American Medical Association Family Medical Guide - American Medical Association [485]
Treatment
The treatment of indigestion depends on the cause. If a doctor has ruled out other disorders, he or she will recommend the measures in the box below. The doctor may also recommend an over-the-counter antacid. If preventive measures or over-the-counter antacids do not relieve your symptoms, your doctor may prescribe a medication to help stop or prevent symptoms.
Relieving and Preventing Indigestion
Take the following steps to prevent indigestion or to help relieve it when it occurs:
• Keep a food diary. Avoid the foods or drinks that seem to cause your indigestion. Different foods affect people differently.
• Relax during a meal and for at least half an hour afterward. Stress can cause indigestion.
• When you eat, breathe through your nose, chew with your mouth closed, and eat slowly to avoid swallowing air along with your food, which can cause bloating and contribute to your discomfort.
• Take small bites and chew your food thoroughly. Good digestion begins in the mouth.
• Stay upright for at least 60 minutes after eating. Avoid late-night eating.
• Don’t use aspirin or other over-the-counter pain relievers or caffeine. They can irritate the stomach lining.
• Sleep with your head and shoulders propped up at a 30° angle. Acid production is greatest at night, and gravity helps prevent acid from flowing into the esophagus from the stomach.
• Don’t smoke. Smoking encourages the production of stomach acid.
Gastroesophageal Reflux Disease
The muscles at the entrance to the stomach normally prevent the contents of the stomach from moving back up into the esophagus. In gastroesophageal reflux disease (GERD), these muscles relax at inappropriate times, allowing stomach acid and digestive enzymes to enter the esophagus (called acid reflux). Stomach acid can cause inflammation in the esophagus.
The opening to the stomach is controlled by the diaphragm, the dome-shaped muscle that separates the chest from the abdomen. In a condition called hiatal hernia, a weakness in the diaphragm allows part of the upper part of the stomach to protrude into the chest, which can sometimes contribute to the symptoms of GERD. However, a person can have a hiatal hernia and not have any symptoms of GERD (and someone can have severe symptoms of GERD but not have a hiatal hernia).
The chronic inflammation of GERD can lead to ulcers in the esophagus. The chronic inflammation can also cause scarring and narrowing of the esophagus (see page 752). GERD is a common condition, especially in older people, people who are overweight or who smoke, and pregnant women. The chronic inflammation can eventually lead to esophageal cancer (see page 754).
Symptoms
The main symptoms of GERD are increasing pain in the lower part of the breastbone and a burning sensation in the upper abdomen that can extend into the mouth (indigestion; see previous page). The discomfort occurs regularly when your stomach is full or when you change position (such as when you bend over or lie flat). Other symptoms of GERD include belching and an acidic taste in your mouth. Some people may have difficulty swallowing.
Diagnosis
To diagnose GERD, your doctor will probably perform a procedure called endoscopy (see page 766) to examine your esophagus. He or she may also recommend manometry (see next page) to measure changes in pressure in the esophagus that occur during swallowing, and tests to measure the amount of acid in the stomach over 24 hours.
Hiatal hernia
Normally the stomach lies below the diaphragm, the sheet of muscle that separates the chest from the abdomen (right). A hiatal hernia (far right) occurs when part of the stomach protrudes up into