Indigestion - Diagnosis and treatment - Mayo Clinic

Diagnosis

To diagnose indigestion, your healthcare professional asks you about your symptoms, recent meals, eating habits, medical history, life stresses, exposure to anyone who's ill and other questions. Your answers help your health professional understand the possible factors linked to your symptoms.

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You also have a thorough medical exam. This includes tapping or pressing on your abdomen and listening to your abdomen with a stethoscope.

Your healthcare professional may be able to diagnose functional indigestion based on your symptoms, medical history and exam.

H. pylori test

Your healthcare professional may order a test for H. pylori bacteria. This may be done with a tissue sample from the stomach, breath test or stool sample.

Other tests

Other tests may be needed if your healthcare professional is concerned about particular symptoms or findings from your exam. You also may need more tests if the first line of treatment for indigestion does not help with symptoms. These tests may include:

• Blood tests. Lab tests of blood samples may find signs of other conditions that can cause symptoms of indigestion.
• Endoscopy. An endoscope is a tube with a camera that passes down the throat and into the digestive system. This test is called endoscopy. It can show diseased or damaged tissue. Tools used during this test also can remove a tiny sample of tissue for lab testing. This test mainly is used for adults age 50 and older who have new symptoms of indigestion.
• Imaging tests can show diseased tissues, blockage in the digestive system or other irregular findings.

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your indigestion-related health concerns. Start Here

Treatment

A variety of treatments may improve symptoms of indigestion.

Diet and medicine changes

Changes to the diet and possible changes in medicines are the first steps in lessening symptoms. These include the following:

• Avoid fatty, acidic or spicy foods.
• Avoid caffeine, alcohol and carbonated beverages.
• Avoid pain medicines such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
• Ask your healthcare professional if any of your prescription medicines may be contributing to indigestion. Ask if there are alternatives.
• Review your use of dietary supplements or herbal remedies with your healthcare professional to see if there is anything that may be contributing to your symptoms.

Mental healthcare

Talk therapy with a psychotherapist can help you manage depression, anxiety and related factors that may be contributing to indigestion. Prescription medicines also may help lessen symptoms of depression and anxiety.

Medicines for the digestive system

Your healthcare professional may prescribe medicines or recommend medicines you can buy without a prescription to lessen indigestion symptoms. These may include:

• Antibiotics. If you tested positive for H. pylori bacteria, a treatment with antibiotics and acid-reduction medicines may lessen symptoms.
• Proton pump inhibitors, also called PPIs, which reduce the production of acids in the stomach. These medicines are available in prescription and over-the-counter doses. PPIs you can buy without a prescription include lansoprazole (Prevacid 24 HR), omeprazole (Prilosec OTC) and esomeprazole (Nexium 24HR).
• H-2-receptor blockers, which also reduce acid production, are available in prescription and nonprescription doses. H-2-receptor blockers you can buy without a prescription include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR).
• Prokinetics. These prescription medicines help the stomach empty faster and tighten the valve between the stomach and esophagus.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Lifestyle changes that can be part of your routine may help lessen symptoms or prevent the return of symptoms:

• Avoid fatty, acidic or spicy foods. Avoid caffeine, alcohol and carbonated beverages.
• Eat five or six small meals a day instead of three large meals.
• Avoid pain medicines such as aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
• Exercise regularly and maintain a healthy weight.
• Stop smoking if you smoke.
• Avoid stressors when possible.
• Practice meditation or other mindfulness exercises to help manage stress.

Alternative medicine

Alternative and complementary treatments that may improve symptoms of indigestion include:

• Peppermint oil or a combination of peppermint and caraway oils.
• A Japanese herbal formula called rikkunshito.
• Acupuncture.
• Yoga and mindfulness practices.

Check with your healthcare professional before you take any supplements. Your health professional can help make sure the dose is safe for you. It's also important to make sure the supplement won't react with any other medicines you take.

Preparing for your appointment

You're likely to start by seeing your primary healthcare professional. You may be referred to a doctor who specializes in digestive diseases, called a gastroenterologist. Here's some information to help you get ready for your appointment and know what to expect.

What you can do

• Be aware of any restrictions before your appointment, such as not eating solid food before your appointment.
• Write down your symptoms, including when they started and how they may have changed or worsened over time.
• Make a list of all your medicines, vitamins or supplements and the doses and reasons for taking each one.
• Write down your key medical information, including other diagnosed conditions.
• Write down key personal information, including any recent changes or stressors in your life. Also, include a detailed description of your typical daily diet.
• Write down questions to ask during your appointment.

Some basic questions you may wish to ask include:

• Do you think my condition is temporary or chronic?
• What kinds of tests do I need?
• What treatments can help?
• Are there any dietary restrictions that I need to follow?
• Could any of my medicines be causing my symptoms?

In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer questions your healthcare professional may ask, such as:

• When did your symptoms begin?
• How would you describe the pain? How would you rate it on a scale of 1 to 10?
• How often do you have symptoms? Are they constant?
• Does anything worsen symptoms? Does anything help them?
• How would you describe your diet? How may fruits and vegetables do you eat?
• How much alcohol and caffeine do you have on a typical day?
• Are you feeling depressed or anxious?
• Have you experienced any recent major stressor or life change?
• Do you use tobacco? What kind?
• Are your symptoms better or worse on an empty stomach?
• Have you vomited blood or black material?
• Have you had any changes in your bowel habits, including stools turning black?
• Have you lost weight?
• Have you felt like vomiting or vomited?

Indigestion care at Mayo Clinic

1. Indigestion (dyspepsia). National Institute of Diabetes and Digestive and Kidney Disease. https://www.niddk.nih.gov/health-information/digestive-diseases/indigestion-dyspepsia. Accessed March 3, .
2. Olson CG, et al. Current opinion: Functional dyspepsia. Current Opinion in Gastroenterology. ; doi:10./MOG..
3. Lacy BE, et al. The treatment of functional dyspepsia: Present and future. Expert Review of Gastroenterology & Hepatology. ; doi:10./...
4. Ferri FF. Dyspepsia, nonulcerative. In: Ferri's Clinical Advisor . Elsevier; . https://www.clinicalkey.com. Accessed March 3, .
5. Kellerman RD, et al. Gaseousness, indigestion, nausea, and vomiting. In: Conn's Current Therapy . Elsevier; . https://www.clinicalkey.com. Accessed March 3, .
6. Goldman L, et al., eds. Approach to the patient with gastrointestinal disease. In: Goldman-Cecil Medicine. 27th ed. Elsevier; . https://www.clinicalkey.com. Accessed March 3, .
7. Dyspepsia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/symptoms-of-gastrointestinal-disorders/dyspepsia. Accessed March 3, .
8. Feldman M, et al., eds. Dyspepsia. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; . https://www.clinicalkey.com. Accessed March 3, .
9. Amerikanou C, et al. Food, dietary patterns, or is eating behavior to blame? Analyzing the nutritional aspects of functional dyspepsia. Nutrients. ; doi10./nu.
10. Nimmagadda R. Allscripts EPSi. Mayo Clinic. Dec. 2, .
11. Medical review (expert opinion). Mayo Clinic. March 18, .
12. Ali RAR, et al. Review of recent evidence on the management of heartburn in pregnant and breastfeeding women. BMC Gastroenterology. ; doi:10./s-022--w.

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CON-

Five Key Factors That Affect Acidity

Today we’ll talk about what’s behind the trends in acidity for different molecules and discuss the most important factors that determine these values.

I’ve written in schoolmarmish tones before about how pKa is one of the most important measures you can learn in organic chemistry, and not knowing some basic pKa values  before an exam is a lot like walking up to a poker table without knowing the values of the hands: you’re going to lose your shirt. (See article: Know Your pKas)

Let’s quickly review the basics of acidity and basicity. Here’s the condensed version:

1. Bronsted acids are proton donors, Lewis acids are electron pair acceptors. Converse: Brønsted base = proton acceptor, Lewis base = electron pair donor.
2. A conjugate base is what you obtain when you remove a proton (H+) from a compound. For instance, HO– is the conjugate base of water. O2- is the conjugate base of HO–. Conversely, conjugate acids are what you obtain when you add a proton to a compound. The conjugate acid of water is H3O+.
3. Quick quiz: is pH 1 acidic or basic? pKa is similar to pH in that low (and even negative values) denote strong acids. That’s because pKa is based on the equilibrium:
   
4. According to this, anything which stabilizes the conjugate base will increase the acidity. Therefore pKa is also a measure of how stable the conjugate base is. Put another way, strong acids have weak conjugate bases, and vice versa.

With that out of the way, let’s get started.

Table of Contents

1. Factor #1 – Charge.
2. Factor #2 – The Role of the Atom
3. Factor #3 – Resonance
4. Factor #4 – Inductive effects
5. Factor #5 – Orbitals
6. Quiz Yourself!
7. Notes

1. Factor #1 – Charge.

Removal of a proton, H+ , decreases the formal charge on an atom or molecule by one unit. This is, of course, easiest to do when an atom bears a charge of +1 in the first place, and becomes progressively more difficult as the overall charge becomes negative. The acidity trends reflect this:

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Note that once a conjugate base (B-) is negative, a second deprotonation will make the dianion (B 2-). While far from impossible, forming the dianion can be difficult due to the buildup of negative charge and the corresponding electronic repulsions that result.

2. Factor #2 – The Role of the Atom

This point causes a lot of confusion due to the presence of two seemingly conflicting trends.

Here’s the first point: acidity increases as we go across a row in the periodic table. This makes sense, right? It makes sense that HF is more electronegative than H2O, NH3, and CH4 due to the greater electronegativity of fluorine versus oxygen, nitrogen, and carbon. A fluorine bearing a negative charge is a happy fluorine.

But here’s the seemingly strange thing. HF itself is not a “strong” acid, at least not in the sense that it ionizes completely in water. HF is a weaker acid than HCl, HBr, and HI. What’s going on here?

You could make two arguments for why this is.  The first reason has to do with the shorter (and stronger) H-F bond as compared to the larger hydrogen halides.

The second has to do with the stability of the conjugate base. The fluoride anion, F(–) is a tiny and vicious little beast, with the smallest ionic radius of any other ion bearing a single negative charge. Its charge is therefore spread over a smaller volume than those of the larger halides, which is energetically unfavorable: for one thing, F(–) begs for solvation, which will lead to a lower entropy term in the ΔG.

Note that this trend also holds for H2O and H2S, with H2S being about 10 million times more acidic.

3. Factor #3 – Resonance

A huge stabilizing factor for a conjugate base is if the negative charge can be delocalized through resonance. The classic examples are with phenol (C6H5OH) which is about a million times more acidic than water, and with acetic acid (pKa of ~4).

Watch out though – it isn’t enough for a π system to simply be adjacent to a proton – the electrons of the conjugate base have to be in an orbital which allows for effective overlap.

4. Factor #4 – Inductive effects

Electronegative atoms can draw negative charge toward themselves, which can lead to considerable stabilization of conjugate bases. Check out these examples:

Predictably, this effect is going to be related to two major factors: 1) the electronegativity of the element (the more electronegative, the more acidic) and the distance between the electronegative element and the negative charge.

5. Factor #5 – Orbitals

Again, the acidity relates nicely to the stability of the conjugate base. And the stability of the conjugate base depends on how well it can accomodate its newfound pair of electrons. In an effect akin to electronegativity, the more s character in the orbital, the closer the electrons will be to the nucleus, and the lower in energy (= stable! ) they will be.

Look at the difference between the pKa of acetylene and alkanes: 25! That’s 10 to the power of 25, as in, “100 times bigger than Avogadro’s number”.

Just to give you an idea of scale. That’s the amazing thing about chemistry – the sheer range in the power of different phenomena is awe-inspiring. (See article: pKa Values Span 60 Orders Of Magnitude)

There’s actually a mnemonic I’ve found that can help you remember these effects. This is credited to Dr. Christine Pruis, Senior Lecturer at Arizona State University Tempe.

Charge

Atom

Resonance

Dipole Induction

Orbitals

= CARDIO.

Tread carefully with mnemonics, but there you go.

Quiz Yourself!

Become a  MOC member to see the clickable quiz with answers on the back.

Become a  MOC member to see the clickable quiz with answers on the back.

Become a  MOC member to see the clickable quiz with answers on the back.

Become a  MOC member to see the clickable quiz with answers on the back.

Become a  MOC member to see the clickable quiz with answers on the back.

For more information, please visit Fuming Furnace.

Notes