Indigestion

[4] 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.

[8] Functional indigestion is estimated to affect about 15% of the general population in western countries and accounts for a majority of dyspepsia cases.

[1] In patients younger than 60 years of age, testing for the bacteria H. pylori and if positive, treatment of the infection is recommended.

[1] Patients experiencing indigestion likely report one, a combination of, or all of the following symptoms:[6][10] There may be abdominal tenderness, but this finding is nonspecific and is not required to make a diagnosis.

Tenderness to palpation over the right upper quadrant, or Murphy's sign, may suggest cholecystitis or gallbladder inflammation.

Alarm features are thought to be associated with serious gastroenterologic disease and include:[12] Indigestion is a diagnosis related to a combination of symptoms that can be attributed to "organic" or "functional" causes.

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.

[6] 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.

[6] 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.

[13] Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying (gastroparesis) or impaired accommodation to food.

[21] Defined by post-prandial fullness or early satiation that interferes with daily life, without any evidence of organic disease.

[22] 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.

Traditional therapies used for this diagnosis include lifestyle modification (e.g., diet), antacids, proton-pump inhibitors (PPIs), H2-receptor antagonists (H2-RAs), prokinetic agents, and antiflatulents.

[30] 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.

[35] Prokinetics (medications focused on increasing gut motility), such as metoclopramide or erythromycin, has a history of use as a secondary treatment for dyspepsia.

[36] 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.

[37] Indigestion is a common problem and frequent reason for primary care physicians to refer patients to GI specialists.