Indigestion (Dyspepsia)

 

Indigestion (dyspepsia) refers to an uncomfortable feeling of fullness after meals that is associated with nausea, belching, heartburn, and sometimes bloating. It is often worsened by consuming very spicy, fatty foods, along with caffeine consumption.

Indigestion mainly affects the stomach, the first portion of the small intestine and in certain cases can also involve the esophagus, causing these organs to function abnormally. It is a chronic disease in which the discomfort varies in frequency and intensity, usually for many months or years.

Epidemiology

Indigestion is one of the most common conditions. In the United States, for example, 20% of people suffer from indigestion. Most likely, only 10% of those affected will seek medical attention to solve this problem. Physicians refer to indigestion as non-ulcer or functional dyspepsia to differentiate it from the signs and symptoms related to peptic ulcer disease.

Causes of Indigestion (Dyspepsia)

Some of the medical problems or conditions that are related to dyspepsia include:

-Gallstones
-Cirrhosis of the liver
-Ulcer in the duodenum
-Acute dilatation of the stomach
-Stomach ulcer
-Chronic gastritis
-Cancer of the digestive tract
-Heart failure
-Hepatitis
-Hiatal hernia
-Pulmonary embolism
-Pulmonary tuberculosis
-Elevated blood nitrogen levels due to renal failure

Drugs

Medications that are related to the occurrence of dyspepsia include:

-Nonsteroidal anti-inflammatory drugs (NSAIDs).
-Diuretics
-Antibiotics
-Corticosteroids

Other Causes of Indigestion (Dyspepsia)

Dyspepsia may occur after digestive or other surgery, as well as gastritis, which often follows a surgical procedure.

Symptoms 

The main symptoms of indigestion include:

-Pain or discomfort in the upper abdomen.
-Belching
-Nausea
-Abdominal bloating
-Feeling full after eating only a small amount of food, known as early satiety
-Occasional vomiting

Risk Factors

Factors that may increase the likelihood of dyspepsia include:

-Advanced age
-Some over-the-counter medications, such as aspirin and ibuprofen.
-Smoking
-Alcohol use
-History of physical or sexual abuse in childhood
-Female sex

Diagnosis

It is important for the gastroenterologist to take a detailed history, including questioning, in which the patient can describe in detail the symptoms related to the presence of dyspepsia. Inquiry should be made as to whether the patient is experiencing an unusual or overwhelming amount of emotional stress.

The physical examination will focus on the abdomen, looking for the presence of fluid (ascites), abdominal distention, obvious hernias, jaundice (yellowing of the skin) and spotting (ecchymosis).

The appearance of discomfort, and if these are of great intensity, in people over 55 years of age, merits the performance of tests to determine the cause. These tests include:

-Blood tests
-Breath and stool test (detection of Helicobacter pylori bacteria).
-Digestive endoscopy
-Imaging studies such as x-rays or CT scans.

Once all the complementary tests have been performed, and they do not yield a possible diagnosis, the patient is considered to be suffering from functional dyspepsia.

Complications

Dyspepsia is usually mild in most cases. However, severe indigestion may occasionally trigger some complications.

Esophageal stricture

Reflux of acidic gastric contents can cause indigestion. Esophageal stricture is a disorder in which stomach acid leaks into the esophagus irritating the delicate esophageal mucosa. This irritation can lead to scarring and narrowing of the esophageal duct.

People with esophageal stricture may have difficulty swallowing (dysphagia). Food may get stuck in the pharynx and cause chest pain. In severe cases, a surgical procedure called esophageal dilation may be needed to widen the esophagus.

Pyloric stenosis

A narrowing or stenosis occurs at the level of the pylorus, which is the area that joins the stomach to the duodenum (initial portion of the small intestine). The contact of the acid content with the pylorus causes stenosis and scarring, as a result of which food is not digested properly. Likewise, sometimes a surgical procedure will be required to improve or treat pyloric stenosis.

Treatment

Treatment of indigestion depends on the cause of the indigestion and the severity of the discomfort. If symptoms are mild or occur infrequently, lifestyle modifications may alleviate them. These modifications involve reducing the consumption of fatty and spicy foods, in addition, less caffeine, chocolate and alcohol should be consumed. It is also advisable to stop smoking. A restful sleep of at least 7 hours may also be helpful in mild indigestion.

Drugs

In cases where the discomfort of indigestion is frequent or of greater severity, the gastroenterologist may prescribe certain medications.

Antacids

They neutralize the effects of hydrochloric acid originating in the stomach. Some of these medications include a combination of magaldrate and simethicone. The physician prescribes them in the first instance for mild indigestion or dyspepsia.

H-2 receptor antagonists

These drugs decrease the levels of stomach acidity, and their action time is longer than that of antacids, in addition, they act faster in relieving symptoms, although they are currently little used due to the appearance of more potent drugs, such as PPIs. These drugs include cimetidine, famotidine, ranitidine, among others.

Proton Pump Inhibitors (PPI)

They are very effective in both dyspepsia and gastroesophageal reflux disease, reduce stomach acidity and are more potent than antacids. These drugs include omeprazole, lanzoprazole, esomeprazole, among others.

Prokinetics

These compounds help to improve the movement or motility of the stomach, to achieve better stomach emptying. They can present side effects such as tiredness, depression, drowsiness, anxiety and muscle contractions. Cinitapride is one of the most commonly used prokinetics.

Antidepressants

They are used in low doses especially in cases of functional dyspepsia, i.e. when no organic cause has been found. In certain cases, these drugs can alleviate the pain sensation experienced by the patient. They are not without side effects, which may include nausea, headache, agitation, constipation and night sweats.

Diet in Dyspepsia

Fiber is very important as it cleanses the intestine and makes digestion more adequate. Foods high in fiber promote better digestive health. Fruits, nuts, legumes and whole grains contain a lot of fiber and are an excellent way to protect against indigestion.

Spicy or very high-fat foods should be avoided. It is important to consume fluids with meals to help move food through the digestive tract and promote good digestion. Eating four to five meals in smaller portions instead of three large meals can also help the digestive system.

References

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Indigestion (Dyspepsia)
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Indigestion (Dyspepsia)
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Indigestion (dyspepsia) refers to an uncomfortable feeling of fullness after meals that is associated with nausea, belching, heartburn, and sometimes bloating. It is often worsened by consuming very spicy, fatty foods, along with caffeine consumption.
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