How is indigestion treated?
Mild indigestion may be relieved by the reassurance that clinical evaluation revealed no abnormalities. Drugs that cause acid reflux or dyspepsia are stopped. Patients with GERD are advised to reduce the use of ethanol (alcohol), coffee, chocolate and tobacco. Lifestyle modifications like a low fat diet, avoiding snacks before bedtime and keeping the head end of the bed elevated may bring relief. Stay relaxed, try meditation.
Specific therapies include drugs that reduce gastric acid, stimulate motility, or decrease gastric sensitivity.
Commonly used drugs belong to the following classes:
1) Acid-Suppressing or Neutralizing Medications
These are of great utility in GERD.
- Histamine H2 antagonists: Cimetidine, ranitidine, famotidine, and nizatidine
- Proton pump inhibitors (PPIs): Omeprazole, lansoprazole, rabeprazole, pantoprazole, or esomeprazole. These are more potent than H2 antagonists.
- Liquid antacids with or without alginic acid
- Sucralfate.
Many of these medications are available over the counter without prescriptions. Proton pump inhibitors (PPi) are more potent than H2 antagonists. Most times, treatment is initiated with PPIs and then stepped down. Combination of the two classes is also employed. PPIs are however ruthlessly ‘over prescribed’ in most cases. It is to be noted that overuse is not devoid of complications though they are relatively safe drugs.
2) Helicobacter pylori Eradication
Helicobacter pylori associated with peptic ulcer and conditions like gastric lymphoma. A number of different drug regimens are available for its eradication. Most include a PPi and two antibiotics. The duration of the treatment is 10-14 days.
3) Gastrointestinal Motor Stimulants (Prokinetics)
Utility of Gastrointestinal Motor Stimulants (Prokinetics) like metoclopramide, erythromycin, domperidone, and tegaserod in GERD is limited. Convincing evidences of their efficacy to cure functional dyspepsia are not yet available.
In addition to these, Antinausea Drugs may be ordered depending upon the complaints.
Aerophagia (Excessive unconscious swallowing of air) is difficult to manage. Stress reduction, dietary modifications and behavioral therapy may help.
