Indigestion at 60 or Older?Why Guidelines Suggest a Scope First
Bloating & DigestionArticleUpper-belly pain, burning or feeling full too fast is usually harmless, but the age you start having it changes the advice. A joint U.S. and Canadian gastroenterology guideline suggests an upper endoscopy for people 60 and older with indigestion, and an H. pylori test, then acid reducers, for younger people. Here is the step-by-step path.
In this article
Indigestion (dyspepsia) means pain or burning in the upper belly, often with feeling full quickly or uncomfortably full after meals. The American College of Gastroenterology and the Canadian Association of Gastroenterology issued a joint guideline on how to evaluate it, and age is the first branch point.1
If you’re 60 or older
The guideline suggests an upper endoscopy (a scope of the esophagus, stomach and first part of the intestine) to rule out an underlying cause.1 It’s a conditional recommendation, so your situation matters.1
People at higher risk of stomach cancer, such as those who grew up in a country with high rates or who have a family history, may be offered a scope at a younger age.1
If you’re younger than 60
- Test for H. pylori with a breath or stool test, and treat it if positive.1 See our guide to stomach ulcers and H. pylori.
- If that’s negative or doesn’t help, try an acid reducer (PPI).1
- If that doesn’t work, a low-dose tricyclic antidepressant or a medicine that speeds stomach emptying may be tried.1
If the scope is normal
You may be told you have functional dyspepsia.1 The guideline recommends treating H. pylori if present, then trying a PPI, then a tricyclic antidepressant, then a stomach-emptying medicine, in that order.1 Routine stomach-emptying tests aren’t recommended for everyone.1 Our functional dyspepsia follow-up script and gastric emptying test questions can help.
Things to mention at your visit
- When it started and whether it’s new for you
- Pain relievers you take; see NSAIDs and stomach bleeding
- Family history of stomach cancer
- Any weight loss, vomiting or trouble swallowing
Our guides to heartburn vs. GERD and stopping long-term acid reducers cover related questions.
Try: “I’m 62 and have had upper-belly burning and early fullness for two months. Do I need an endoscopy, and should I be tested for H. pylori?”
Bloated by Dinner includes a Belly Clock log and a Test-It list with a visit script. Use them to record when symptoms start relative to meals and what makes them better or worse. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't ignore professional advice or delay getting care because of something you read here. Vomiting blood, black or bloody stools, trouble swallowing, unexplained weight loss, a lump in the belly, or chest pain need prompt medical care; chest pain can be a heart problem. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses a clinical guideline. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- American Journal of Gastroenterology (abstract via PubMed), 2017ACG and CAG Clinical Guideline: Management of Dyspepsia (opens in a new tab)abcdefghij
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