WHAT IS IT?
Dyspepsia is the medical term for indigestion. Not a disease in itself, dyspepsia is often a symptom of other diseases or disorders. Dyspepsia, a burning discomfort in the upper abdomen, is often brought on by eating too much, eating too quickly, or by eating foods that are very spicy, rich, or fatty. Because symptoms are often increased during times of stress, dyspepsia may also be referred to as nervous indigestion. Other causes of dyspepsia include: excessive use of alcoholic beverages or caffeine, excessive acidity of the stomach, gastroesophageal reflux, faulty functioning of the stomach or intestines, insufficient quantity or quality of bile secretion needed to facilitate digestion, liver disease, parasitic infections, lactose intolerance, pregnancy, pancreatic disease, intra-abdominal cancer (malignancy), thyroid disease, and a form of dyspepsia that occurs with coronary ischemia (heart disease). Dyspepsia may also occur with the use of certain drugs including iron, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, diuretics, and cardiotonic glycosides. Occasionally, persistent or recurrent dyspepsia is associated with a peptic ulcer, gallstones, or inflammation of the esophagus (esophagitis). However, in up to half of the dyspepsia cases that seek treatment, no explanation for the symptoms is discovered.
HOW IS IT DIAGNOSED?
History: Symptoms of dyspepsia may include vague abdominal discomfort, a sense of fullness after eating, belching, heartburn, bloating, gas (flatulence), and loss of appetite. It may also include
nausea and vomiting. Symptoms may occur irregularly or in different patterns, but are usually increased in times of stress.
Physical exam may reveal abdominal pain, distention, and increased bowel sounds due to excessive gas in the stomach or intestine. The site of the pain and pattern of symptoms can help to identify underlying causes. Signs of organic disease, including weight loss, enlarged organs, abdominal mass, or blood in the stool indicate the need for further investigation.
Tests: Testing the stool for occult blood is mandatory. Initial laboratory work should also include a complete blood count (CBC), and liver chemistry panel. A diagnostic gastroscopy (scope used to examine the inside of the stomach) may be performed to exclude peptic ulcer disease, gastroesophageal reflux disease, and gastric malignancy. Abdominal sonography (ultrasound) is only performed when biliary or pancreatic disease is suspected.
HOW IS IT TREATED?
Treatment is directed at the underlying cause. Alcohol and caffeine intake should be curtailed, and offending medications eliminated. In some cases, the individual may need to keep a record of food intake, symptoms, and daily events in order to reveal dietary or social factors that trigger the dyspepsia episodes.
WHAT MIGHT COMPLICATE IT?
Dyspepsia may be complicated by the underlying condition causing it. Taking antacid drugs may initially mask the underlying disease or disorder, delaying diagnosis and treatment.
PREDICTED OUTCOME
Since dyspepsia is not a disease in itself, but rather a symptom of other diseases or disorders, the predicted outcome depends on the underlying cause.
ALTERNATIVES
Dyspepsia is a symptom of many other diseases and disorders including gastrointestinal tract dysfunction, pancreatic disease, biliary tract disease, thyroid disease, coronary ischemia, pregnancy, side effects of certain drugs, and excessive alcohol consumption.
APPROPRIATE SPECIALISTS
Gastroenterologist, general practitioner, internist.