Indigestion

Indigestion, sometimes called dyspepsia, is a general term covering a group of nonspecific symptoms in the digestive tract. It is often described as a feeling of fullness, bloating, nausea, heartburn, or gassy discomfort inthe chest or abdomen. The symptoms develop during meals or shortly afterward.In most cases, indigestion is a minor problem that often clears up without professional treatment.

Indigestion is a widespread condition, estimated to occur in 25% of the adultpopulation of the United States.

The symptoms associated with indigestion have a variety of possible physicalcauses, ranging from commonplace food items to serious systemic disorders:

  • Diet. Milk, milk products, alcoholic beverages, tea, and coffee cause indigestion in some people because they stimulate the stomach's production of acid.
  • Medications. Certain prescription drugs as well as over-the-counter medications can irritate the stomach lining. These medications include aspirin, non-steroidal anti-inflammatory drugs, some antibiotics, and oral contraceptives.
  • Disorders of the pancreas and gallbladder, including inflammation of the gallbladder or pancreas, cancer of the pancreas, and gallstones.
  • Intestinal parasites, such as fluke and tapeworm infections, giardiasis, and strongyloidiasis.
  • Systemic disorders, including diabetes, thyroid disease, collagen vascular disease.
  • Cancers of the digestive tract.
  • Conditions associated with women's reproductive system, including menstrualcramps, pregnancy, and pelvic inflammatory disease.

Indigestion often accompanies an emotional upset because the part of the nervous system involved in the so-called "fight-or-flight" response also affects the digestive tract. Many people in the general population will experience heartburn, "butterflies in the stomach," or stomach cramps when they arein upsetting situations--such as school examinations, arguments with familymembers, crises in their workplace, and so on. Some people's digestive systems appear to react more intensely to emotional stress due to hypersensitive nerve endings in their intestinal tract.

In some cases, the patient's description of the symptoms suggests a specificdigestive disorder as the cause of the indigestion. Some doctors classify these cases into three groups:

Esophagitis is an inflammation of the tube that carries food from the throatto the stomach (the esophagus). The tissues of the esophagus can become irritated by the flow (reflux) of stomach acid backward into the lower part of theesophagus. If the patient describes the indigestion in terms of frequent orintense heartburn, the doctor will consider gastroesophageal reflux disease (GERD) as a possible cause. GERD is a common disorder in the general population, affecting about 30% of adults.

Patients who smoke and are over 45 are more likely to have indigestion of thepeptic ulcer type. This group also includes people who find that their indigestion is relieved by taking antacids or eating a small amount of food.

Most cases of chronic indigestion--as many as 65%--fall into this category. Nonulcer dyspepsia is sometimes called functional dyspepsia because it appearsto be related to abnormalities in the way that the stomach empties its contents into the intestine. In some people, the stomach empties either too slowlyor too rapidly. In others, the stomach's muscular contractions are irregularand uncoordinated. These disorders of stomach movement (motility) may be caused by hypersensitive nerve endings in the stomach tissues. Patients in thisgroup are likely to be younger than 45 and have a history of taking medications for anxiety or depression.

Because indigestion is a nonspecific set of symptoms, patients who feel sickenough to seek medical attention are likely to go to their primary care doctor. The history does not always point to an obvious diagnosis. The doctor can,however, use the process of history-taking to evaluate the patient's mood oremotional state in order to assess the possibility of a psychiatric disturbance. In addition, asking about the location, intensity, timing, and recurrence of the indigestion can help the doctor weigh the different diagnostic possibilities.

Since most cases of indigestion are not caused by serious disorders, many doctors prefer to try medications and other treatment measures before ordering an endoscopy. During this procedure, the doctor uses an endoscope, a slender tube-shaped instrument, to look at the lining of the patient's stomach. If thepatient has indigestion of the esophagitis type or nonulcer type, the stomach lining will appear normal. If the patient has PUD, the doctor will be ableto see breaks or ulcerated areas in the tissue. He or she may also order other imaging tests, such as ultrasound, or blood tests, especially if the patient is over 45.

Many patients benefit from the doctor's reassurance that they do not have a serious or fatal disorder. Cutting out alcoholic beverages and drinks containing caffeine often helps. The patient may also be asked to keep a record of food intake, daily schedule, and symptom severity. Food diaries sometimes reveal psychologic or dietary factors that influence indigestion.

Patients with the esophagitis type of indigestion are often treated with drugs that block the secretion of stomach acid, such as ranitidine (Zantac) and famotidine (Pepcid).

Patients with motility disorders may be given prokinetic drugs, which speed up the emptying of the stomach and increase intestinal motility. They includemetoclopramide (Reglan) and cisapride (Propulsid).

Most cases of mild indigestion do not need medical treatment. For patients who consult a doctor and are given an endoscopic examination, 5-15% are diagnosed with GERD and 15-25% with PUD. About 1% of patients who are endoscoped have stomach cancer. Most patients with functional dyspepsia do well on medication.

Indigestion can often be prevented by attention to one's diet, general stresslevel, and ways of managing stress. Specific preventive measures include:

  • Quitting smoking.
  • Cutting down on or eliminating alcohol, tea, or coffee.
  • Avoiding fatty and spicy foods.
  • Eating slowly and keeping mealtimes relaxed.
  • Practicing yoga or meditation.
  • Not taking aspirin or other medications on an empty stomach.
  • Keeping one's weight within normal limits.

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