Indigestion (Dyspepsia, Upset Stomach)

  • Medical Author:
    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What are the symptoms of dyspepsia (indigestion)?

We usually think of symptoms of dyspepsia as originating from the upper gastrointestinal tract, primarily the stomach and first part of the small intestine. These symptoms include:

  • upper abdominal pain (above or around the navel),
  • belching,
  • nausea (with or without vomiting),
  • abdominal bloating (the sensation of abdominal fullness without objective distention),
  • early satiety (the sensation of fullness after a very small amount of food), and,
  • abdominal distention (swelling as opposed to bloating).

The symptoms most often are provoked by eating, which is a time when many different gastrointestinal functions are called upon to work in concert. This tendency to occur after meals is what gave rise to the notion that dyspepsia might be caused by an abnormality in the digestion of food.

It is appropriate to discuss belching in detail since it is a commonly misunderstood symptom associated with dyspepsia. The ability to belch is almost universal. Belching, also known as burping or eructating, is the act of expelling gas from the stomach out through the mouth. The usual cause of belching is a distended (inflated) stomach that is caused by swallowed air or gas. The distention of the stomach causes abdominal discomfort, and the belching expels the air and relieves the discomfort. The common reasons for swallowing large amounts of air (aerophagia) or gas are gulping food or drink too rapidly, anxiety, and carbonated beverages. People often are unaware that they are swallowing air. Moreover, if there is not excess air in the stomach, the act of belching actually may cause more air to be swallowed. "Burping" infants during bottle or breastfeeding is important in order to expel air in the stomach that has been swallowed with the formula or milk.

Excessive air in the stomach is not the only cause of belching. For some people, belching becomes a habit and does not reflect the amount of air in their stomachs. For others, belching is a response to any type of abdominal discomfort and not just to discomfort due to increased gas. Everyone knows that when they have mild abdominal discomfort, belching often relieves the problem. This is because excessive air in the stomach often is the cause of mild abdominal discomfort; as a result, people belch whenever mild abdominal discomfort is felt, whatever the cause.

If the problem causing the discomfort is not excessive air in the stomach, then belching does not provide relief. As mentioned previously, it even may make the situation worse by increasing air in the stomach. When belching does not ease the discomfort, the belching should be taken as a sign that something may be wrong within the abdomen and that the cause of the discomfort should be sought. Belching by itself, however, does not help the physician determine what may be wrong because belching can occur in virtually any abdominal disease or condition that causes discomfort.

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