Indigestion, nonulcer

Non-ulcer indigestion, also known as functional indigestion is a condition wherein the symptoms of indigestion are seen, but upper abdomen does not have a duodenal ulcer, stomach ulcer, inflamed esophagus or inflamed stomach. The endoscopic examination of gut gives normal results. It usually affects young adults; women are more affected than men. Nearly 60% of people suffering from indigestion have non-ulcer indigestion.


The exact cause of non-ulcer indigestion is still not known. However, scientists believe that few factors may contribute to the condition such as

  • Alteration of sensation in the stomach or duodenum, causing irritable bowel syndrome. About 33% of persons suffering from non-ulcer indigestion have irritable bowel syndrome.
  • Reduction in the efficiency of stomach wall, increasing the time for the stomach contents to reach duodenum causing indigestion
  • Infection of stomach with a bacterium called H. pylori might be another factor
  • Certain foods such as tomatoes, spicy foods, chocolates, peppermint, alcohol, coffee and hot drinks cause non-ulcer indigestion. They may worsen the condition if symptoms of indigestion are already present.
  • Certain medicines such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen), corticosteroids, and estrogens may cause non-ulcer indigestion.

Signs and symptoms

The symptoms are similar to that of indigestion such as nausea, bloating, belching.

Feeling of stomach fullness during a meal or immediately after the meal, flatulence, burning sensation or pain in the upper abdomen region or deep inside the chest (which may disappear after taking food or antacid), and vomiting.


The doctor will first ask about your symptoms and assess medical history. Then he or she would recommend for the following tests:

  • Lab tests to evaluate the thyroid function (T3, T3RU, T4, and TSH) and other metabolic disorders e.g. diabetes
  • Breath and stool tests, for presence of Helicobacter pylori (associated with peptic ulcer)
  • Endoscopy, to examine upper abdomen (oesophagus, stomach, and duodenum) to check the presence of ulcer. A biopsy may also be recommended to examine the tissue sample.
  • Imaging tests (X-ray or CT scan), to check intestinal obstruction.

If the above tests are negative, patient should be evaluated for anxiety, stress and emotional events because these conditions sometimes affect digestion.

In most of the cases, the condition can be managed simply by reducing stress, anxiety and emotional events. If the problem still persists, the following treatment options are considered.

  • Acid-suppressing drugs: Proton pump inhibitors such as pantoprazole, omeprazole, rabeprazole
  • H2 receptor antagonists such as cimetidine, ranitidine, Famotidine and nizatidine to reduce stomach acid.

If acid-suppressing medicine fails to relieve symptoms, prokinetic drug (domperidone) may be given.

Other medications include:

  • Sucralfate or bismuth
  • Antispasmodic drugs such as drotaverine, mebeverine to relieve cramps
  • Antidepressant drugs
Treating H. pylori infection: If a person is found to be infected with H. pylori, he/ she should be treated by giving medicines (2 antibiotics and 1 proton pump inhibitor) two times a day for seven days. However, a study found that only one in fifteen patients suffering from non-ulcer indigestion, after treated for H. pylori infection got relief from symptoms of indigestion.
Lifestyle Changes: you can easily manage the symptoms by making certain life-style changes like:
  • Stop drinking alcohol
  • Stop smoking
  • Eating meals regularly
  • Maintaining normal body weight
  • Avoid eating fat rich food

Measures to be taken to prevent symptoms of indigestion are as follows:

  • Eat food in small quantities and at regular intervals
  • Chew the food properly, don’t be in a rush
  • After eating, food do not go to bed for next 3 hours, allowing gastro intestinal tract to digest the food
  • Stop drinking tea, coffee and alcohol
  • Stop taking fat rich foods e.g. butter
  • Bring body weight to normal
  • Stop taking aspirin and NSAIDs, which causes acid secretion
  • Make yourself free from anxiety and worry by practicing yoga and meditation