If the cause of indigestion can be identified, treatment of indigestion should be directed to correct the cause if possible. If the cause can not be identified, treatment has to be symptomatic and based on general principle of management.The common causes of indigestion are GERD (gastro-esophageal acid reflux disease) and functional dyspepsia (can not be treated satisfactorily unlike GERD).
Treatment of GERD:
Treatment of gastro-esophageal acid reflux disease should be started with PPI (proton pump inhibitor) drugs like omeprazole, pentoprazole, lansoprazole etc. PPIs are the first line and most effective drugs in treatment of GERD. Less potent but useful drugs are histamine H2 antagonists such as cimetidine, ranitidine, famotidine etc. and these drugs are generally used for treatment of mild to moderate GERD. If GERD is severe, proton pump inhibitors must be used and for very long duration. Patient can be put on histamine H2 antagonists such as cimetidine, ranitidine if treatment with PPI is giving good response. Combination therapy with a proton pump inhibitor and an H2 antagonist are not required but has been proposed for some refractory cases.
Eradication of H. pylori may also be required and helpful in many cases of indigestion as H. pylori is one of the causative factors of peptic ulcer and peptic ulcer is a common cause of indigestion. Many combination drugs are available for eradication of H. pylori. Most of the combinations include 10–14 days of a proton pump inhibitor with 2 antibiotics like metronidazole, clarithromycin and amoxicillin (any two of these three antibiotics). Eradication of H. pylori infection is associated with reduced prevalence of GERD, especially in the elderly patients.
Some general principles of treatment of indigestion should be followed. For example if the cause (e.g. GERD, lactase deficiency, biliary colic etc.) of indigestion can be identified, the therapy should be directed towards the cause of indigestion. If the cause can not be identified, than treatment should be directed towards symptomatic relief of the patient for improving patients’ health.
General principle of treatment of indigestion:
For mild indigestion, reassurance may be the only intervention needed, (especially mentioning the patient of indigestion that a careful evaluation revealed no serious organic disease). Medicines that can cause acid reflux or dyspepsia should be avoided and stopped (if already using) if possible. Patients with GERD (gastro-esophageal reflux disease) should limit alcohol, caffeine, chocolate, and tobacco use because of the effects of these substances on the LES (lower esophageal sphincter) is usually relaxing, which causes easy acid reflux to esophagus. Other measures like consumption of a low-fat diet, avoiding snacks before bedtime, and elevating the head of the bed should be taken as general measure.
Specific therapies for organic disease (if present) should be offered when possible and if the disease can be identified. Examples of specific therapies are surgery, which is appropriate in disorders like biliary colic, while diet changes are indicated for lactase deficiency or celiac disease. Some illnesses such as peptic ulcer disease may be cured by specific medical regimens. However, as most indigestion is caused by GERD or functional dyspepsia, medications that reduce gastric acid, stimulate motility, or blunt gastric sensitivity are indicated.