Update on Indigestion

Med Clin North Am. 2021 Jan;105(1):19-30. doi: 10.1016/j.mcna.2020.08.012. Epub 2020 Nov 7.


Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. Patients without any identifiable cause for their symptoms are diagnosed with functional dyspepsia. Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.

Keywords: Dyspepsia; Epigastric pain syndrome; Functional dyspepsia; Helicobacter pylori test and treat; Post-prandial distress syndrome.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Cognitive Behavioral Therapy
  • Complementary Therapies
  • Diagnosis, Differential
  • Diet
  • Dyspepsia* / diagnosis
  • Dyspepsia* / etiology
  • Dyspepsia* / physiopathology
  • Dyspepsia* / therapy
  • Gastrointestinal Agents / therapeutic use
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori
  • Humans
  • Postprandial Period
  • Prebiotics
  • Probiotics / therapeutic use
  • Proton Pump Inhibitors / therapeutic use
  • Syndrome


  • Anti-Bacterial Agents
  • Antidepressive Agents, Tricyclic
  • Gastrointestinal Agents
  • Prebiotics
  • Proton Pump Inhibitors