Acid indigestion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Acid indigestion, also called dyspepsia, is a type of indigestion involving an excess of hydrochloric acid in the stomach. Frequent occurrence of acid indigestion can lead to aggravation of the duodenum or to an aggravation of the lining of the stomach, both of which can lead to ulcers which can be life-threatening. However, it is important to note that some 85 to 95% of all stomach ulcers are caused by infection with the bacterium Helicobacter pylori, and not by excess acidity.

Acid indigestion should be distinguished from heartburn, which typically involves aggravation of the esophagus.

Causes

Common Causes

Common contributors to acid indigestion are:

• Eating foods with too much fat in them.
• Eating foods with too much spice in them.
• Excess consumption of
  • Alcohol
  • Caffeine
• Smoking
• Overeating
• Eating too late in the evening, or eating just before sleeping.

Over the counter remedies (antacids) are available at almost all grocery stores and drugstores. However, a kind of dependence can develop on these medications, and other complications can arise from excess use of antacids.

Causes of Acid Indigestion in Alphabetical Order

• 4-Chlorodehydromethyltestosterone
• Adefovir
• Amanita phalloides
• Atazanavir
• Cholestyramine
• Cholestyramine Resin
• Colofac
• Couvade
• Diabulimia
• Duloxetine
• Eating fatty foods
• Eating just before sleeping
• Eating spicy foods
• Eating too late in the evening
• Efavirenz
• Emtricitabine
• Epoetin Alfa Injection
• Excess alcohol consumption
• Excess caffeine consumption
• Fentanyl Skin Patches
• Frovatriptan
• Garlic
• Gulf War syndrome
• Hookworm
• Imatinib
• Interferon Beta-1b Injection
• Lithium
• Meropenem Injection
• Multiple chemical sensitivity
• Niacin
• Oral allergy syndrome
• Ovarian cancer
• Overeating
• Oxycodone and aspirin
• Pergolide
• Pramlintide injection
• Primary hyperparathyroidism
• Quetiapine
• Rivastigmine
• Simvastatin
• Smoking
• Sodium dichloroisocyanurate
• SSRI discontinuation syndrome
• Suillus luteus
• Tadalafil
• Tiotropium Oral Inhalation
• Trichophagia
• Tropical sprue
• Vitamin C

Historical Perspective

• Acid indigestion [Disease name] was first discovered in the 1980s by a group of clinicians and researchers who at the time described it as discomfort behind the sternum (retrosternal) or in the abdominal region (epigastric) related to the gastrointestinal system, occurring within a timeframe of greater than four weeks. Patients were sub-classified into various groups based on cause, mechanism of disease, and presenting symptoms. This was done to assist clinicians in selecting the most appropriate therapy. These include: reflux-like, ulcer-like, dysmotility-like, and unspecified dyspepsia. [scientist name], a [nationality + occupation], in [year] during/following [event] .
• In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
• Subsequently, in 1991, the Rome II Classification reviewed the subgroups for dyspepsia . They disregarded the reflux-like subgroup with the opinion that they should be considered as having Gastro-esophageal Reflux Disease (GERD) until proven otherwise. Currently, this is widely accepted but still has an ongoing discussion. They concluded that acid indigestion should be described as pain only centered in the abdominal region (epigastric) without a specific duration.
• Irritable Bowel Syndrome (IBS) is also a diagnosis of exclusion .
• In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

• Acid Indigestion [Disease name] may be classified according to Rome II Classification [classification method] into 3 [number] subtypes/groups :

• Ulcer-like - Significant pain in the upper abdomen. [group1]
• Dysmotility-like - Non-painful discomfort in the upper abdomen e.g. early satiety, bloating, or nausea. [group2]
• Unspecified - Cannot be classified into either of the above groups. [group3]

• Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

• The exact pathogenesis of acid indigestion is still currently under discussion. Various mechanisms has been previously described. There is the iatrogenic cause of Acid indigestion, which could be due to pill esophagitis or non-steroidal anti-inflammatory drug intolerance. Symptoms of this can be derived from history of patient and review of systems. [disease name] is characterized by [feature1], [feature2], and [feature3].
• The major pathophysiological mechanism include: Gastrointestinal motor abnormalities; altered visceral sensation; psychosocial factors. An interplay between all 3 better explains the mechanism behind this disease.
• Of importance is infection with Helicobacter pylori. [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Differentiating [disease name] from other Diseases

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

• [Differential dx1]
• [Differential dx2]
• [Differential dx3]

Epidemiology and Demographics

• The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
• In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

• Patients of all age groups may develop [disease name].

• [Disease name] is more commonly observed among patients aged [age range] years old.
• [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

• [Disease name] affects men and women equally.

• [Gender 1] are more commonly affected with [disease name] than [gender 2].
• The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

• There is no racial predilection for [disease name].

• [Disease name] usually affects individuals of the [race 1] race.
• [Race 2] individuals are less likely to develop [disease name].

Risk Factors

• Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

• [Disease name] is usually asymptomatic.
• Symptoms of [disease name] may include the following:

• [symptom 1]
• [symptom 2]
• [symptom 3]
• [symptom 4]
• [symptom 5]
• [symptom 6]

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

• There are no [imaging study] findings associated with [disease name].

• [Imaging study 1] is the imaging modality of choice for [disease name].
• On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
• [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

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