger indigestion in some people.

Further information about how to alleviate indigestion can be found at gesundheitsinformation.de.

Some simple steps can be taken to help manage indigestion.

For example, self-monitoring and keeping a diary of symptoms can be used to determine if certain foods trigger symptoms.

Sometimes, avoiding foods or drinks that are not well tolerated can provide relief. It can also be helpful to:

• eat regularly.
• avoid large meals.
• chew properly.
• eat slowly.

In some cases, relaxation exercises can also help alleviate the symptoms.

It can also be reassuring to remember that indigestion does not cause complications.

Particularly if the symptoms are recurrent, it can help to accept the condition and learn to cope with the symptoms better. This is often achieved over time.