The word dyspepsia comes from Greek and means “improper digestion.” It refers to upper abdominal discomfort usually linked to food, alcohol or certain medicines. Common offenders include antibiotics, NSAIDs, digoxin, bisphosphonates and theophylline. Lifestyle factors such as smoking and stress also contribute.
Chronic dyspepsia is when symptoms repeatedly occur over time. Typical symptoms include epigastric pain, bloating, belching, nausea, vomiting and feeling full very quickly after starting a meal.
The four major causes include:
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Malignancy (rare but important)
- Functional dyspepsia – abnormal stomach function without detectable damage
Pathophysiology
Several mechanisms explain why dyspepsia occurs. In functional dyspepsia (the most common form), the stomach and duodenum behave abnormally.
Key mechanisms include:
- Visceral hypersensitivity – nerves in the stomach and duodenum become very sensitive.
- Impaired gastric accommodation – stomach cannot relax well after eating.
- Delayed gastric emptying – food stays longer in the stomach.
- Antral distention – lower stomach becomes overstretched.
- Abnormal duodenojejunal motility – uncoordinated intestinal movements.
Acute dyspepsia is often linked to poor eating habits, alcohol, smoking and stress. Chronic dyspepsia is commonly associated with peptic ulcers, GERD, H. pylori infection and sometimes malignancy.
Clinical Features
Acute dyspepsia is usually short-lasting and self-limiting. No diagnostic tests are needed unless severe symptoms appear.
Warning signs that require medical referral:
- Unexplained weight loss
- Persistent vomiting
- Severe continuous abdominal pain
- Dysphagia (difficulty in swallowing)
- Vomiting blood (hematemesis)
- Black stools (melena)
Patients with functional dyspepsia often complain of many abdominal and even psychological symptoms such as anxiety and depression.
Other Red-Flag Indicators
- Early satiety
- Loss of appetite
- Age > 55 years with new-onset dyspepsia
- Anemia
- Jaundice
- History of peptic ulcer disease
Patients who are younger than 55 years and do not have alarming symptoms can be tested for H. pylori as part of routine evaluation. Those above 55 years or showing red flags should undergo upper GI endoscopy.
Management of Dyspepsia
Non-Pharmacological Therapy
Lifestyle changes play a major role in controlling dyspepsia symptoms. Recommended measures include:
- Eat a bland, non-spicy diet
- Stop smoking
- Reduce or avoid alcohol
- Avoid coffee and excess caffeine
- Perform regular exercise for weight reduction
- Eat smaller meals more frequently
- Avoid lying down immediately after eating
Many patients experience significant improvement with lifestyle correction alone.
Pharmacological Therapy
1. Antacids
Combination antacids containing aluminum and magnesium salts provide quick relief by neutralizing stomach acid and coating irritated tissues.
- Suspensions work faster than tablets.
- Usual dose: 15 ml three times daily.
2. H2 Receptor Antagonists
These medicines block the action of histamine on stomach parietal cells, reducing acid secretion.
- Ranitidine: 150 mg twice daily / 300 mg once daily
- Famotidine: 20 mg twice daily / 40 mg once daily
3. Proton Pump Inhibitors (PPIs)
PPIs irreversibly bind to gastric proton pumps and suppress both basal and stimulated acid secretion. They are more effective than H2 blockers and should be taken 30–60 minutes before breakfast.
- Omeprazole: 20 mg once daily
- Pantoprazole: 40 mg once daily
- Rabeprazole: 20 mg once daily
- Lansoprazole: 30 mg once daily
4. Sucralfate
Acts as a protective barrier by binding to ulcerated mucosa at acidic pH (2–2.5). Useful for symptom reduction and mucosal healing.
- 1 g four times daily OR 2 g twice daily
5. Prokinetic Agents
These improve stomach motility and emptying. Metoclopramide (5–10 mg three times daily) is commonly used but should only be taken under medical supervision because of possible neurological side effects.
Metoclopramide works by:
- Blocking D2 receptors
- Enhancing acetylcholine release in the stomach
- Inhibiting acetylcholinesterase
If H. pylori infection is confirmed, appropriate eradication therapy offers long-term improvement.
Alternative Therapies
- Peppermint oil
- Caraway preparations
These may help relieve bloating and discomfort in some patients.
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