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Nonulcer dyspepsia (indigestion)

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From MayoClinic.com


For most people, treating indigestion primarily focuses on preventing recurrence and on self-care. For others, nonulcer dyspepsia tends to be a long-lasting (chronic) or recurrent condition requiring medical treatment. Treatment options include:

Several types of medications are available for managing the signs and symptoms of nonulcer dyspepsia. These may include:

  • Antacids. Multi-ingredient antacids (Maalox, Mylanta, others) in liquid or tablet form are a common treatment for indigestion. Antacids neutralize stomach acid and can provide fast pain relief.

  • Acid blockers. Drugs such as cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid) decrease the amount of acid your stomach produces.

  • Proton pump inhibitors. These types of medications shut down the acid "pumps" within acid-secreting stomach cells. Proton pump inhibitors reduce acid by blocking the action of these tiny pumps. They include the prescription medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and esomeprazole (Nexium). A similar drug, pantoprazole (Protonix), can be taken orally or intravenously.

  • Prokinetic agents. These drugs help your stomach empty more rapidly and may help tighten the valve between your stomach and esophagus, reducing the likelihood of upper abdominal discomfort. Doctors commonly prescribe the medication metoclopramide (Reglan) for nonulcer dyspepsia.

  • Antispasmodics. These drugs relax the smooth muscles in your intestines, working to decrease indigestion. Commonly prescribed medications include dicyclomine (Bentyl, Dibent) and hyoscyamine (Levsin, Cystospaz).

  • Acid suppressors (cytoprotective agents). These medications are designed to help protect the tissues that line your stomach and small intestine. They include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec). If you're taking NSAIDs regularly, your doctor may suggest that you also take one of these medications to protect your stomach. Another cytoprotective agent is bismuth subsalicylate (Pepto-Bismol).

  • Low-dose antidepressants. Tricyclic antidepressants or drugs known as selective serotonin reuptake inhibitors (SSRIs), taken in low doses, may help inhibit the activity of neurons that control the intestines. Your doctor may suggest antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil). SSRIs such as fluoxetine (Prozac, Sarafem) or paroxetine (Paxil) also may be helpful.

  • Antibiotic treatment for Helicobacter pylori infection. Tests may indicate that these common ulcer-causing bacteria are present in your stomach, though you have no ulcer. Treatment for H. pylori infection is with antibiotics, sometimes given in combination with a proton pump inhibitor. Antibiotics most commonly prescribed for treatment of H. pylori include amoxicillin (Amoxil, Wymox), clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline (Achromycin V). Some pharmaceutical companies package a combination of two antibiotics together, with an acid suppressor or cytoprotective agent, specifically for treatment of H. pylori infection. These combination treatments are sold under the brand names Prevpac and Helidac.

  • Behavior therapy
    This type of treatment focuses on changing unwanted or unhealthy behaviors, typically using a system of rewards and reinforcements of positive behavior. In the case of nonulcer dyspepsia, for instance, if you tend to overeat or eat too quickly, often causing you indigestion, you might be trained in ways to stop such habits, therefore reducing your risk of abdominal discomfort.


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