Dyspepsia ("Indigestion")
Dyspepsia is pain or discomfort centered in the upper abdomen. Symptoms can also include, bloating, belching, satiety (feeling full after a meal), nausea or vomiting.
Most people suffering dyspepsia have functional (non ulcer) dyspepsia, meaning that tests fail to identify any known causes. Functional dyspepsia does not lead to cancer or other serious illnesses.
In fewer cases, peptic ulcers are associated with the dyspepsia..
Indigestion from overeating or failing to chew food thoroughly can cause dyspeptic feelings that usually go away naturally.
Indigestion, however, can be the result of a gastrointestinal condition or a side effect of medications. Stress or anxiety can bring on the dyspepsia symptoms. Some individuals, suffer frequently recurring dyspepsia.
When tests fail to find abnormalities in the gastrointestinal tract, the dyspepsia is identified as functional (non-ulcer) dyspepsia. About 60 percent of people with recurring dyspepsia have functional dyspepsia.
Usually, the dyspepsia symptoms go away, but some people suffer frequent occurrences, adversely affecting their quality of life.
Stress, anxiety or depression may be contributing factors. Also, dyspepsia is a side effect of many medicines.
Most people have indigestion occasionally, particularly after a large spicy meal. Usually, it goes away without treatment. Indigestion can be worsened by:
- Stress and anxiety
- Anti-inflammatory medicines
- Arthritis medicines Coffee
- Excessive alcohol
- Tobacco
- Drugs
- Large, spicy or fatty meals
- Irregular meals
- Insufficient consumption of water
- Peptic ulcer
- Pregnancy
A layer of mucus lining the stomach, intestines and esophagus acts as a barrier to stomach acid. If the mucus layer is damaged, the acid can irritate the tissues underneath, causing pain and ulcers.
Helicobacter pylori (H. pylori) dyspepsia
H. pylori is a bacterium that can gradually alter the protective layer of mucus lining the stomach and duodenum, permiting stomach acid to 'burn' the underlying cells causing inflammation and ulcers.
Drugs
Drugs that can disrupt the digestive system include:
- Anti-inflammatory medicines
- Bisphosphonates
- Calcium antagonists
- Corticosteroids
- Heart medication
- Iron supplements
- Narcotic pain relievers
- Nitrates
- Some antibiotics
- Some asthma medications
- Steroids
Signs and Symptoms of Dyspepsia
Symptoms of indigeston can reflect more serious conditions such as an ulcer or, more rarely, cancer. If you suffer abdominal pain more than four successive days, you must see your doctor for a diagnosis.
Dyspepsia symptoms are most often induced by eating. The symptoms can include:
- Upper abdominal pain (above the navel,
- Early satiety,
- Fullness,
- Bloating,
- Nausea and
- Vomiting.
The symptoms of occasional indigestion are familiar to most people. If these dyspepsia symptoms recur frequently, however, they could signal something more serious. Indigestion can be a symptom of stomach or oesophageal cancer. This is very rare, but only a thorough examination by a specialist can rule it out.
Heartburn is a burning pain (behind the breastbone) caused by a reflux (back flow) of stomach acid into your oesophagus (food tube). The pain can be so severe it can sometimes feel like a heart attack. Heartburn is not dyspepsia, however.
A stressful lifestyle, unhealthy diet and smoking are risk factors associated with dyspepsia. Other factors include cancer of the stomach, peptic ulcers and some medicines.
Non-steroidal Anti-inflammatory Drugs (NSAIDS) are frequently associated with medication-related dyspepsia.
When to See a Doctor
If you have recurring dyspepsia, talk to your doctor. This is especially important if any one or combination of the following is true for you:
- over 50 years of age
- recently lost weight without trying
- difficulty swallowing
- severe vomiting or appetite loss
- feel a mass in your stomach area
- black, tarry stools
- severe pain in the upper right abdomen
- discomfort unrelated to eating
- lump in the abdomen
- anemia, which can cause tiredness, dizziness and shortness of breath
- indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm
- symptoms that persist for more than two weeks
- symptoms that don't respond to treatment.
Screening and Diagnosis 1, 2
In some cases the dyspepsia can be accompanied by a gastrointestinal disorder such as irritable bowel syndrome (IBS). Your doctor may refer you to a gastroenterologist (a medically qualified specialist in diseases and disorders of the digestive system) for further diagnosis.
The gastroenterologist examines your medical history, physical condition and performs various tests to rule out:
- Bowel cancer,
- Acute appendicitis,
- Diverticulitis,
- Intestinal inflammation,
- Intestinal parasites,
- Crohn's colitis,
- Ulcerative colitis and
- other conditions.
Functional dyspesia can be diagnosed only when such possible causes of the symptoms are eliminated. Because many of the symptoms of dyspepsia overlap with symptoms of more-serious gastrointestinal conditions, the medical tests may be required. For example, the presence of the H. pylori bacterium might be detected in a sample of feces, by a breath test, or from a biopsy.
Such symptoms as vomiting, bleeding, or weight loss, and other symptoms requires an endoscopy. Prompt endoscopy can help rule out serious disease. Endoscopy is important particularly for patients over the age of 45 or 50 to detect possible gastric cancer.
Treatment of Dyspepsia
Many feel uneasy about possible side effects of medical treatments, which can range from mild to potentially serious. Each patient's reaction to medication can be different. Consequently, you may wish to discuss with your doctor the suitability of natural remedies (Self Care) before committing yourself to a course of drug treatments.
Because predicting side-effects is diffiicult, you must tell your doctor if you experience any problems with your medication.
The 'Standard Triple Therapy'
A frequently used drug treatment consists of three therapy stages in sequence:
- Amoxicillin (or metronidazole for those allergic to penacillin) AND
- Clarithromycin for the treatment of clarithromycin-resistant strains of H. pylori (the use of levofloxacin may be an option) AND
- Proton pump inhibitor such as omeprazole (or pantoprazole or rabeprazole).
If you are receiving drug treatment, you must follow your doctor’s instructions carefully and report any side effects to him immediately.
Consult your doctor about self-care, particularly if you intend to use herbs.
A 2004 meta-analysis pooling data from three double-blind placebo-controlled studies found the multiple herbal extract Iberogast significantly more effective than a placebo treating dyspepsia for functional dyspepsia by targeting multiple dyspeptic pathologies. This German-made phytopharmaceutical was found equivalent to and significantly superior to two standard drugs at reducing the symptoms of functional dyspepsia over a four week period.3
A 2002 study indicated that high doses of standardised artichoke leaf extract (ALE) may reduce symptoms of dyspepsia. Of the 516 participants, 454 completed the study. In the two dosage groups, compared with baseline, all dyspeptic symptoms reduced significantly. Health-related quality of life was significantly improved in both groups compared with baseline. The authors conclude that artichoke leaf extract "shows promise to ameliorate upper gastro-intestinal symptoms and improve quality of life in otherwise healthy subjects suffering from dyspepsia". 4
A 2006 article in the American Journal of Clinical Nutrition published evidence that probiotic yogurt may help eradicate H. pylori infection, which is associated with some instances of dyspepsia. 5
1. Pagana K.D., Pagana T.J. (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, St. Louis, Mosby. 3rd ed.
2. Fischbach F. T., Dunning M.B. (2004) Manual of Laboratory and Diagnostic Tests, Philadelphia: Lippincott Williams and Wilkins. (III, eds.) 7th ed.
3. Madisch A, Holtmann G, Mayr G, et al. (2004) Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion. 69:45-52.
4. Marakis G, Walker AF, Middleton RW, Booth JC, Wright J, Pike DJ, Artichoke leaf extract reduces mild dyspepsia in an open study. Phytomedicine. 2002 Dec;9(8):694-9.
5. Désirée Lie, MD, MSEd Laurie Barclay, MD (2006) Probiotic Yogurt May Help Eradicate H. pylori Infection, American Journal of Clinical Nutrition. 83:864-869
Bibliography
Holtmann G, Adam B, Haag S, et al. (2003) Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 18:1099-1105.
Holtmann, G., et al. (2003) Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment. Pharmacol. Ther. 18(11-12): 1099-105.
Bundy, R., et al. (2004) Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J. Altern. Complement. Med. 10(4): 667-9.
Gawronska A, Dziechciarz P, Horvath A, et al. (2007) A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 25:177-184.
Moayyedi P, Soo S, Deeks J, Delaney B, Harris A, Innes M, Oakes R, Wilson S, Roalfe A, Bennett C, Forman D. (2000) Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database of Systematic Reviews Issue 2. Art. No.: CD002096. DOI: 10.1002/14651858.CD002096.pub4
Farrell, Stephen, Milliken, Irene, Murphy, Jane L., Wootton, Steve A. and McCallion, William A. (2005) Nonulcer dyspepsia and Helicobacter pylori eradication in children. Journal of Pediatric Surgery, 40, (10), 1547-1550. (doi:10.1016/j.jpedsurg.2005.06.027)
http://eprints.soton.ac.uk/25484/
Thamlikitkul V, Bunyapraphatsara N, Dechatiwongse T, et al. (1989) Randomized double blind study of Curcuma domestica Val. for dyspepsia. J Med Assoc Thai. 72:613-620.
Arora A, Sharma MP. (1990) Use of banana in non-ulcer dyspepsia. Lancet. 335:612-613.
von Arnim U, Peitz U, Vinson B, et al. (2007) STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 102:1268-1275.
Alleviating the symptoms of dyspepsia
http://drgreene.mediwire.com/main/Default.aspx?P=Content&ArticleID=143033
Dyspepsia: What It Is and What to Do About It
http://familydoctor.org/474.xml
What Causes Dyspepsia?
http://www.wisegeek.com/what-causes-dyspepsia.htm
Functional (Non-Ulcer) Dyspepsia
http://www.patient.co.uk/showdoc/23069186/
Dyspepsia
http://www.wrongdiagnosis.com/sym/dyspepsia.htm
Is Helicobacter pylori the cause of dyspepsia?
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1881886
Indigestion - symptoms, causes, of dyspepsia, heartburn
http://hcd2.bupa.co.uk/fact_sheets/html/Dyspepsia.html
Dyspepsia - causes, symptoms and healing options
http://www.allayurveda.com/ail_dyspepsia.htm
Acute Appendicitis: Onset of inflammation of the appendix. The appendix is a small pouch attached to your large intestine. Appendicitis usually occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor. [RETURN]
Abdomen: The space between the chest and pelvis containing the stomach, appendix, colon, rectum, kidneys, bladder gallbladder, spleen, liver and pancreas. [RETURN]
Anemia: Too few red blood cells to carry sufficient oxygen to other cells in the body. [RETURN]
Biopsy: The removal of a sample of tissue for purposes of diagnosis. [RETURN]
Bloating: Subjective feeling of abdominal fullness. [RETURN]
Bowel: The bowel consists of the large and the small intestines. It is the tube involved in digestion, extending from the stomach to the anus. [RETURN]
Colon: The part of the large intestine extending from the cecum to the rectum. [RETURN]
Crohn's colitis (Crohn’s disease): A chronic inflammatory bowel disease primarily of the small and large intestine. [RETURN]
Depression: A physical and mental disorder affecting mood, feelings and thoughts. [RETURN]
Diverticulitis: Inflammation of diverticula, small pockets of tissue, bulging outwards from the walls of the colon. [RETURN]
Duodenum: The first part of the small intestine extending from the bottom of the stomach. [RETURN]
Dyspepsia: Condition, often provoked by eating, characterized by such symptoms as upper abdominal pain, bloating, satiety, nausea, belching. [RETURN]
Endoscopy: Examination of the inside of the body through endoscope, a flexible tube with a light at one end. [RETURN]
Esophagus: The tube associated with swallowing that connects the throat to the stomach. [RETURN]
Feces (faeces): The excrement discharged from the intestines through the anus. [RETURN]
Functional dyspepsia: Dyspepsia not associated with observable physical abnormalities. [RETURN]
Gastroenterologist: A doctor specializing in disorders of the gastrointestinal tract. [RETURN
Gastrointestinal tract: The tube extending from the mouth to the anus, including the esophagus, stomach, small and large intestines, pancreas, liver, gallbladder and biliary system. [RETURN]
Heartburn: A warm, burning feeling rising from behind the breastbone toward the neck, usually caused by stomach acid rising into the esophagus. This condition has nothing to do with the heart. [RETURN]
Inflammation: A type of nonspecific immune response by the body reacting to infection, irritation or injury. Characterized by redness, swelling and pain. [RETURN]
Intestine: The tube consisting of the small and large intestines extending from the stomach to the anus. [RETURN]
Irritable bowel syndrome (IBS): Abnormal contractions in the gastrointestinal tract. [RETURN]
Mucus: A thick, slippery fluid produced in the lining of organs such as the intestines. [RETURN]
Nausea: The urge to vomit. [RETURN]
Peptic ulcer: Corrosion of the lining of the stomach, duodenum, or esophagus by stomach digestive acids. [RETURN]
Satiety: Feeling of fullness with little intake of food. [RETURN]
Stool: Vernacular for fecal matter (excrement). [RETURN]
Ulcerative colitis: A disease causing ulcers in the lining of the rectum and colon. It is one of a group of diseases called inflammatory bowel disease. [RETURN]
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