Indigestion

What is indigestion?

Also known as dyspepsia, indigestion is a condition that is characterized by a variety of symptoms that may include nausea, sensation of stomach fullness, belching, abdominal pain, and often symptoms of gastroesophageal reflux disease (GERD), such as heartburn. It also may include stomach ulcer disease and gastritis (stomach inflammation).

Another condition that can fall into the category of indigestion, due to overlapping symptoms, is irritable bowel syndrome (IBS), a common disorder resulting from a variety of abnormalities that are generally minor, as they are not connected with any anatomic problems, inflammation, or other disease process, such as infection or cancer. Such abnormalities include intolerance to certain types of carbohydrates, often due to a deficiency of the enzymes needed to break down the particular substance. IBS is characterized by abdominal pain and altered, or unpredictable bowel habits, including diarrhea and constipation.

How common is indigestion during pregnancy?

Dyspepsia is very common during pregnancy. Approximately 80 percent of pregnant women experience this condition at some point. About 10 15 percent of adults in the US suffer from IBS, which is recognized most often during a person’s 20s and 30s and affects females twice as often as males, so IBS often co-exists with pregnancy.

How is indigestion diagnosed?

Determination of whether you have indigestion is made based on your history, particularly your reporting of symptoms, such as nausea and bloating. You doctor will also ask questions and examine you to investigate more specific problems such as GERD and ulcers. To test your stomach for the presence of a bacterial species called Helicobacter pylori, which causes ulcers, your doctor may order a urea breath test in which youll be given a light meal with an agent called urea that is labeled with a special carbon atom that can be detected either by a radiation sensor (carbon-14), or through a process called mass spectrometry (carbon-13). As for IBS, this is typically a diagnosis of exclusion. This means that you are sent to a specialist – in this case, a gastroenterologist – to evaluate you for several different diseases, such as IBD, serious gastrointestinal infections, genetic disorders affecting the digestive tract, and cancers, and if all tests turn out negative IBS is diagnosed. The various workups generally include blood tests and several types of imaging. In some cases IBS may be found to result from minor enzyme deficiencies, such as lactose intolerance (inability to digest milk sugar) or the person is found to have what is called fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) intolerance. This means that she has trouble digesting any of a range of carbohydrates. In either case, the condition may be controlled at least partly through control of the diet.

Does indigestion cause problems during pregnancy?

Dyspepsia can manifest with various upper gastrointestinal symptoms, such as nausea and vomiting, bloating and belching, and abdominal pain. GERD can develop, producing heartburn, sore throat, and cough, and if it continues can lead to long term problems such as ulcer disease, or cancer. H. pylori infection occurs less frequently than it has occurred in the past in developed countries, but classically it has been associated with dyspepsia of pregnancy, and it is the major cause of ulcer disease, plus after many years it can lead to cancer. Diarrhea caused by IBS also can aggravate hemorrhoids, which themselves are provoked by pregnancy. If your digestive disturbance comes at night, which it often does with IBS, this could lead a pregnant woman to go to sleep later than planned. Combined with a schedule that requires you to wake early in the morning, this can lead to inadequate sleep.

Does indigestion during pregnancy cause problems for the baby?

Generally, maternal dyspepsia and IBS do not cause problems for the baby. However, if you develop certain complications, such as a bleeding ulcer that causes you to lose large amounts of blood, this can interfere with your ability to deliver oxygen and nutrients to the placenta and the developing baby.

What to consider about taking medications when you are pregnant:

• The risks to yourself and your baby if you do not treat the indigestion
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat indigestion during pregnancy?

Indigestion is treated symptom by symptom, which can involve some medications. GERD and heartburn can be treated with agents that reduce acid production, called H-2 antihistamines. These include cimetidine, famotidine, nizatidine, and ranitidine. Stronger medications, called proton pump inhibitors, include lansoprazole and omeprazole. Ranitidine, cimetidine, and famotidine are considered to be fairly safe in pregnancy as are lansoprazole and omeprazole.3

IBS-associated cramping in the digestive tract is treated with medications called antispasmodics. It can also be treated with certain anti-depressant drugs, such as amitriptyline and fluoxetine. The way that these drugs fit in with pregnancy is that their safety for the developing baby has not been proven, but theres no clear indication that theyre harmful either, so they can be used in certain cases.

The drug loperamide, given for diarrhea, is very safe for the developing baby because it is not absorbed from the intestines into the bloodstream, so there is no way that it can reach the baby in the first place. Some concern, however, surrounds an anti-diarrheal drug called alosetron, so if loperamide works for you this is the drug of choice against diarrhea. Theres another anti-diarrheal drug called eluxadoline, which works similarly to loperamide, but its safety in pregnancy has not been studied widely.

Finally, laxatives are also used for IBS, particularly a type of laxative called an osmotic laxative. These work by drawing water into fiber to add bulk to stool, which helps both against diarrhea and constipation.

Who should NOT stop taking medication for indigestion during pregnancy?

Women with GERD symptoms should continue to take their medication since the condition has a major negative impact on quality of life and the benefit of the medications outweighs any risks. For other symptoms, each woman must work with her practitioner to decide if she needs to treat them with medications, try a change of diet, or put up with the symptom until after pregnancy.

What should I know about choosing a medication for indigestion?

You may find Pregistrys expert reports about the individual medications to treat indigestion here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for indigestion when I am breastfeeding?

Medications given for GERD are generally considered safe in women who are breastfeeding, even if tiny amounts of the drugs enter the milk. Some of the agents used in IBS, particularly loperamide and osmotic laxatives, are thought to be very safe as they never are absorbed from the mothers digestive tract.

What alternative therapies besides medications are there to treat indigestion?

Ginger can be slightly effective in combatting the gastrointestinal effects of pregnancy, including nausea. Dietary approaches to IBS are very important and include adequate intake of fiber and fluids, assessment of the effects of spicy or fatty food and reduction of these foods if helpful, and reductions of caffeine and alcohol. A diet low in FODMAPs should be attempted for a minimum of 3-4 weeks under dietitian guidance. A low, or no, lactose diet should also be attempted. With the dietary approaches, its basically trial and error to see if indigestion is improved. Certain approaches work for some people and not others. Symptoms also tend to improve with regular aerobic exercise, plus there are psychological therapies that can be helpful for some people.

What can I do for myself and my baby when I have indigestion during pregnancy?

Cooperate with your physicians, engage in a regular exercise program thats appropriate for pregnancy, and visit a dietitian to discuss possible dietary changes.

Resources for indigestion during pregnancy:

For more information about indigestion before, during, and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles:

• Mayo Clinic: First Trimester Pregnancy: What to expect
• U.K. National Health Service: Indigestion and Heartburn in Pregnancy