By dr joel enejeta
What is dyspepsia?
A non-specific term that describes pain and sometimes other symptoms which come from the upper GI (the stomach, oesophagus or duodenum).
The main symptom is usually pain or discomfort in the upper abdomen, heartburn (a burning sensation felt in the lower chest area), bloating, belching, quickly feeling full after eating, feeling sick (nausea) or vomiting. Symptoms are often related to eating.
Symptoms tend to occur in bouts which come and go, rather than being present all the time.
For example, after a hot and large spicy meal.
Common causes of dyspepsia
Most cases of recurring dyspepsia are due to one of the following:
-Non-ulcer dyspepsia. This is sometimes called functional dyspepsia. It means that no known cause can be found for the symptoms. About 6 in 10 people who have recurring bouts of dyspepsia have non-ulcer dyspepsia. The cause is not clear, although H. pylori infection may account for some cases (see below).
– Duodenal and stomach (gastric) ulcers.
-Duodenitis and gastritis (inflammation of the duodenum and/or stomach) –
– Acid reflux, Esophagitis and GERD.
-Pancreatitis, malabsorption syndrome. and GBDx.
-Hiatus hernia. A hernia occurs when an internal part of the body, such as an organ, pushes through a weakness in the surrounding muscle or tissue wall.
-Obesity. If you are very overweight, you are more likely to experience indigestion because of increased pressure inside your abdomen (tummy). This can force open your oesophageal sphincter after a large meal, causing acid reflux.
Medication. Some drugs may cause dyspepsia as a side-effect.
NSAIDs are the most common culprits. Via prostaglandins inhibition
Others like: digoxin, antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines, bisphosphonates.
Excessive intake of Alcohol and cigarette smoking
Others include:
-Pregnancy, emotional stress, depression and anxiety
-Stomach cancer and oesophageal cancer as well as hepatic and renal failure can cause dyspepsia less commonly when they first develop.
-H. pylori More than a quarter of people in the UK become infected with H. pylori at some stage in their life. Once you are infected, unless treated, the infection usually stays for the rest of your life. About 3 in 20 people who are infected with H. pylori develop an ulcer.
Management
-Lifestyle changes
-Make sure you eat regular meals.
-Lose weight if you are obese.
-If you are a smoker, consider giving up.
-Don’t drink too much alcohol. NICE guideline For all types of dyspepsia,
For dyspepsia which is likely to be due to acid reflux – when heartburn is a major symptom – the following may also be worth considering:
-Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.
-Bedtime. If symptoms recur most nights, the following may help:
Go to bed with an empty, dry stomach. To do this, don’t eat in the last three hours before bedtime, and don’t drink in the last two hours before bedtime.
If you are able, try raising the head of the bed by 10-20 cms (for example, with books or bricks under the bed’s legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this, do not use additional pillows, because this may increase.
Treatment
Acid-suppressing medication
A one-month trial of full-dose medication which reduces stomach acid may be considered – in particular, if:
Symptoms are more suggestive of acid reflux or oesophagitis. H. pylori does not cause these problems.
Infection with H. pylori has been ruled out.
- pylori has been treated but symptoms persist.
There are two groups of drugs to reduce stomach acid – proton pump inhibitors (PPIs) and H2-receptor antagonists.
Reducing acid in the stomach can help in many cases of dyspepsia, whatever the underlying cause.
In case of treatment failure or relapse, there may be other underlying pathologies and the treatment depends on what is found or ruled out by the tests.
