Good news about bad digestion
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: I've been feeling bloated and nauseated off and on for months, usually after I eat. I don't think I have heartburn or an ulcer because I don't have any burning or pain. What else could be wrong?

A: Your symptoms sound like dyspepsia, which translates literally to "bad digestion." This common problem affects about a quarter of the population and hits men and women equally. Doctors call it functional dyspepsia when there is no structural problem to explain the symptoms. The classic symptoms are discomfort in the upper abdomen that often occurs during or shortly after eating and a bloated, full feeling that comes and goes over days or months.

Unfortunately, no one knows what causes functional dyspepsia. Some doctors believe that people with the problem may simply be more sensitive to normal sensations in the gastrointestinal tract or have a lower pain threshold than most people. Or they may have slowerthan normal digestion or stiff stomach walls.

Most of the time, dyspepsia isn't serious and often improves with lifestyle changes. For example, avoiding fatty foods, coffee and alcohol may help, since these substances may make symptoms worse. Certain medications, including painkillers in the nonsteroidal anti-inflammatory drug (NSAID) and opiate families, iron preparations, and the old standby heart medication digitalis, may also cause dyspepsia.

People often worry that their dyspepsia symptoms may signal something more serious. One possibility is a peptic ulcer, which causes a raw, crater-like break in the lining of the stomach. But a dull, gnawing ache is the most common symptom of a peptic ulcer. Gallstones, which can block the neck of the gallbladder causing pain, may also cause symptoms of dyspepsia. Another possibility is inflammation of the lining of the first part of the small intestine. However, less than 20 percent of people with functional dyspepsia have this condition, known as duodenitis.

Cancer of the lining of the stomach is another but extremely rare possibility. But people who are older than 45 and have a family history of gastrointestinal cancer should see a doctor right away if they develop new dyspepsia symptoms. The same goes for people who have other worrisome symptoms, such as weight loss, bleeding or difficulty swallowing.

If you have warning symptoms or if your dyspepsia is severe, persistent or atypical, your doctor may look inside your stomach with an endoscope (see illustration) to check for serious problems. If this and other tests don't turn up a cause for your symptoms, the condition is considered to be functional dyspepsia.

For most people with dyspepsia, doctors often start by recommending a drug that cuts down the amount of acid made by the stomach, such as famotidine (Pepcid) or omeprazole (Prilosec). He or she may also test your breath, blood or stool for H. pylori, a bacterial infection that is a common cause of ulcers. If you have an ulcer or gastric inflammation and the test is positive, your doctor will prescribe antibiotics to get rid of the bacteria. But most experts don't believe that antibiotics will help for simple dyspepsia.

Studies have found that placebos (sugar pills) may work as well as active medications for treating dyspepsia. Because 25 percent to 60 percent of people respond to simple medications, doctors often recommend them. Over-thecounter drugs used to treat heartburn, such as the antacids Tums and Rolaids, are safe and inexpensive. Other possible treatments include simethicone (Mylanta and Gas-X), which rids the gut of gas bubbles.

In addition to avoiding foods and medications that may aggravate dyspepsia, your may also find that eating smaller, more frequent meals may help control your symptoms. It's also a good idea to chew your food slowly and completely to avoid swallowing excess air. Adopt a healthy diet, and don't lie down within two hours of finishing a meal. Reducing stress may also help. Make an effort to get plenty of sleep (at least seven hours a night) and exercise regularly -- but don't work out right after you eat. You might also try relaxation therapies such as deepbreathing exercises or meditation.

In our fast paced, fastfood world, dyspepsia is a common complaint. Fortunately, simple measures will help most people feel better.

Copyright 2007 the President and Fellows of Harvard Co l l e g e . Developed by Harvard Health Publications (www.health.harvard.edu) . Distributed by UFS. Submit questions to harvard_ adviser@hms.harvar d.edu.