What is Dyspepsia or indigestion ? What are its causes?

A common complaint in clinical practice. Term dyspepsia indicate, pain or discomfort in the upper abdomen which can be acute ,chronic or recurrent. Patients with dyspepsia also complain of heartburn, that if present indicate underlying gastroesophageal reflux disease. Patients usually use the term indigestion to describe any problems related to food. It seen in 80% of population.

Characteristic associated symptoms are population.

• Upper abdominal fullness,

• Early satiety

• Burning,

• Bloating,

• Belching,

• Nausea,

• Retching,

Alarm features in dyspepsia.

• Weight loss

• Anaemia

• Persistent Vomiting

• Vomiting of blood  ,passage of blood in stool

• Difficulty in swallowing

• Palpable abdominal mass

• Constant or severe pain

If any of the alarming symptoms are present detailed evaluation is required. Detailed evaluation is also needed in people presenting with new onset dyspepsia at the age more than 55 and young people if not responding to treatment.

Causes of indigestion or dyspepsia

Indigestion directly related to food Drug Intolerance.

Sudden self limited indigestion can occur with overeating ,quick eating ,high fat food intake, eating during stressful circumstances, excessive alcohol or coffee intake.

Drug Intolerance - Commn drugs ivolved are aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, digoxin, iron, antibiotics (metronidazole, macrolides), diabetes drugs (metformin, alpha-glucosidase inhibitors, , donepezil, rivastigmine, and opioids

Gut  Dysfunction

Peptic ulcer disease (5–15% ). Gastroesophageal reflux disease ( 20% ). Gastric cancer ( 1% ). Helicobacter pylori Infection.are seen

Other Conditions

Diabetes, thyroid disease, kidney disease, heart attack, pregnancy, intra-abdominal cancers, Pancreatic Disease, Disease of the gall bladder and bile duct may be seen.

Functional Dyspepsia

Most common cause of chronic indigestion is functional dyspepsia. Upto two third of patients have no significant cause for their indigestion. Tt is difficult to treat although it is benign.

Recent employment changes, physical and sexual abuse, marital disharmony, depression, anxiety, depression, and fear of serious disease all may lead to development of symptoms. Functional dyspepsia is often seen in young people anxiety and depression or on psychiatric drugs .

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Management of dyspepsia or indigestion

Although dyspepsia or indigestion is common in general population detailed evalution is required in new onset dyspepsia in elderly people, young people not improving with empirical treatment . Also when alarming symptoms such as  weight loss, organomegaly, abdominal mass, or fecal occult blood are present.

Initial laboratory test should include

• Complete blood count,

• Electrolytes,such as serum sodium and potassium

• Liver enzymes,

• Calcium,

• Thyroid function tests.

Special Examinations

• Upper Endoscopy - Useful in detecting mucosal erosion, stomach ulceration and cancers. Young people test for H pylori is done noninvasive test for H pylori such as IgG serology, fecal antigen test, or urea breath test

• Abdominal imaging (ultrasonography or CT scanning), if disease of pancreas or gall bladder is suspected

Treatment of Dyspepsia

Functional Dyspepsia

Even though functional dyspepsia is benign and no organic cause is found it is difficult to control their symptoms

• General Measures

In those with mild and intermittent symptoms life style changes and reassurance will help to reduce the symptoms. In certain people it is precipitated by food and drugs. People should take precaution to avoid such food and drugs. Excessive alcohol, caffeine, fatty food should be avoided.

• Drugs

People with indigestion and heartburn get relief with H2-receptor antagonists examples ranitidine or nizatidine, famotidine, or cimetidine or proton pump inhibitors omeprazole, esomeprazole, or rabeprazole, lansoprazole or antoprazole.

Low doses of antidepressants such as desipramine is helpful in some patients

Metoclopromide may be tried, but chronic use is not advised

Anti-H pylori Treatment - A ntibiotic to treat H Pylori is given.

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