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Dyspepsia

Related Terms

  • Gas
  • Indigestion
  • Poor Digestion
  • Stomach Upset

Uses

Principal Proposed Natural Treatments

Other Proposed Natural Treatments

Dyspepsia is a catchall term that includes a variety of digestive problems such as stomach discomfort, gas, bloating, belching, appetite loss, and nausea. Although many serious medical conditions can cause digestive distress, the term dyspepsia is used when no identifiable medical cause can be detected. In this way, dyspepsia is like a stomach version of the symptoms in the intestines called irritable bowel syndrome .
The standard medical approach to dyspepsia begins by looking for an identifiable medical condition such as gallstones , ulcers , or esophageal reflux . If none is found, various treatments are often suggested on a trial-and-error basis, including medications that reduce stomach acid as well as those that decrease spasm in the digestive tract. The drugs cisapride (Propulsid) and metoclopramide (Reglan) increase stomach emptying, and have also been tried for dyspepsia. However, cisapride has been taken off the market, and metoclopramide causes many side effects.
It's thought that stress plays a role in dyspepsia, as it does with irritable bowel syndrome. Interestingly, one study of 30 people with dyspepsia found that after 8 weeks of treatment with placebo, 80% reported their symptoms had improved. 1 This unusually high placebo response emphasizes the emotional contribution to this condition.
In Europe, it is widely believed, though without much supporting evidence, that dyspepsia is commonly caused by inadequate function of the gallbladder.

Principal Proposed Natural Treatments

Artichoke Leaf

An extract of artichoke leaf has undergone considerable study in the last few years as a treatment for a variety of conditions, most prominently high cholesterol . Artichoke leaf is one of many herbs thought to stimulate gallbladder function. 7 In 2003, a large (247-participant) study evaluated artichoke leaf as a treatment for dyspepsia. 24 In this carefully conducted study, artichoke leaf extract proved significantly more effective than placebo for alleviating symptoms of functional dyspepsia. A study of an herbal combination containing artichoke leaf is described below.
For more information, including dosage and safety issues, see the full Artichoke article.

Turmeric

The spice turmeric contains a substance, curcumin, that may stimulate gallbladder contractions. 2,3 A double-blind, placebo-controlled study including 106 people compared the effects of 500 mg of curcumin 4 times daily against placebo (as well as against a locally popular over-the-counter treatment). After 7 days, 87% percent of the curcumin group experienced full or partial symptom relief from dyspepsia as compared to 53% of the placebo group. 4
For more information, including dosage and safety issues, see the full Turmeric article.

Other Proposed Natural Treatments

Combination Herbal Treatments

Several studies, enrolling a total of more than 600 participants, have found benefits with a proprietary herbal combination therapy containing bitter candytuft ( Iberis amara ) as the major active ingredient. 22,25,26,27,31 The largest of these was an 8-week, double-blind study of 315 people with functional dyspepsia, in which the candy tuft product proved significantly more effective than placebo. 31
A double-blind trial of 60 people given either placebo or a combination of artichoke leaf, celandine and boldo found improvements in symptoms of indigestion after 14 days of treatment. 7 Similarly positive effects were seen in a double-blind trial of 76 individuals given a combination treatment containing turmeric and celandine. 8
Note : Reports have raised concerns that celandine can damage the liver. 9-11 In addition, boldo is dangerous for use by pregnant women, or individuals with liver or kidney disease.

Essential Oils of Carminative Herbs

Herbs believed to assist in the passing of gas are traditionally called "carminatives." Classic carminatives include caraway , chamomile , dill, fennel , peppermint , spearmint, and turmeric . Essential oils made from some of these herbs have been studied for the treatment of dyspepsia.
For example, a double-blind, placebo-controlled study including 39 individuals found that an enteric-coated peppermint-caraway oil combination taken 3 times daily for 4 weeks significantly reduced dyspepsia pain as compared to placebo. 12 Of the treatment group, 63.2% was pain free after 4 weeks, compared to 25% of the placebo group.
Results from a double-blind comparative study including 118 people suggest that the combination of peppermint and caraway oil is comparably effective to the standard drug cisapride, which is no longer available. 13 After 4 weeks, the herbal combination reduced dyspepsia pain by 69.7%, whereas the conventional treatment reduced pain by 70.2%.
A preparation of peppermint, caraway, fennel, and wormwood oils was compared to metoclopramide in another double-blind study enrolling 60 individuals. 14 After 7 days, 43.3% of the treatment group was pain-free compared to 13.3% of the metoclopramide group. Metoclopramide works by reducing gastric emptying time (in other words, speeding the passage of food from the stomach into the intestines). Interestingly, some evidence suggests that peppermint oil may have the same effect. 32
Note : Essential oils of herbs can present health risks. In particular, wormwood (the herb in absinthe) is dangerous when taken long term. Physician supervision is strongly recommended. See the Essential Oil article for more information.

Cayenne

Preliminary evidence suggests that oral use of the herb cayenne can reduce the pain of dyspepsia. This may seem like an odd use of the herb; intuitively, it seems that hot peppers should be hard on the stomach. However, contrary to popular belief, hot peppers don’t actually inflame the tissues they contact; in fact, hot peppers aren’t even harmful for ulcers! 20 Rather, they merely produce sensations similar to those caused by actual damage.
Here’s how it works: All hot peppers contain a substance called capsaicin. When applied to tissues, capsaicin causes release of a chemical called substance P . Substance P is ordinarily released when tissues are damaged; it is part of the system the body uses to detect injury. When hot peppers artificially release substance P, they trick the nervous system into thinking that an injury has occurred. The result: a sensation of burning pain. When capsaicin is applied regularly to a part of the body, substance P becomes depleted in that location. This is why individuals who consume a lot of hot peppers gradually build up a tolerance. It’s also the basis for a number of medical uses of capsaicin. When levels of substance P are reduced in an area, all pain in that area is somewhat reduced. Because of this effect, capsaicin cream is widely used for the treatment of painful conditions such as shingles, arthritis, and diabetic neuropathy.
Oral use of capsaicin may also reduce discomfort in the stomach. In a double-blind study, 30 individuals with dyspepsia were given either 2.5 g daily of red pepper powder (divided up and taken prior to meals) or placebo for 5 weeks. 21 By the third week of treatment, individuals taking red pepper were experiencing significant improvements in pain, bloating, and nausea as compared to placebo, and these relative improvements lasted through the end of the study.

Other Herbs and Supplements

A controlled (but not blinded) study of 46 people suggests that banana powder, a traditional Indian food, may help treat dyspepsia. After 8 weeks of treatment, 75% of the people taking banana powder reported complete or partial symptom relief compared to 20% of those who received no treatment. 15
Herbs with a reputation for relaxing a nervous stomach, such as chamomile , valerian , and lemon balm , are also sometimes recommended for dyspepsia. Numerous other herbs that have been recommended for dyspepsia include angelica root, anise seed, barberry , bitter orange peel, blessed thistle , cardamom, centaury, chicory, dandelion root, cinnamon , cloves, coriander, devil's claw , dill, gentian , ginger , horehound , juniper , linden , milk thistle , radish, rosemary , sage , St. John's wort , star anise, and yarrow .
A tea made from the "fruits" or seeds of parsley is a traditional remedy for colic, indigestion, and intestinal gas. 18,19
Reduced levels of digestive enzymes may play a role in dyspepsia. One double-blind study found that use of pancreatic enzyme supplements improved symptoms following consumption of a high-fat meal. 23 However, another placebo-controlled study failed to find pancreatic enzymes helpful for dyspepsia symptoms in general. 16
Very weak evidence hints that melatonin might be helpful for dyspepsia. 29
One study failed to find probiotics (friendly bacteria) helpful for dyspepsia in children. 28
Two studies failed to find the carotenoid astaxanthin more effective than placebo for the treatment of stomach irritation in people with dyspepsia. 30,33
Betaine hydrochloride increases the acidity of the stomach, and on that basis it has been proposed as a digestive aid for people with inadequate stomach acid. However, there is no evidence that reduced stomach acid levels causes symptoms of indigestion.

Herbs and Supplements to Use Only With Caution

Various herbs and supplements may interact adversely with drugs used to treat dyspepsia. For more information on this potential risk, see the individual drug article in the Drug Interactions section of this database.

References

1 Mearin F, Balboa A, Zarate N, et al. Placebo in functional dyspepsia: symptomatic, gastrointestinal motor, and gastric sensorial responses. Am J Gastroenterol. 1999;94:116-125.

2 Rasyid A, Lelo A. The effect of curcumin and placebo on human gall-bladder function: an ultrasound study. Aliment Pharmacol Ther. 1999;13:245-249.

3 Ammon HP, Wahl MA. Pharmacology of Curcuma longa. Planta Med. 1991;57:1-7.

4 Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T, et al. Randomized double blind study of Curcuma domestica Val. for dyspepsia. J Med Assoc Thai. 1989;72:613-620.

7 Kupke D, von Sanden H, Trinczek-Gartner H, et al. An evaluation of the choleretic activity of a plant-based cholagogue [translated from German]. Z Allgemeinmed. 1991;67:1046-1058.

8 Niederau C, Gopfert E. The effect of chelidonium- and turmeric root extract on upper abdominal pain due to functional disorders of the biliary system. Results from a placebo-controlled double-blind study [translated from German]. Med Klin. 1999;94:425-430.

9 Greving I, Meister V, Monnerjahn C, et al. Chelidonium majus: a rare reason for severe hepatotoxic reaction. Pharmacoepidemiol Drug Safety. 1998;7:S66-S69.

10 Benninger J, Schneider HT, Schuppan, et al. Acute hepatitis induced by greater celandine (Chelidonium majus). Gastroenterology. 1999;117:1234-1237.

11 Strahl S, Ehret V, Dahm H, et al. Necrotizing hepatitis after taking herbal remedies [translated from German]. Dtsch Med Wochenschr. 1998;123:1410-1414.

12 May B, Kuntz H-D, Kieser M, et al. Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung. 1996;46:1149-1153.

13 Madisch A, Heydenreich CJ, Wieland V, et al. Treatment of functional dyspepsia with a fixed peppermint oil and caraway oil combination preparation as compared to cisapride. A multicenter, reference-controlled double-blind equivalence study. Arzneimittelforschung. 1999;49:925-932.

14 Westphal J, Horning M, Leonhardt K. Phytotherapy in functional upper abdominal complaints. Results of a clinical study with a preparation of several plants. Phytomedicine. 1996;2:285-291.

15 Arora A, Sharma MP. Use of banana in non-ulcer dyspepsia. Lancet. 1990;335:612-613.

16 Kleveland PM, Johannessen T, Kristensen P, et al. Effect of pancreatic enzymes in non-ulcer dyspepsia. A pilot study. Scand J Gastroenterol. 1990;25:298-301.

17 Rodriguez-Stanley S, Collings KL, Robinson M, et al. The effects of capsaicin on reflux, gastric emptying and dyspepsia. Aliment Pharmocol Ther. 2000;14:129-134.

18 Review of Natural Products. St. Louis, Mo: Facts and Comparisons; 1991: Parsley monograph.

19 Gruenwald J. PDR for Herbal Medicines. Montvale, NJ: Medical Economics; 1998:1023-1024.

20 Graham DY, Smith JL, Opekun AR. Spicy food and the stomach. Evaluation by videoendoscopy. JAMA. 1988;260:3473-3475.

21 Bortolotti M, Coccia G, Grossi G, et al. The treatment of functional dyspepsia with red pepper. Aliment Pharmacol Ther. 2002;16:1075-1082.

22 Madisch A, Melderis H, Mayr G, et al. A plant extract and its modified preparation in functional dyspepsia. Results of a double-blind placebo controlled comparative study. Z Gastroenterol. 2001;39:511-517.

23 Suarez F, Levitt MD, Adshead J, et al. Pancreatic supplements reduce symptomatic response of healthy subjects to a high fat meal. Dig Dis Sci. 1999;44:1317-1321.

24 Holtmann G, Adam B, Haag S, et al. Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 2003;18:1099-1105.

25 Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion. 2004;69:45-52. 2004 Jan 30. [Epub ahead of print]

26 Gundermann KJ, Godehardt E, Ulbrich M. Efficacy of a herbal preparation in patients with functional dyspepsia: a meta-analysis of double-blind, randomized, clinical trials. Adv Ther. 2003;20:43-49.

27 Rosch W, Liebregts T, Gundermann KJ, et al. Phytotherapy for functional dyspepsia: A review of the clinical evidence for the herbal preparation STW 5. Phytomedicine. 2006 Sep 13. [Epub ahead of print]

28 Gawronska A, Dziechciarz P, Horvath A, et al. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25:177-184.

29 Klupinska G, Poplawski T, Drzewoski J, et al. Therapeutic effect of melatonin in patients with functional dyspepsia. J Clin Gastroenterol. 2007;41:270-274.

30 Andersen LP, Holck S, Kupcinskas L, et al. Gastric inflammatory markers and interleukins in patients with functional dyspepsia treated with astaxanthin. FEMS Immunol Med Microbiol. 2007 May 23. [Epub ahead of print]

31 von Arnim U, Peitz U, Vinson B, et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102:1268-1275.

32 Inamori M, Akiyama T, Akimoto K, et al. Early effects of peppermint oil on gastric emptying: a crossover study using a continuous real-time (13)C breath test (BreathID system). J Gastroenterol. 2007;42:539-542.

33 Kupcinskas L, Lafolie P, Lignell A, et al. Efficacy of the natural antioxidant astaxanthin in the treatment of functional dyspepsia in patients with or without Helicobacter pylori infection: A prospective, randomized, double blind, and placebo-controlled study. Phytomedicine. 2008 May 6.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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