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| | '''For patient information on this topic, click [[indigestion (patient information)|here]].''' |
| {{Indigestion}} | | {{Indigestion}} |
| {{Search infobox}} | | {{CMG}}; {{AE}} {{RT}} |
| {{CMG}} {{RT}} | |
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| '''''Synonyms and keywords:''''' Dyspepsia
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| ==[[Indigestion overview|Overview]]== | | ==[[Indigestion overview|Overview]]== |
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| | ==[[Indigestion historical perspective|Historical Perspective]]== |
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| | ==[[Indigestion classification|Classification]]== |
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| ==[[Indigestion historical perspective|Historical Perspective]]== | | ==[[Indigestion pathophysiology|Pathophysiology]]== |
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| ==Classification==
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| [[Dyspepsia]] is broadly classified into two major types:
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| * <u>'''Ulcer dyspepsia'''</u> - accounts to 20-30 % of all dyspepsia cases and is caused by [[Peptic ulcer disease]], [[GERD]]. Structural disease of the gastrointestinal tract exists in ulcer dyspepsia and hence endoscopy is abnormal.
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| * <u>'''Non-ulcer dyspepsia'''</u> - also called '''Functional dyspepsia'''. Functional dyspepsia (FD) is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89-90%), postprandial fullness (75-88%), and early satiety (50-82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary.<ref>{{cite journal |author=Lacy BE, Talley NJ, Locke GR, ''et al.'' |title=Review article: current treatment options and management of functional dyspepsia |journal=Aliment. Pharmacol. Ther. |volume=36 |issue=1 |pages=3–15 |year=2012 |month=July |pmid=22591037 |doi=10.1111/j.1365-2036.2012.05128.x |url=}}</ref> Causes of functional dyspepsia are not clear but researchers have focused on the following factors:
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| **Gastric motor function
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| **Visceral sensitivity
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| **Helicobacter pylori infection
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| **Psychosocial factors
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| ==Pathophysiology==
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| ==Epidemiology and Demographics==
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| ==Risk Factors==
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| * Eating meals too quickly
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| * Emotional stress while eating
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| * Overabundance of high-fiber foods
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| * Overconsumption of alcohol
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| * Overconsumption of caffeine
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| * Spicy, high-fat, and greasy foods
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| * Tobacco use
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| * Too much food at meals
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| ==Screening==
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| ==Complete Differential Diagnosis of the Causes of Indigestion==
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| (Most common)
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| *[[Acid reflux]] / [[Heartburn]]
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| *[[Alcohol]]
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| *[[Aspirin]] and many other painkillers
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| *[[Duodenal ulcer]]
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| *[[Eating fatty foods]]
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| *[[Eating just before sleeping]]
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| *[[Eating spicy foods]]
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| *[[Eating too late in the evening]]
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| *[[Excess caffeine consumption]]
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| *[[Gastric ulcer]]
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| *[[Intestinal obstruction]]
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| *[[Malabsorption]]
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| *[[Obesity]]
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| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| [[4-Chlorodehydromethyltestosterone]], [[Amanita phalloides]], [[Smoking]], [[Sodium dichloroisocyanurate]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[4-Chlorodehydromethyltestosterone]], [[Adefovir (patient information)]], [[acarbose]], [[Aspirin]] and many other painkillers, [[alendronate]], [[Atazanavir (patient information)]], [[Calcium channel blockers]], [[Cholestyramine (patient information)]], [[Cholestyramine Resin (patient information)]], [[Colofac]], [[Duloxetine]], [[erythromycin]], [[Efavirenz (patient information)]], [[Estrogen]] and [[Oral contraceptives]], [[Emtricitabine (patient information)]], [[Epoetin Alfa Injection (patient information)]], [[Fentanyl Skin Patches (patient information)]], [[Frovatriptan (patient information)]], [[Imatinib (patient information)]], [[Interferon Beta-1b Injection (patient information)]], [[Lithium (patient information)]], [[methylxanthines]], [[metronidazole ]], [[Meropenem Injection (patient information)]], [[Oxycodone]], [[orlistat]], [[Potassium]] supplements, [[Pergolide (patient information)]], [[Pramlintide injection (patient information)]], [[Quetiapine (patient information)]], [[Rivastigmine (patient information)]], [[Simvastatin]], [[Tadalafil]], [[Tiotropium Oral Inhalation (patient information)]], [[Steroid medications]], [[Thyroid medicines]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Carcinoid syndrome]], [[Diabetes mellitus]], [[hyperparathyroidism ]], [[Hyperthyroidism]], [[Primary hyperparathyroidism]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| [[Multiple chemical sensitivity]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Achlorhydria]], [[Acid reflux]] / [[Heartburn]], [[Acute viral hepatitis]], [[Adult hypertrophic pyloric stenosis]], [[Aerophagy]], [[Cholecystitis]], [[Chronic hepatitis]], Acute and chronic [[Pancreatitis]], [[Cirrhosis of liver]], [[Coeliac disease]], [[Colonic cancer]], [[Crohn's disease]], [[Duodenal cancer]], [[Duodenal lymphoma]], [[Duodenal polyps]], [[Duodenal ulcer]], [[Duodenal webs]], [[Duodenitis]], [[Esophageal carcinoma]], [[Esophagitis]], [[Gallstones]], [[Gastric cancer]], [[Gastric lymphoma]], [[Gastric motility disorder]], [[Gastric ulcer]], [[Gastritis]], [[Gastroesophageal reflux disease]], [[Gastrointestinal tumors]], [[Hiatus hernia]], [[Hypertrophic gastritis]], [[Intestinal motility disorder]], [[Intestinal obstruction]], [[Irritable bowel syndrome]], [[Malabsorption]], [[Ménétriér's disease]], [[Pancreatic cancer]], [[Peptic ulcers]], [[Small intestinal bacterial overgrowth]], [[Tropical sprue]], [[Ulcerative colitis]], [[Hepatoma]], [[Ischemic bowel disease]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Amebic dysentery]], [[Fascioliasis]], [[Gastrointestinal mucormycosis]], [[Giardiasis]], [[H. Pylori]], [[Hookworm]], [[Opisthorchiasis]], [[Strongyloidiasis]], [[Syphilis]], [[Tuberculosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| [[Autonomic neuropathy]]
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Diabulimia]], Eating fatty foods, Eating just before sleeping, Eating spicy foods, Eating too late in the evening, Excess alcohol consumption, Excess caffeine consumption, [[Garlic]], [[Indian gooseberry]], [[Overeating]], [[Suillus luteus]]
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Ovarian cancer]], [[Extranodal Marginal Zone B-cell Lymphoma of Mucosa-Associated Lymphoid Tissue]], [[Colonic cancer]], [[Duodenal cancer]], [[Duodenal lymphoma]], [[Esophageal carcinoma]], [[Gastric cancer]], [[Gastric lymphoma]], [[Gastrointestinal tumors]], [[Pancreatic cancer]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| [[Niacin]], [[Vitamin C]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| [[Hypercalcaemia]], [[Uremia]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Oral allergy syndrome]], [[Sarcoidosis]], [[Scleroderma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Couvade]], [[Gulf War syndrome]], [[Alcohol]], [[Gas]], [[Stress]], [[Tobacco]], [[Obesity]], [[SSRI discontinuation syndrome]], [[Trichophagia]]
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| |-
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| |}
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| (In alphabetical order)
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| {{MultiCol}}
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| *[[4-Chlorodehydromethyltestosterone]]
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| *[[acarbose]]
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| *[[Achlorhydria]]
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| *[[Acid reflux]] / [[heartburn]]
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| *Acute and chronic [[Pancreatitis]]
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| *[[Acute viral hepatitis]]
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| *[[Adefovir (patient information)]]
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| *[[Adult hypertrophic pyloric stenosis]]
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| *[[Aerophagy]]
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| *[[Alcohol]]
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| *[[alendronate]]
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| *[[Amanita phalloides]]
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| *[[Amebic dysentery]]
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| *[[Anxiety]]
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| *[[Aspirin]] and many other painkillers
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| *[[Atazanavir (patient information)]]
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| *[[Autonomic neuropathy]]
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| *[[Calcium channel blockers]]
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| *[[Carcinoid syndrome]]
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| *[[Cholecystitis]]
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| *[[Cholestyramine (patient information)]]
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| *[[Cholestyramine Resin (patient information)]]
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| *[[Chronic hepatitis]]
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| *[[Cirrhosis of liver]]
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| *[[Coeliac disease]]
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| *[[Colofac]]
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| *[[Colon cancer]]
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| *[[Couvade]]
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| *[[Crohn's disease]]
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| *[[Diabetes mellitus]]
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| *[[Diabulimia]]
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| *[[Duloxetine]]
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| *[[Duodenal cancer]]
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| *[[Duodenal lymphoma]]
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| *[[Duodenal polyps]]
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| *[[Duodenal ulcer]]
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| *[[Duodenal webs]]
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| *[[Duodenitis]]
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| *[[Eating fatty foods]]
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| *[[Eating just before sleeping]]
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| *[[Eating spicy foods]]
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| *[[Eating too late in the evening]]
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| *[[Efavirenz (patient information)]]
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| *[[Emtricitabine (patient information)]]
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| *[[Epoetin Alfa Injection (patient information)]]
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| *[[erythromycin]]
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| *[[Esophageal carcinoma]]
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| *[[Esophagitis]]
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| *[[Estrogen]] and [[Oral contraceptives]]
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| *[[Excess caffeine consumption]]
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| *[[Extranodal Marginal Zone B-cell Lymphoma of Mucosa-Associated Lymphoid Tissue]]
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| *[[Fascioliasis]]
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| *[[Fentanyl Skin Patches (patient information)]]
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| *[[Food intolerance]]
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| *[[Frovatriptan (patient information)]]
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| *[[Gallstones]]
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| *[[Garlic]]
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| *[[Gas]]
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| *[[Gastric cancer]]
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| *[[Gastric lymphoma]]
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| *[[Gastric motility disorder]]
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| *[[Gastric ulcer]]
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| *[[Gastritis]]
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| *[[Gastroesophageal reflux disease]]
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| {{ColBreak}}
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| *[[Gastrointestinal mucormycosis]]
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| *[[Gastrointestinal tumors]]
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| *[[Giardiasis]]
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| *[[Gluten allergy]]
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| *[[Gulf War syndrome]]
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| *[[H. Pylori]]
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| *[[Hepatoma]]
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| *[[Hiatus hernia]]
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| *[[Hookworm]]
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| *[[Hypercalcaemia]]
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| *[[hyperparathyroidism ]]
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| *[[Hyperthyroidism]]
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| *[[Hypertrophic gastritis]]
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| *[[Imatinib (patient information)]]
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| *[[Indian gooseberry]]
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| *[[Interferon Beta-1b Injection (patient information)]]
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| *[[Intestinal motility disorder]]
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| *[[Intestinal obstruction]]
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| *[[Ischemic bowel disease]]
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| *[[Irritable bowel syndrome]]
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| *[[Lithium (patient information)]]
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| *[[Malabsorption]]
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| *[[Ménétriér's disease]]
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| *[[Meropenem Injection (patient information)]]
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| *[[methylxanthines]]
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| *[[metronidazole ]]
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| *[[Multiple chemical sensitivity]]
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| *[[Niacin]]
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| *[[Obesity]]
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| *[[Opisthorchiasis]]
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| *[[Oral allergy syndrome]]
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| *[[orlistat]]
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| *[[Ovarian cancer]]
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| *[[Overeating]]
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| *[[Oxycodone and aspirin (patient information)]]
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| *[[Pancreatic cancer]]
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| *[[Pergolide (patient information)]]
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| *[[potassium supplements]]
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| *[[Pramlintide injection (patient information)]]
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| *[[Pregnancy]]
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| *[[Primary hyperparathyroidism]]
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| *[[Quetiapine (patient information)]]
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| *[[Rivastigmine (patient information)]]
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| *[[Sarcoidosis]]
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| *[[Scleroderma]]
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| *[[Simvastatin]]
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| *[[Small intestinal bacterial overgrowth]]
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| *[[Smoking]]
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| *[[Sodium dichloroisocyanurate]]
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| *[[SSRI discontinuation syndrome]]
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| *[[Steroids]]
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| *[[Stress]]
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| *[[Strongyloidiasis]]
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| *[[Suillus luteus]]
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| *[[Syphilis]]
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| *[[Tadalafil]]
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| *[[Thyroid medicines]]
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| *[[Tiotropium Oral Inhalation (patient information)]]
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| *[[Tobacco]]
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| *[[Trichophagia]]
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| *[[Tropical sprue]]
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| *[[Tuberculosis]]
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| *[[Ulcerative colitis]]
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| *[[Uremia]]
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| *[[Vitamin C]]
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| {{EndMultiCol}}
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| ==Natural History, Complications and Prognosis==
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| ==Diagnosis==
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| ===Symptoms===
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| Symptoms of indigestion are as follows:
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| * A pain or a burning feeling in the upper portion of the [[stomach]]
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| * Feeling sick to one's stomach; [[nausea]]
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| * Feeling bloated
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| * Sometimes uncontrollable [[burping]]
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| * [[Heartburn]]
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| * Feeling feverish
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| * A bitter taste in the mouth from stomach acid coming up into the [[esophagus]].
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| * Rumbling in your stomach.
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| * Sense of fullness after eating
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| * A feeling as though something is lodged in the esophagus
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| * Pain and discomfort at the [[Xiphoid process|xiphoid]] region
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| * Sudden chills, comparable to those felt during fevers.
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| ===Physical Examination===
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| ===Lab Tests===
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| 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.
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| 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 by''[[Helicobacter 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.
| | ==[[Indigestion causes|Causes]]== |
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| Medication related dyspepsia is usually related to [[non-steroidal anti-inflammatory drug|Non-Steroidal Anti-inflammatory Drugs (NSAIDs)]] and can be complicated by bleeding or ulceration with perforation of the stomach wall.
| | ==[[Indigestion differential diagnosis|Differentiating Indigestion from other Conditions]]== |
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| == Treatment == | | ==[[Indigestion risk factors|Risk Factors]]== |
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| * [[Antacids]] neutralize excess stomach acid, and can provide temporary relief of indigestion
| | ==[[Indigestion natural history|Natural History, Complications and Prognosis]]== |
| * Antacids 4 hours prior to exercise
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| * Rest
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| * Activity modification
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| * Digestive enzymes capsules
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| * If symptoms persist, immediate referral to physician to rule out more serious abdominal conditions or diseases.
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| * Drink lots of water
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| | ==Diagnosis== |
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| == References ==
| | [[Indigestion history and symptoms|History and Symptoms]] | [[Indigestion physical examination|Physical Examination]] | [[Indigestion laboratory findings|Laboratory Findings]] | [[Indigestion abdominal x ray|Abdominal X Ray]] | [[Indigestion CT|CT]] | [[indigestion MRI|MRI]] | [[Indigestion echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Indigestion other imaging findings|Other Imaging Findings]] | [[Indigestion other diagnostic studies|Other Diagnostic Studies]] |
| {{reflist|2}}
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| {{SIB}}
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| {{Symptoms and signs}}
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|
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| | ==Treatment== |
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| | [[Indigestion medical therapy|Medical Therapy]] | [[Indigestion surgery|Surgery]] | [[Indigestion prevention|Prevention]] | [[Indigestion cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Indigestion future or investigational therapies|Future or Investigational Therapies]] |
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| | ==Case Studies== |
| | [[Indigestion case study one|Case #1]] |
| | ==Related Chapters== |
| | *[[Dyspepsia]] |
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Digestive disease symptoms]] | | [[Category:Symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Grammar]]
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