Dr. Emre Gecer
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abdominal_distension

Indigestion (Dyspepsia): Causes and Effective Treatments

Indigestion (dyspepsia) is a common gastroenterological complaint that presents with upper abdominal pain, burning, bloating, and early satiety, and affects 20–30% of the population. This guide covers the distinction between functional and organic dyspepsia, diagnostic approaches, and evidence-based treatment options.

March 26, 2026
Dr. Emre Gecer
1 min read

  • Epigastric pain: pain or burning in the central upper abdomen
  • Epigastric burning: burning sensation in the stomach region
  • Postprandial fullness: uncomfortably full feeling after meals
  • Early satiety: feeling full before finishing a normal-sized portion

  • Postprandial distress syndrome (PDS): post-meal fullness and early satiety predominate
  • Epigastric pain syndrome (EPS): epigastric pain and burning predominate

  • Peptic ulcer disease: gastric or duodenal ulcer (the most common cause)
  • Gastroesophageal reflux disease (GERD): dyspepsia and GERD frequently overlap
  • Gastritis: inflammation of the stomach mucosa (particularly H. pylori–related)
  • Gastric cancer: rare but serious — should be considered especially in patients over 55 with alarm symptoms
  • Gallbladder disease: gallstones, cholecystitis
  • Medications: NSAIDs (ibuprofen, aspirin), antibiotics, iron preparations
  • Pancreatitis: acute or chronic pancreatic inflammation
  • Celiac disease: should be investigated particularly in refractory dyspepsia

  • Urea breath test: non-invasive, high sensitivity and specificity (>95%)
  • Stool antigen test: non-invasive, practical
  • Endoscopic biopsy: rapid urease test, histology, culture
  • Serology: indicates past infection; not suitable for evaluating treatment response

  • Unintended weight loss (more than 5%)
  • Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
  • Recurrent vomiting
  • Signs of gastrointestinal bleeding (melena, hematemesis, iron deficiency anemia)
  • Epigastric mass
  • Family history of gastric cancer

  • Test for H. pylori (urea breath test or stool antigen test)
  • If positive, give eradication therapy
  • If negative, or if symptoms persist after eradication, start empirical PPI therapy
  • If there is no response to 8 weeks of PPI therapy, plan endoscopy

  • Clarithromycin-based triple therapy: PPI + clarithromycin + amoxicillin (14 days)
  • Bismuth-based quadruple therapy: PPI + bismuth subsalicylate + metronidazole + tetracycline (14 days)
  • Concomitant therapy: PPI + amoxicillin + clarithromycin + metronidazole (14 days)

  • Use: standard dose, once daily, in the morning on an empty stomach, 30 minutes before food
  • Treatment duration: 4–8 weeks
  • Assessment of response: if symptoms have not improved at 4 weeks, the dose can be increased or endoscopy planned

  • Metoclopramide: dopamine antagonist; effective in nausea and gastroparesis, but carries the risk of extrapyramidal side effects with long-term use
  • Domperidone: crosses the blood–brain barrier less so neurological side effects are fewer; however, must be used cautiously because of QT prolongation risk
  • Itopride: used in some countries for functional dyspepsia

  • Eat small and frequent meals: prefer 5–6 small meals per day; large portions cause gastric distension and worsen symptoms
  • Eat slowly: chew each bite well; fast eating leads to swallowing air and early satiety
  • Avoid trigger foods: fatty foods, spicy dishes, onions, garlic, tomato sauce, citrus fruits, chocolate, mint, carbonated drinks
  • Limit alcohol and caffeine: both increase gastric acid secretion and irritate the gastric mucosa
  • Don't lie down right after eating: there should be at least 3 hours between the last meal and going to bed

  • Quit smoking: smoking weakens the protective mechanisms of the gastric mucosa and increases ulcer risk
  • Stress management: chronic stress increases gastric acid secretion and visceral sensitivity. Regular exercise, meditation, and deep-breathing techniques are helpful.
  • Weight control: obesity contributes to dyspepsia and reflux by raising intra-abdominal pressure
  • Medication review: drugs that can cause dyspepsia — NSAIDs, aspirin, iron, calcium, bisphosphonates — should be stopped if not necessary, or replaced with alternatives

  • Presence of any alarm symptom (weight loss, dysphagia, bleeding, vomiting)
  • New-onset dyspepsia in patients over 55
  • Persistent symptoms despite 4–8 weeks of treatment
  • Frequently recurring complaints
  • Family history of gastric cancer
  • Persistent complaints that significantly affect quality of life

  • Harrison's Principles of Internal Medicine, 22nd Edition — Chapter: Dyspepsia
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th Edition
  • Stanghellini V, et al. Rome IV — Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380–1392
  • Moayyedi PM, et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017
Dr. Emre Gecer

Dr. Emre Gecer

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İlgilendiğim bazı şeyler var. Sinema kuramı, senaryo mekaniği, sanat akımları, jazz müzik, finans teorisi, python, yapay zeka, makine öğrenmesi ve tıpın ilgimi çeken konuları gibi. Bunlar hakkında not düşebileceğim, düşüncelerimi paylaşabileceğim bir alan yaratmak istedim. Birazda hayatın içinden anlar, hikayeler eklerim diye düşünüyorum. Buranın zamanla gelişeceğine inanıyorum, belki de uzun vadede bambaşka bir şeye dönüşür. Neden olmasın?

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