Symptoms of dyspepsia usually occur in bouts, often after eating. They include the following:
1. Drug treatment
Antacids - These drugs primarily work by neutralising stomach acid, thereby reducing the acidity in the stomach and minimising reflux of stomach acid onto the oesophagus. They are usually taken after meals and at bedtime when required. Liquid antacids usually work faster than tablets or capsules. Magnesium-based antacids can cause diarrhoea whilst aluminium-based antacids can be constipating. Since antacids reduce the acidity of the stomach contents, absorption of acidic drugs (e.g. digoxin) can be impaired. Conversely, some drugs may be absorbed more quickly (eg. pseudoephedrine). Additionally, magnesium trisillicate and magnesium hydroxide can bind to some drugs, thereby decreasing their efficacy.
Anti-secretory meds - These include the H2-receptor antagonists and proton pump inhibitors (PPI). Both classes of medicines reduce the secretion of acid from gastric parietal cells. H2-receptor antagonists competitively inhibit histamine from binding to H2 receptors on parietal cells whereas proton pump inhibitors work by inhibiting the hydrogen-potassium adenosine triphosphate enzyme system in parietal cells that is involved in the production of stomach acid. Proton pump inhibitors have a delayed onset of action compared to H2-receptor antagonists but are associated with greater symptomatic relief and have a longer duration of action
2. H. Pylori test
Helicobacter pylori is a bacterium that affects approximately two-thirds of people in the world. It can survive the harsh acidic environment of the stomach by penetrating into the stomach lining where it is protected by a mucous layer that prevents the immune cells from reaching the bacterium. People with H. pylori infection usually remain asymptomatic but in some cases infection can cause complications such as development of gastric or duodenal ulcers, cancer, duodenitis and gastritis. Testing for H. pylori infection can be done using 13C-urea breath tests. These tests should not be completed within 4 weeks of treatment with an antibacterial or within two weeks of treatment with an antisecretory drug. If the test is positive a one-week triple-therapy regimen is recommended which includes a PPI, clarithromycin and either amoxicillin or metronidzole. If a macrolide has been used for other infections, the regimen should include a PPI, amoxicillin and metronidazole.
3. Lifestyle changes to minimise dyspepsia