Dyspepsia is basically a chronic upset stomach--painful, difficult, or disturbed digestion that might be accompanied by symptoms such as nausea and vomiting, heartburn, bloating, or stomach discomfort.

This digestive problem may have an identifiable cause, such as bacterial or viral infection, peptic ulcer, gallbladder, or liver disease. The bacteria Helicobacter pylori is often present in individuals suffering from duodenal or gastric ulcers. Investigation of recurrent indigestion should rule outthese possible causes.

Often, there is no organic cause for dyspepsia, in which case it is classified as functional or nonulcer dyspepsia. There is evidence that functional dyspepsia may be related to a state known as dysmotility, in which the esophagus,stomach, and upper intestine contract spontaneously. These patients may respond to a group of drugs called prokinate agents.

In terms of external causes, a review of the patient's eating habits (e.g. chewing with the mouth open, gulping food, or talking while chewing) could reveal a tendency to swallow air. This may contribute to feeling bloated or excessive belching or gas. Smoking, caffeine, alcohol, or carbonated beverages sometimes contribute to the discomfort. Sensitivity or allergy to certain food substances may cause gastrointestinal distress, while some medications are associated with indigestion. In addition, stomach problems may also be a response to stress or emotional unrest.

Treatment of dyspepsia might begin with a physical examination to rule out internal bleeding. If blood is found through a rectal exam, laboratory studies,including a blood count, may be ordered. A physician might also order upper-gastrointestinal x-ray studies using barium so he or she can see any abnormalities. Endoscopy, a technology for examining the inside of body cavities, permits collection of tissue and culture specimens that could help reach a diagnosis.

The treatment of dyspepsia is based on assessing symptoms and suspected causes. Clinical evaluation is aimed at distinguishing those patients who requireimmediate testing from those who can safely benefit from more conservative initial treatment. Some of the latter may require only reassurance, dietary modifications, or antacid use. Medications to block production of stomach acids,prokinate agents, or antibiotic treatment might be in order. However, further diagnostic investigation is necessary if there is severe abdominal pain, pain radiating to the back, unexplained weight loss, difficulty swallowing, a palpable mass, or anemia. Additional testing is also required if a patient does not respond to prescribed medications.

Typically, about half of patients with dyspepsia will be found to have eitherduodenal/gastric ulcer disease or irritable bowel syndrome. Very few are shown to have cancer. Meanwhile, many people suffering from functional dyspepsiaare found to have (gastritis.

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