Conditions We Treat
Dyspepsia, Gastritis, GERD and Hiatal Hernia
Dyspepsia — indigestion — is a very common disorder and affects almost one fourth of adult males and females. This page explains dyspepsia and the conditions that sit alongside it: gas and bloating, gastritis, peptic ulcer, acid reflux and GERD, hiatal hernia, and H. pylori infection — what causes them, how they are diagnosed, how they are treated, and when symptoms mean you should see a gastroenterologist. GastroPlus Digestive Disease Centre has four hospitals in Ahmedabad, at Vastrapur, Nikol, Bapunagar and Bopal.
Conditions covered on this page
- Dyspepsia and indigestion
- Gas and bloating
- Gastritis
- Peptic ulcer
- Reflux and GERD
- Hiatal hernia, or lax LES
What causes dyspepsia
In many cases it is difficult to pinpoint one cause, and it is multifactorial instead. A lot of research is going on, especially to understand functional dyspepsia. A few of the causes are listed below.
- Ulcers in the stomach or duodenum
- Medications, such as aspirin, ibuprofen and naproxen
- Helicobacter pylori (H. pylori) infection in the stomach
- Abnormal muscle function or relaxation of the stomach
- Abnormal neural function or sensitivity
- Very rarely, cancer
How dyspepsia is diagnosed
Dyspepsia is diagnosed clinically, and by certain criteria that define functional dyspepsia. Based on your symptoms, the doctor will determine whether or not you need any tests to check for possible associated problems with your lungs or heart, or for anaemia. You will be encouraged to stop behaviours that are known to be possible causes of dyspepsia:
- Fatty food and fast food: these remain in the stomach longer than proteins and can cause distension, discomfort or pain
- Keep a diary of the foods that bother you, and avoid them
- Consider losing weight if you are overweight
- Avoid taking aspirin, ibuprofen and similar medicines
- Consider the possibility that other drugs you are taking may have dyspepsia as a side effect
- Eating small, frequent meals can be helpful — for example, five to six small meals per day
Medicines and endoscopy for dyspepsia
The treating gastrophysician may use acid-suppressing and stomach-motility-improving drugs.
He may order an endoscopy if your symptoms are not improving — a procedure in which a flexible tube is passed into your stomach. Endoscopy allows a specialist to inspect your oesophagus and stomach to look for any inflammation or ulcers.
Treating bothersome gas
Bothersome gas is generally treated with dietary measures and lifestyle modifications.
- Cut down on foods that cause gas: beans, brussels sprouts, broccoli, cabbage, cauliflower, onions, artichokes, asparagus, pears, apples, peaches, prunes, sugar-free candies, chewing gum, carbonated beverages, beer, fruit drinks, wheat bread and bran, and fried and fatty foods
- Reduce the use of dairy products such as cheese and ice cream
- Reduce the amount of air you swallow during meals by eating slowly and properly, and by avoiding chewing gum and hard candy
Treatment for GERD
Lifestyle change is the mainstay of initial management. This includes avoiding foods like caffeinated drinks, chocolate, tomato-based products, spicy foods, citrus, garlic, onions, peppers, fatty foods and mint or peppermint. The reason is that these either lead to more relaxation of the muscle of the lower food pipe, or to increased acid production.
- Eat smaller meals, and avoid vigorous exercise or going to bed for three hours after meals
- Avoid using tobacco products, alcohol and painkillers, and avoid wearing tight clothes around the stomach
- Elevate the head of your bed using 4 to 6 inch blocks, to help prevent acid from rising up at night
- If you are overweight, lose some weight
- Medications like antacids, and medicines that reduce acid production, are used
- Endoscopic and surgical treatment are reserved for those who do not respond to the above treatments
Treatment for a hiatal hernia
In most cases, where the hiatal hernia is small, no treatment is needed. Someone with persistent symptoms may need the following treatments, which are similar to those for GERD.
- Weight loss, if you are overweight
- Avoid fatty and spicy foods, caffeine, chocolate, onions and citrus
- Eat smaller meals, and avoid eating for three hours before bed
- Antacids, acid-reducing medications, and prokinetic or motility drugs
- If medications, diet and lifestyle fail to improve symptoms, surgery to repair the hiatal hernia may be needed
When to seek medical advice
Many naturopathic and alternative medicine therapies are available in the market, but they not only lack evidence — even the safety of such treatments is unclear.
Functional dyspepsia, GERD, gas and dyspepsia often come back over time. Treatment may therefore need to be modified or adapted, to improve your ability to cope with these ongoing symptoms, which in many cases cannot be entirely eliminated.
A normal human passes gas 10 to 20 times per day, or 700 ml per day. Consult a gastroenterologist if gas is associated with other symptoms such as pain in your abdomen, nausea, vomiting, bleeding, weight loss, fever or chest pain, or if it interferes with your ability to live a normal life.
Consult a gastroenterologist if you have persistent symptoms, or unusual symptoms such as blood in vomit, black stools or weight loss.
If your GERD, hiatal hernia or gastritis symptoms occur often, or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, contact your health care provider.
Frequently asked
What is dyspepsia and what is GERD?
This is a very common disorder and affects almost one fourth of adult males and females. In layman's words, dyspepsia means indigestion. By definition it means pain or discomfort in the upper abdomen: fullness after eating or without eating, which may or may not be accompanied by heartburn or regurgitation (symptoms of gastro-oesophageal reflux disease, or GERD), or by a change in bowel habits (irritable bowel syndrome, or IBS). Dyspepsia is very common, and it can be constant or come in intervals. Associated symptoms like bloating, nausea, burping and a feeling of fullness soon after eating are very common in dyspepsia. In the absence of a structural explanation for these symptoms, it is known as functional dyspepsia. Dyspepsia is often confused with GERD, where acid in the stomach refluxes back up into the food pipe; pain or burning due to reflux is in the chest instead of the abdomen.
Why do I produce lots of gas?
Every one of us has gas, and so burping or passing gas is normal. We swallow air every time we eat or drink. You may swallow air when you are nervous, eat too fast, chew gum, drink through a straw, or have aerated drinks. Most of the gas that we burp out is the gas that we swallowed. On the other hand, most lower intestinal gas is produced when bacteria in your colon ferment carbohydrates that are not digested in your small intestine.
What is gastritis?
In simple words, gastritis means swelling or inflammation of the stomach wall lining. It is of two types: acute, or sudden, and chronic, or long-standing. In most cases it is a benign condition, but in rare cases it can lead to ulcers and even cancer.
What are the causes of gastritis?
In most cases no obvious cause is found. Certain painkillers, blood thinners, alcohol, smoking and other drugs can cause gastritis. H. pylori infection, surgery, bile reflux and stress can also lead to gastritis.
What are the symptoms of gastritis?
Burning or pain in the upper abdomen are the most common symptoms of gastritis. Nausea, vomiting, loss of appetite or weight loss may also be symptoms of gastritis.
How is gastritis diagnosed?
After history and examination, your doctor may advise certain lab tests, sonography and endoscopy to diagnose gastritis.
What are the treatment options for gastritis?
The gastroenterologist will advise you to modify your lifestyle by avoiding certain foods, smoking and stress, and certain medicines such as painkillers, as well as alcohol and tobacco or smoking. He may also prescribe medicine for infection or for acid suppression.
What is GERD (gastro-oesophageal reflux disease)?
Normally the food pipe, which is made up of specialised muscle, acts as a one-way tube and so does not allow food or acid to reflux back into it from the stomach. In GERD the lower part of the food pipe relaxes excessively, or is weak, allowing acid to enter the food pipe. This in turn leads to swelling or inflammation of the lining of the food pipe, which gives a burning sensation or pain in the chest.
What are the symptoms of GERD?
Heartburn and acid regurgitation. Rarely, hoarseness, coughing, breathing and sinus problems, dental erosions, and difficulty swallowing.
How is GERD diagnosed?
The two most common tests used are upper endoscopy and manometry.
What are the complications of GERD?
Barrett's oesophagus, which is a precursor of malignancy of the lower food pipe, and stricture of the food pipe, which leads to swallowing problems.
What is a hiatal hernia?
A large dome-shaped muscle, the diaphragm, separates your chest and your stomach. In a hiatal hernia, the top portion of the stomach pushes into the chest through a weakened opening in the diaphragm, where the food pipe (oesophagus) joins your stomach — called the hiatal opening.
What causes a hiatal hernia?
In most cases no obvious cause is found. Obesity, strain over the abdomen and trauma can cause or aggravate symptoms.
What are the symptoms of a hiatal hernia?
Small hiatal hernias are usually asymptomatic and are diagnosed incidentally when you are evaluated for other reasons. A large hiatal hernia can allow food and stomach acid to back up into your oesophagus, leading to heartburn, chest pain, belching and nausea.
How is a hiatal hernia diagnosed?
By doing an endoscopy or a barium swallow X-ray, carried out for heartburn, reflux, chest pain or another reason.
What is H. pylori?
It is a bacterium called Helicobacter pylori and is commonly found in the stomach. It is found in approximately 70 to 80% of the Indian population and 50% of the world's population. It is one of the most common causes of ulcer and gastritis. Rarely, it can also lead to stomach cancer.
What causes H. pylori infection?
H. pylori infection is usually acquired through contaminated food, liquids and water.
What are the symptoms of H. pylori infection?
In most cases there are no symptoms of infection. A few of the infected patients may develop gastritis, ulcers and, rarely, stomach cancer.
How is H. pylori diagnosed?
It can be diagnosed by a breath test, by endoscopy and biopsy, or by a stool antigen test.
How is H. pylori treated?
H. pylori is treated by a combination of antibiotics and acid-suppressing drugs.
Where to go next
Need expert digestive or liver care?
Book a consultation with a GastroPlus specialist — same-day appointments available.