Dyspepsia, commonly called indigestion, is treatable through a combination of dietary changes, acid-suppressing medication, and sometimes low-dose nerve-targeting drugs. The right approach depends on what’s causing it: an identifiable problem like an ulcer or bacterial infection (organic dyspepsia), or persistent symptoms with no clear structural cause (functional dyspepsia). Most people improve with straightforward first steps, though some need a layered strategy.
Start With Dietary Changes
Fat is the single strongest dietary trigger for dyspepsia symptoms. In controlled studies, high-fat meals consistently provoke more epigastric pain, nausea, fullness, and bloating than equivalent meals where the calories come from carbohydrates instead. One study compared a high-fat yogurt (24 grams of fat) against a low-fat version (1 gram of fat) and found significantly worse symptoms with the fatty option. Even adding 30 grams of margarine to soup was enough to increase pain and nausea in people with functional dyspepsia compared to the same soup without added fat.
Beyond reducing fat, a few other changes have solid backing. Coffee increases gastric acid secretion and is linked to symptom flares across multiple studies. Alcohol does the same while also disrupting the rate at which your stomach empties. Ultra-processed foods are associated with a higher risk of functional dyspepsia as well. A practical starting point is to eat smaller, more regular meals, cut back on caffeine and alcohol if they seem to bother you, and keep fatty foods moderate.
For people whose symptoms center on bloating, fullness right after eating, or early fullness that stops them finishing a meal, restricting certain fermentable carbohydrates (a low-FODMAP diet) may help. In a preliminary trial of 25 patients who followed a low-FODMAP diet for six weeks, more than half improved in fullness, early satiation, and upper abdominal bloating. Mannitol (found in some fruits and artificial sweeteners) and galacto-oligosaccharides (found in legumes and some grains) were the most commonly identified triggers during reintroduction.
Acid-Suppressing Medication
Proton pump inhibitors (PPIs) are the most widely used first-line medication for dyspepsia. They reduce stomach acid production and work for both organic causes like ulcers and for functional dyspepsia where no structural damage is found. A Cochrane review covering 25 trials found that PPIs outperform placebo, and importantly, low-dose PPIs performed similarly to standard-dose ones, meaning you don’t necessarily need a higher dose to get relief.
Most trials tested treatment courses of two to four weeks, with some extending beyond six weeks. A typical approach is to try a PPI for four to eight weeks and then reassess. If symptoms resolve, your doctor may suggest stepping down to the lowest effective dose or stopping altogether, since long-term PPI use carries its own considerations. If a four-to-eight-week trial doesn’t help, that’s useful information too, as it points toward other treatment strategies.
Testing for and Treating H. Pylori
Helicobacter pylori is a stomach bacterium that causes ulcers, chronic inflammation, and dyspepsia symptoms in a significant number of people. If you’re under 60 with no alarming symptoms, current guidelines favor a “test and treat” approach: get tested for H. pylori (usually through a breath test or stool test), and if positive, take a course of antibiotics to eradicate it.
The recommended first-line treatment has shifted in recent years. The American College of Gastroenterology now recommends a 14-day course of bismuth-based quadruple therapy for patients who haven’t been treated before. This involves a PPI twice daily plus three other medications taken multiple times a day. The older approach of using clarithromycin-based triple therapy is now specifically recommended against unless lab testing has confirmed the bacteria are sensitive to clarithromycin, because resistance rates have climbed too high in many regions. Alternative regimens exist for people who can’t tolerate the standard protocol.
Successfully clearing the infection resolves dyspepsia for a meaningful percentage of people, particularly those whose symptoms stem from ulcers or gastritis caused by the bacterium.
Drugs That Speed Stomach Emptying
Some people with dyspepsia have a stomach that empties too slowly, leading to prolonged fullness, bloating, and nausea after meals. Prokinetic agents address this by stimulating the nerve-driven muscle contractions that move food through the digestive tract. These medications are typically considered when PPIs haven’t worked or when delayed emptying is suspected.
Availability varies by country. In the U.S., options are limited. Domperidone, which is widely used in Europe and Canada, requires a special application to the FDA for access. Metoclopramide is the main FDA-approved option in this class but carries a risk of involuntary movement side effects with long-term use, so it’s generally prescribed cautiously and for shorter periods. The evidence for prokinetics in functional dyspepsia is more modest than for PPIs, with researchers noting symptom relief “in some cases” rather than across the board.
Low-Dose Nerve-Targeting Medications
When standard treatments fall short, a class of drugs originally developed as antidepressants can help, not because dyspepsia is psychological, but because these medications dampen pain signaling between the gut and the brain. They’re used at doses far lower than those prescribed for depression.
Tricyclic antidepressants have the strongest evidence here. In a well-designed trial, imipramine at 50 mg daily produced satisfactory symptom relief in 64% of patients at 12 weeks, compared to 37% on placebo. That translates to roughly one in four patients getting meaningful benefit specifically from the medication. Amitriptyline at 25 to 50 mg daily showed particular promise for people with ulcer-like dyspepsia (burning or gnawing pain as the dominant symptom), where it tripled the odds of adequate relief compared to placebo. It also reduced overall symptom scores and nausea in a separate trial.
SSRIs, a different class of antidepressant, have been less impressive. Escitalopram performed no better than placebo in a 12-week trial. Sertraline showed mixed results: improvement on one symptom scoring system but no clear benefit in overall quality of life or global symptom resolution. For now, tricyclics are the preferred option in this category.
Herbal Treatments With Clinical Evidence
One herbal preparation has accumulated enough clinical trial data to be worth mentioning. STW 5 (sold as Iberogast) is a blend of nine plant extracts: bitter candytuft, angelica root, milk thistle fruit, caraway fruit, celandine herb, liquorice root, chamomile flower, lemon balm leaf, and peppermint leaf. A pooled analysis of controlled studies found it was significantly more effective than placebo for functional dyspepsia symptoms. It’s available over the counter in many countries and is sometimes used as an add-on or alternative for people who prefer to avoid prescription medication or who haven’t responded to PPIs alone.
When Further Investigation Is Needed
Most dyspepsia doesn’t signal anything dangerous, but certain features warrant a closer look with an upper endoscopy (a camera examination of the esophagus and stomach). Current guidelines recommend endoscopy for anyone 60 or older who develops new dyspepsia symptoms lasting at least a month. The age threshold may be lower for people at higher baseline risk of upper gastrointestinal cancer, such as those of Southeast Asian descent.
For people under 60, individual alarm symptoms like unintentional weight loss, difficulty swallowing, or anemia are less predictive than you might expect. Each one alone has a positive predictive value of less than 1% for malignancy. That said, when several alarm features cluster together or symptoms are severe, endoscopy is still appropriate. The key point is that a single worrying symptom in a younger person doesn’t automatically mean cancer, but it does mean the conversation with your doctor should be more detailed.
Weight and Lifestyle Factors
Carrying extra weight contributes to both acid reflux and dyspepsia symptoms. Data from a large cohort study found that losing enough weight to reduce BMI by 3.5 points over time cut the risk of frequent reflux symptoms by nearly 40%. A hospital-based study found that a 5 to 10% weight loss in women and greater than 10% in men led to significant reductions in overall symptom scores. If you’re overweight and dealing with persistent indigestion, weight loss is one of the few interventions that addresses the underlying mechanical problem rather than just suppressing symptoms.
Stress management also plays a role for functional dyspepsia, given the strong gut-brain connection driving the condition. While the evidence for specific stress-reduction techniques is less quantified than for medications, the biology is clear: heightened nervous system activity increases visceral sensitivity, making normal digestive processes feel uncomfortable or painful. Regular physical activity, adequate sleep, and whatever stress management works for you (whether that’s exercise, meditation, or simply reducing overcommitment) can meaningfully lower the baseline sensitivity of your gut.