Indigestion
Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Raviteja Guddeti, M.B.B.S. [2]
Synonyms and keywords: Dyspepsia
Overview
Indigestion is a term used to describe a feeling of fullness or discomfort during or after a meal. It can be accompanied by burning or pain in the upper stomach. It is a condition that is frequently caused by eating too fast, especially by eating high-fat foods quickly. It is also called Dyspepsia or Stomach upset.There are many possible causes of Indigestion, of which some are related to lifestyle. The Rome III committee defined Indigestion / Dyspepsia as one or more of the following symptoms :
- Postprandial fullness (termed postprandial distress syndrome)
- Early satiation (meaning inability to finish a normal sized meal or postprandial fullness)
- Epigastric pain or burning (termed epigastric pain syndrome)
Discomfort or pain in the upper abdomen, early fullness while eating, bloating, sense of fullness after eating are the usual symptoms expressed by the patients. Sometimes indigestion is accompanied by Heartburn which is a separate condition.
Historical Perspective
Indigestion is an old English word meaning ‘lack of digestion’, and dyspepsia symptoms have been recognized since the birth of medicine. However, the underlying pathogenesis of dyspepsia only began to be appreciated when Baillie in 1799 first described the anatomy and symptoms of gastric ulcer disease.
Development of barium X-ray radiology by Cannon in 1897 led to the clinical recognition of peptic ulcer disease and its relationship with symptoms.
Walter Alvarez at the Mayo Clinic in Rochester, MN was the first to apply the term 'functional dyspepsia' in 1916 to describe patients with ulcer-like symptoms and a normal X-ray.
Pathophysiology
Epidemiology and Demographics
Risk Factors
Screening
Complete Differential Diagnosis of the Causes of Indigestion
(Most common)
- Aspirin and many other painkillers
(By organ system)
(In alphabetical order)
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Natural History, Complications and Prognosis
Diagnosis
Symptoms
Symptoms of indigestion are as follows:
- A pain or a burning feeling in the upper portion of the stomach
- Feeling sick to one's stomach; nausea
- Feeling bloated
- Sometimes uncontrollable burping
- Heartburn
- Feeling feverish
- A bitter taste in the mouth from stomach acid coming up into the esophagus.
- Rumbling in your stomach.
- Sense of fullness after eating
- A feeling as though something is lodged in the esophagus
- Pain and discomfort at the xiphoid region
- Sudden chills, comparable to those felt during fevers.
Physical Examination
Lab Tests
People without risk factors for serious causes of dyspepsia usually do not need investigation beyond an office based clinical examination. However, people over the age 55 years and those with alarm features are usually investigated by esophagogastroduodenoscopy (EGD or OGD in Britain). In this painless investigation the esophagus, stomach and duodenum are examined through an endoscope passed down through the mouth. This will rule out peptic ulcer disease, medication related ulceration, malignancy and other rarer causes.
People under the age of 55 years with no alarm features do not need EGD but are considered for investigation for peptic ulcer disease caused byHelicobacter pylori infection. Investigation for H.pylori infection is usually performed when there is a moderate to high prevalence of this infection in the local community or the person with dyspepsia has other risk factors for H. pylori infection, related for example to ethnicity or immigration from a high-prevalence area. If infection is confirmed it can usually be eradicated by medication.
Medication related dyspepsia is usually related to Non-Steroidal Anti-inflammatory Drugs (NSAIDs) and can be complicated by bleeding or ulceration with perforation of the stomach wall.
Treatment
- Antacids neutralize excess stomach acid, and can provide temporary relief of indigestion
- Antacids 4 hours prior to exercise
- Rest
- Activity modification
- Digestive enzymes capsules
- If symptoms persist, immediate referral to physician to rule out more serious abdominal conditions or diseases.
- Drink lots of water
References
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