Dyspepsia (Indigestion): What It Is, What Causes It, and What to Do
Indigestion is one of those everyday problems that can feel minor… until it keeps coming back. The medical term for indigestion is dyspepsia, which simply means a collection of uncomfortable symptoms in the upper stomach area.
In this guide, we’ll explain dyspepsia in plain language, what to watch out for, and what typically helps
What does dyspepsia feel like?
Dyspepsia often includes one or more of the following symptoms:
- Upper stomach pain or discomfort
- Bloating or feeling uncomfortably full after eating
- Feeling full quickly (even after small meals)
- Belching, regurgitation, or a “sour water” feeling in the mouth
- Heartburn or burning behind the breastbone
- Nausea or vomiting
- Retrosternal (chest-area) burning
A quick note: “organic” vs “functional” dyspepsia
Doctors usually group dyspepsia into two broad types:
Organic dyspepsia means there’s a clear cause, such as:
- Peptic ulcers
- Acid reflux (GERD)
- Less commonly, upper GI cancers
Functional dyspepsia means symptoms are real, but tests don’t show a clear structural problem. It may be linked to diet, stress, and lifestyle.
Dyspepsia is common—but persistent symptoms should be assessed properly so serious causes aren’t missed
Red flags: when indigestion needs urgent medical attention
Some symptoms increase the chance of a serious underlying problem. If you have any of the below, don’t self-treat—see a doctor promptly.
Alarm features include:
- Age 50 or older (especially if symptoms are new)
- Difficulty or pain when swallowing
- Vomiting blood, passing black stools, or any GI bleeding
- Unexplained weight loss
- Iron deficiency (with or without anaemia)
- A palpable abdominal mass
- Severe or persistent abdominal pain
- Regular use of ulcer-causing meds like NSAIDs (e.g., ibuprofen, diclofenac)
- Strong family history of upper GI cancer or relevant genetic syndromes
If you’re under 50 with no red flags: the usual starting approach
When someone is under 50, has no alarm features, and no concerning medical history, management often starts with a “low-risk” pathway.
1) Test for H. pylori
Helicobacter pylori is a common stomach infection that can cause inflammation and ulcers. Recommended non-invasive tests include:
- Urea breath test, or
- Stool antigen test
Important: In high-prevalence settings like South Africa, blood (serology) tests are not recommended because they may not reliably show active infection.
2) Try acid-reducing treatment (PPI trial)
A proton pump inhibitor (PPI) reduces stomach acid and can help symptoms settle. A typical trial is 6–8 weeks.
3) If H. pylori is positive, treat it
If the test is positive, eradication therapy is recommended.
4) Reassess
If symptoms persist or return after initial treatment, the guidance recommends upper endoscopy (a camera test of the oesophagus and stomach).
When is an endoscopy recommended upfront?
If you are 50+, have alarm features, or have persistent symptoms, an upper endoscopy is recommended to look for ulcers, erosions, growths, or other causes.
Practical lifestyle tips that often help (for everyone)
These everyday changes are recommended in all cases of dyspepsia:
- Avoid common trigger foods (often citrus, tomatoes, chocolate, spicy, fatty/fried foods)
- Eat smaller meals more often
- Choose lower-acid foods where possible
- Stay hydrated
- Maintain a healthy weight
- Avoid tight clothing around the stomach
- Elevate the head of the bed if night symptoms are a problem
- Don’t lie down for 2–3 hours after eating (avoid late-night meals)
- Manage stress (breathing exercises, meditation, relaxation)
- Avoid smoking
- Limit caffeine and alcohol
- Avoid fizzy drinks if they worsen bloating
Over-the-counter and prescription options (simple explanation)
Antacids (fast, short-term relief)
Antacids neutralise stomach acid and can help heartburn, indigestion, and bloating. Common ingredients include calcium carbonate, magnesium hydroxide, or aluminium hydroxide.
They can have side effects (like diarrhoea or constipation) and may interact with other medicines—so if you’re using them often, get checked.
Acid suppression (stronger symptom control)
Acid-suppressing medicines reduce acid production and can be very effective.
- PPIs are often first-line for dyspepsia (examples include esomeprazole, lansoprazole, pantoprazole, rabeprazole).
Long-term PPI use should be reviewed with a clinician due to potential risks.- H2 blockers can help mild-to-moderate symptoms (e.g., famotidine, cimetidine, nizatidine). Ranitidine has been withdrawn for safety reasons.
H. pylori treatment and follow-up (the important bits)
Treatment uses combinations of acid suppression + antibiotics (and sometimes bismuth), and the exact regimen depends on local resistance patterns and prior treatment.
Confirming eradication matters: a urea breath test or stool antigen test is used at least 4 weeks after treatment ends to confirm the infection is cleared.
Frequently asked questions (FAQ)
“Is indigestion always caused by acid?”
Not always. Dyspepsia can be linked to reflux/acid, ulcers, H. pylori, certain medications, diet, and stress.
“If a PPI helps, do I still need tests?”
If you have red flags or are 50+, an endoscopy is recommended to rule out more serious issues.
“When should I stop self-treating?”
If symptoms are persistent, worsening, or you’re relying on antacids/acid reducers frequently—or you have any alarm features—get assessed.
Key takeaways
- Dyspepsia is common and often treatable.
- Red flags (especially age ≥ 50, bleeding, weight loss, swallowing problems, anaemia/iron deficiency) should be checked urgently.
- Low-risk patients typically start with H. pylori testing and/or a PPI trial, plus lifestyle changes.
Source Credit: SAJGH_SAGES_dyspepsia_guidance