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.

Classification

Dyspepsia is broadly classified into two major types:

• Ulcer dyspepsia - 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.

• Non-ulcer dyspepsia - accounts to 70% of all cases. 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. Causes of functional dyspepsia are not clear but researchers have focused on the following factors:
  • Gastric motor function
  • Visceral sensitivity
  • Helicobacter pylori infection
  • Psychosocial factors

Complete Differential Diagnosis of the Causes of Indigestion

(Most common)

• Acid reflux / Heartburn

• Alcohol

• Aspirin and many other painkillers

• Duodenal ulcer

• Eating fatty foods

• Eating just before sleeping

• Eating spicy foods

• Eating too late in the evening

• Excess caffeine consumption

• Gastric ulcer

• Intestinal obstruction

• Malabsorption

• Obesity

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	4-Chlorodehydromethyltestosterone, Amanita phalloides, Smoking, Sodium dichloroisocyanurate
Dermatologic	No underlying causes
Drug Side Effect	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
Ear Nose Throat	No underlying causes
Endocrine	Carcinoid syndrome, Diabetes mellitus, hyperparathyroidism , Hyperthyroidism, Primary hyperparathyroidism
Environmental	Multiple chemical sensitivity
Gastroenterologic	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
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Amebic dysentery, Fascioliasis, Gastrointestinal mucormycosis, Giardiasis, H. Pylori, Hookworm, Opisthorchiasis, Strongyloidiasis, Syphilis, Tuberculosis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Autonomic neuropathy
Nutritional / Metabolic	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
Obstetric/Gynecologic	No underlying causes
Oncologic	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
Opthalmologic	No underlying causes
Overdose / Toxicity	Niacin, Vitamin C
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Hypercalcaemia, Uremia
Rheum / Immune / Allergy	Oral allergy syndrome, Sarcoidosis, Scleroderma
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Couvade, Gulf War syndrome, Alcohol, Gas, Stress, Tobacco, Obesity, SSRI discontinuation syndrome, Trichophagia

(In alphabetical order)

4-Chlorodehydromethyltestosterone acarbose Achlorhydria Acid reflux / heartburn Acute and chronic Pancreatitis Acute viral hepatitis Adefovir (patient information) Adult hypertrophic pyloric stenosis Aerophagy Alcohol alendronate Amanita phalloides Amebic dysentery Anxiety Aspirin and many other painkillers Atazanavir (patient information) Autonomic neuropathy Calcium channel blockers Carcinoid syndrome Cholecystitis Cholestyramine (patient information) Cholestyramine Resin (patient information) Chronic hepatitis Cirrhosis of liver Coeliac disease Colofac Colon cancer Couvade Crohn's disease Diabetes mellitus Diabulimia Duloxetine Duodenal cancer Duodenal lymphoma Duodenal polyps Duodenal ulcer Duodenal webs Duodenitis Eating fatty foods Eating just before sleeping Eating spicy foods Eating too late in the evening Efavirenz (patient information) Emtricitabine (patient information) Epoetin Alfa Injection (patient information) erythromycin Esophageal carcinoma Esophagitis Estrogen and Oral contraceptives Excess caffeine consumption Extranodal Marginal Zone B-cell Lymphoma of Mucosa-Associated Lymphoid Tissue Fascioliasis Fentanyl Skin Patches (patient information) Food intolerance Frovatriptan (patient information) Gallstones Garlic Gas Gastric cancer Gastric lymphoma Gastric motility disorder Gastric ulcer Gastritis Gastroesophageal reflux disease

Gastrointestinal mucormycosis Gastrointestinal tumors Giardiasis Gluten allergy Gulf War syndrome H. Pylori Hepatoma Hiatus hernia Hookworm Hypercalcaemia hyperparathyroidism Hyperthyroidism Hypertrophic gastritis Imatinib (patient information) Indian gooseberry Interferon Beta-1b Injection (patient information) Intestinal motility disorder Intestinal obstruction Ischemic bowel disease Irritable bowel syndrome Lithium (patient information) Malabsorption Ménétriér's disease Meropenem Injection (patient information) methylxanthines metronidazole Multiple chemical sensitivity Niacin Obesity Opisthorchiasis Oral allergy syndrome orlistat Ovarian cancer Overeating Oxycodone and aspirin (patient information) Pancreatic cancer Pergolide (patient information) potassium supplements Pramlintide injection (patient information) Pregnancy Primary hyperparathyroidism Quetiapine (patient information) Rivastigmine (patient information) Sarcoidosis Scleroderma Simvastatin Small intestinal bacterial overgrowth Smoking Sodium dichloroisocyanurate SSRI discontinuation syndrome Steroids Stress Strongyloidiasis Suillus luteus Syphilis Tadalafil Thyroid medicines Tiotropium Oral Inhalation (patient information) Tobacco Trichophagia Tropical sprue Tuberculosis Ulcerative colitis Uremia Vitamin C

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.

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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