What is the initial treatment for acute indigestion?

Initial Treatment for Acute Indigestion

For acute indigestion, antacids are the recommended first-line treatment due to their rapid onset of action and effectiveness in providing immediate symptom relief.

Understanding Acute Indigestion

Acute indigestion (dyspepsia) is characterized by upper abdominal discomfort, often accompanied by:

• Epigastric pain or burning sensation
• Bloating or fullness
• Nausea
• Belching
• Acid regurgitation

Treatment Algorithm

First-Line Treatment

1. Antacids
   • Provide immediate relief through direct neutralization of gastric acid
   • Examples: calcium carbonate, magnesium hydroxide, aluminum hydroxide combinations
   • Dosing: Take at onset of symptoms and as needed
   • Best for on-demand, immediate relief rather than daily maintenance therapy 1

Second-Line Treatment (if antacids insufficient)

1. For ulcer-like/acid-related symptoms (epigastric pain/burning):

   • Proton Pump Inhibitors (PPIs)
     • Omeprazole 20mg once daily before meals 2
     • Continue for up to 4 weeks for symptomatic GERD 2
     • Most effective medication for daily reduction of stomach acid 1

2. For dysmotility-like symptoms (fullness, bloating):

   • Prokinetic agents may be considered 3
   • Note: Cisapride is no longer recommended due to cardiac toxicity 3

3. For significant nausea/vomiting:

   • Antiemetics such as ondansetron may be considered 3
   • Particularly helpful when vomiting impairs oral rehydration 3

Special Considerations

Dietary Management

• Avoid the traditional BRAT (bananas, rice, applesauce, toast) diet as supporting data are limited 3
• Early refeeding is beneficial and decreases intestinal permeability 3
• Instructing patients to refrain from eating solid food for 24 hours is not useful 3

When to Escalate Treatment

• If symptoms persist after 2 weeks of treatment
• If alarm symptoms develop (weight loss, dysphagia, persistent vomiting, anemia)
• Consider endoscopy if symptoms are resistant to empiric therapy 3

Cautions

• Antacids can interact with other medications by changing gastric pH or through adsorption/chelation 4
• Space antacids at least 2 hours apart from other medications
• Long-term use of antacids in large doses may lead to significant adverse effects, especially in patients with underlying diseases such as chronic renal failure 4
• Reduction of gastric acid by antacids may potentially increase risk of foodborne illness in some cases 5

Follow-up Recommendations

• If symptoms resolve with initial treatment, no further action is needed
• If symptoms recur after treatment cessation, consider a trial of on-demand therapy 3
• For persistent symptoms despite appropriate therapy, consider referral to a gastroenterologist for further evaluation

By following this approach, most cases of acute indigestion can be effectively managed with rapid symptom relief while addressing the underlying physiologic disturbance.