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.

What natural or home remedies are used to treat dyspepsia (indigestion)?

Studies of natural and home remedies for indigestion are few. Most recommendations for natural and home remedies have little evidence to support their use. Several potential remedies, however, deserve mention including:

  • Acid-suppressing remedies: The most common cause of dyspepsia is probably gastrointestinal reflux disease (acid reflux or GERD). That may be why remedies such as baking soda, which neutralizes stomach acid, have been recommended. Even if baking soda works, it is more effective (and probably safer) to use antacids in liquid or pill form for this purpose.
  • Ginger: Ginger has been demonstrated to relieve nausea. One small study showed it to be ineffective in relieving dyspepsia, but ginger is harmless and worth a try if nausea is a component of the dyspepsia.
  • Peppermint: Peppermint has been demonstrated to have effects on the function of the gastrointestinal tract; it is among the most potent inhibitors of intestinal muscles. It is effective in another functional disease, irritable bowel syndrome, but there is minimal evidence that it is effective in dyspepsia. Nevertheless, like ginger, it is harmless and worth a try.
  • Meals: Eating smaller, more frequent meals.
  • Lifestyle changes: Stay away from specific foods and drinks, smoking, and alcohol if they provoke symptoms.

What treatments relieve and cure indigestion (dyspepsia)?

The treatment of indigestion is a difficult and unsatisfying topic because so few drugs have been studied and have been shown to be effective. Moreover, the drugs that have been shown to be effective have not been shown to be very effective. This difficult situation exists for many reasons including:

  • Life-threatening illnesses (for example, cancer, heart disease, and high blood pressure) are the illnesses that capture the public's interest and, more importantly, research funding. Indigestion is not a life-threatening illness and has received little research funding. Because of the lack of research, an understanding of the physiologic processes (mechanisms) that are responsible for indigestion has been slow to develop. Effective drugs cannot be developed until there is an understanding of these mechanisms.
  • Research in indigestion is difficult. Indigestion is defined by subjective symptoms (such as pain) rather than objective signs (for example, the presence of an ulcer). Subjective symptoms are more unreliable than objective signs in identifying homogenous groups of patients. As a result, groups of patients with indigestion who are undergoing treatment are likely to contain some patients who do not have indigestion, which may dilute (negatively affect) the results of the treatment. Moreover, the results of treatment must be evaluated on the basis of subjective responses (such as improvement of pain). In addition to being more unreliable, subjective responses are more difficult to measure than objective responses (for example, healing of an ulcer).
  • Different subtypes of indigestion (for example, abdominal pain and abdominal bloating) are likely to be caused by different physiologic processes (mechanisms). It also is possible, however, that the same subtype of indigestion may be caused by different mechanisms in different people. What's more, any drug is likely to affect only one mechanism. Therefore, it is unlikely that any one medication can be effective in all-even most-patients with indigestion, even patients with similar symptoms. This inconsistent effectiveness makes the testing of drugs particularly difficult. Indeed, it can easily result in drug trials that demonstrate no efficacy (usefulness) when, in fact, the drug is helping a subgroup of patients.
  • Subjective symptoms are particularly prone to responding to placebos (inactive drugs). In fact, in most studies, 20% to 40% of patients with indigestion will improve if they receive placebo drugs. Now, all clinical trials of drugs for indigestion require a placebo-treated group for comparison with the drug-treated group. The large placebo response means that these clinical trials must utilize large numbers of patients to detect meaningful (significant) differences in improvement between the placebo and drug groups. Therefore, these trials are expensive to conduct.

The lack of understanding of the physiologic processes (mechanisms) that cause indigestion has meant that treatment usually cannot be directed at the mechanisms. Instead, treatment usually is directed at the symptoms. For example, nausea is treated with medications that suppress nausea but do not affect the cause of the nausea. On the other hand, the psychotropic drugs (antidepressants) and psychological treatments (such as cognitive behavioral therapy) treat hypothetical causes of indigestion (for example, abnormal function of sensory nerves and the psyche) rather than causes or even the symptoms. Treatment for indigestion often is similar to that for irritable bowel syndrome (IBS) even though the causes of IBS and indigestion are likely to be different.

Education

It is important to educate patients with indigestion about their illness, particularly by reassuring them that the illness is not a serious threat to their physical health (though it may be to their emotional health). Patients need to understand the potential causes for the symptoms. Most importantly, they need to understand the medical approach to the problem and the reasons for each test or treatment. Education prepares patients for a potentially prolonged course of diagnosis and trials of treatment. Education also may prevent patients from falling prey to the charlatans who offer unproven and possibly dangerous treatments for indigestion. Many symptoms are tolerable if patients' anxieties about the seriousness of their symptoms can be relieved. It also helps patients deal with symptoms when they feel that everything that should be done to diagnose and treat, in fact, is being done. The truth is that psychologically healthy people can tolerate a good deal of discomfort and continue to lead happy and productive lives.

Medically Reviewed by a Doctor on 10/28/2016
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