September 4, 2015
Many people suffer from episodes or long-lasting upper abdominal indigestion (discomfort, pain, nausea, bloating, gas pain, heartburn), which we call non-ulcer dyspepsia (or NUD). This is when indigestion occurs and there is no evidence of damage to the esophagus, stomach, duodenum or other organs and yet the symptoms occur. At any given time as much as 20% of the population may have some degree of dyspepsia, most of which they treat themselves.
Those with non-ulcer dyspepsia have no internal damage or injury, but we know that different things cause malfunctioning. Digestion occurs by a careful coordination of contractions (peristalsis), churning, mixing and pumping actions in the GI tract. Nerves, hormones and delicate systems in each area control this. Upsets or irritants to these control mechanisms seem to be the cause of NUD. Many times, the stomach doesn’t relax properly to hold the normal amounts of food, fluids or air it can usually handle. Other times, the nerves in the lining of the stomach seems unusually sensitive to the mild chemicals in normal food (acidity, amount of fat, amount of sugars etc.) and sends signals to the brain that give you feelings of queasiness, heaviness, burning or pain. Abnormal peristalsis can occur if a person eats too fast, too often or too seldom, or is stressed. It is possible that NUD is an after-effect of a bacterial or severe viral gastroenteritis (“stomach flu” or “food poisoning”) incident, which may have occurred years before and is long forgotten. When we look at outbreaks of infections and see what happens a year or two later, it seems like 5-10% of people who didn’t used to get indigestion still has some sensitive stomach symptoms which qualify as NUD. Sometimes this goes away, sometimes never does.
Most people have NUD at one point of their lives. A tendency to non-ulcer dyspepsia often seems inherited from a parent or to run in families. Stress, anxiety or aggravation brings on or worsens the risk of acquiring non-ulcer dyspepsia.
Signs & Symptoms
Symptoms vary, and very often the same person has different symptoms at different times. Very common patterns include:
- Queasiness in the morning
- Frequent Belching
- Fullness or bloating in the stomach area after meals
- Poor tolerance to greasy, oily or spicy foods
- Poor tolerance to “acidic” foods (citrus, pineapple or tomato juice, vinegar)
- Poor tolerance to coffee, alcohol, even to soft drinks
- Pain like an ulcer
Screenings & Diagnostic Tests
Your physician can help decide what seems to be wrong by analyzing the symptoms, past tests you’ve had, medicines and other things you take (or tried but which didn’t work), your diet and habits, and knowing about what stress issues may be going on. A limited physical checkup, and sometimes-simple lab tests often allow a very accurate diagnosis. Sometimes we will test for, and treat if positive, a bacterial form of gastritis called H pylori. However, lots of healthy people can have H pylori, which is not causing their indigestion, so treatment of H pylori often does not solve the problem. Sometimes--especially if treatment doesn’t seem to work well or the problem gets much worse or changes--arrangements for special tests are needed. This may include an ultrasound scan if gallbladder disease is suspected, or an endoscope exam to look inside the stomach and duodenum for ulcers or severe inflammation. The Upper GI endoscopy is a test we commonly do for unexplained indigestion or where we suspect a serious cause. After a dose of strong intravenous sedation gets you deeply relaxed or in twilight sleep, we pass a small flexible scope tube by mouth into the stomach to look directly at all the upper GI organs. Pictures, tissue samples and other analysis can be done, such as for the bacteria H pylori.
When indigestion is actually GERD (acid reflux), or is a form of gastritis due to H pylori bacteria or ulcers, treatment is reliably effective, and for most H pylori and ulcers can give permanent cure. However, the much more common NUD condition can be very uncomfortable sometimes but is not dangerous to have, even when it lasts for long periods or keeps coming back periodically. The goals are to get relief, stay comfortable, function as normally as possibly, and to prevent future symptoms. AND to not worry about the condition, once it has been diagnosed. Just like people who get migraines, the seriousness of it isn’t the medical danger, or a cancer risk, or risk of any complications…it is just the symptoms themselves and how they affect your life. Treatment depends on what is causing the problem. If no specific cause is found, treatment focuses on relieving symptoms, often with the least “medicine” necessary. This means: focus on the factors that seem responsible, like diet, lifestyle/stress, and using common OTC remedies, prescription meds if helpful, or alternative therapies.
Lifestyle and Home Remedies
You can make changes to your lifestyle to help relieve your symptoms of dyspepsia. Below are some tips on how to relieve NUD:
Use medications exactly as directed
Medication may not work OR may cause you other problems if not taken properly.
For this condition, medicines are not usually needed longterm, just for flareups.
Change your eating habits.
It's best to eat several small meals instead of two or three large meals.After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
Do not smoke or chew tobacco or vape. If you use marijuana at all, be sure to discuss with your clinician.
Rest or relax more. Stress management is a key for MOST people with NUD.
Think about and start doing things that help you manage stress better. But when you lie down, keep your head higher than your feet, or use a recliner chair if available, in case you do have some reflux (GERD) tendency.
Do not wear tight clothing around your middle area.
Losing just 5 to 10 pounds can help relieve symptoms.