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Dyspepsia: More than Just Indigestion

By: Gwen Y. Reyes-Amurao, M.D.Dyspepsia: More than Just Indigestion

Dyspepsia is a term we often encounter nowadays. Whether it’s from a story of a friend, from a newsprint or TV ad or from a billboard along EDSA, you may have heard about it at one time or another. But what is it really? Is it a disease, a disorder, or simply a fancy term for stomachache? Learn more about it and find out what you can do to help prevent and manage it effectively.

Definition

Dyspepsia is first and foremost not a disease. The presence of it though can indicate the presence of an underlying condition or disease, which makes it a symptom. The Journal of Therapeutic Advancements in Gastroenterology defines dyspepsia as having one or more symptoms of epigastric pain (the upper middle portion of the abdomen), burning, and an overall feeling of fullness after eating despite minimal amounts of food. This is often accompanied by bloating, nausea, and in some cases, severe burping or belching. In a simpler definition stated in the American Journal of Gastroenterology, dyspepsia was defined as episodic or persistent symptoms that include abdominal pain or discomfort in the upper gastrointestinal (GI) tract. Studies show that among all adults, 30 to 40% will likely experience these symptoms in the absence of any medical cause and will have intermittent symptoms in the long run. 

Heartburn is often confused with dyspepsia. Although they both depict abdominal pain or discomfort, they are not the same. Heartburn is almost always associated with Gastroesophageal Reflux Disease (GERD). In some cases, dyspepsia is used interchangeably with indigestion, mainly because there seems to be an abnormality in stomach digestion after food or liquid intake.

Causes

So what causes dyspepsia and are there people who are more likely to get it than others? Medically speaking, dyspepsia is caused by an abnormality in the sensory, stimulatory, and motor functions of the nerves found in the stomach. It is often triggered by one’s lifestyle, diet, and at times, medication intake. According to the Mayo Clinic, these are considered functional or non-organic causes of dyspepsia and indicate that there are no structural or metabolic diseases behind it. Those who have experienced this report increased pain in the following situations:

  • Overeating or eating too fast;
  • Eating oily, fatty, greasy or spicy food;
  • Drinking too much coffee, alcohol, or carbonated drinks;
  • Smoking;
  • During stressful situations or situations that make one anxious; and
  • Taking certain antibiotics, pain relievers or other medications.

Organic causes of dyspepsia can include gastrointestinal diseases such as gastritis, peptic ulcer disease, celiac disease, gallstones, constipation, pancreatitis, and if persistent and prolonged, can even indicate the presence of stomach cancer. Some of the non-gastrointestinal diseases linked with dyspepsia are thyroid disorders and diabetes.

Evaluation

A complete present and past medical history and a thorough physical examination can help determine the cause of dyspepsia, giving specific importance to the age and duration of symptoms. Typically, when a patient is below the age of 50 having on and off dyspepsia with no progression, extensive testing may not be needed. In the presence of other accompanying symptoms such as weight loss and persistent vomiting, the doctor may request for laboratory tests, stool exam, endoscopy, and imaging tests (CT scan or MRI) in order to rule out the presence of any organic cause of dyspepsia.

In essence, diagnostic tests are only advised when considering the presence of GI or non-GI diseases. Because early detection of any underlying condition is crucial to treatment and prognosis of an individual, it is important to see a doctor in the presence of any alarming or unexplained symptoms. 

Treatment and Prevention

As with any condition, treatment will always vary depending on the cause. But in general, education and proper information regam rding the disease or in this case, the symptoms of dyspepsia, can help alleviate any concerns that may further aggravate the situation. Since the gastrointestinal tract is mainly composed of smooth muscles that contract in functional dyspepsia, smooth muscle relaxants can help reduce the strength of the contraction of the smooth muscle and produce less abdominal spasms and therefore less pain. In instances wherein the stomach is going empty at a much slower rate than usual, prokinetic or promotility drugs may help increase motility and transit time and decrease episodes of dyspepsia. 

Aside from these, those who suffer from dyspepsia who are less than 50 years of age and have no other accompanying symptoms are advised to take Proton Pump Inhibitors or PPIs (such as omeprazoles and lansoprazoles) by their gastroenterologists. In some cases, H2-receptor antagonists like Ranitidine may also be advised. But note that these medications may only be indicated for those who have underlying medical conditions that can trigger dyspepsia such as peptic ulcer disease (PUD) or GERD. Consulting with a specialist will help determine which type of medication will be best and why.

For non-organic causes of dyspepsia, lifestyle and diet changes can help ease its symptoms and avoid triggers. For those with known food and milk allergies, it is best to avoid them or choose substitutes for these products. Avoiding alcohol, caffeine, and carbonated drinks are also beneficial, as well as avoiding medications that are known to irritate the stomach such as nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics. Smoking cessation has also helped those experiencing severe dyspepsia. Controlling stress and anxiety levels by doing relaxing and recreational activities proved to have also decreased the frequency of dyspepsia.

Home Remedies for Dyspepsia

Although most of the home remedies lack scientific evidence and have no clinical studies to back them up, many have reported relief from dyspepsia after taking them. Peppermint and ginger have the most reported benefits on indigestion and incidentally pose no serious side effects when taken on a regular basis. Although many have reported relief from taking baking soda in their water, studies show that it can lead to metabolic alkalosis, a serious condition that can lead to confusion, arrhythmia, hypoxia or lack of oxygen in the body, and even death. It is best to always check with a physician prior to taking any other supplements to determine its safety and its effect on the other medications being taken.

Diet and Dyspepsia

Because people often associate their symptoms with food and beverage intake, certain types of food and drinks can either alleviate or trigger dyspepsia. As always, eating a well-balanced diet can help maintain a healthy gut. Here are some tips that can help relieve or prevent dyspepsia:

  • Avoiding food that is spicy or greasy.
  • Eating five or six small meals a day is much better than having three large meals. Not only does it relieve indigestion, but it also helps improve gut motility in the long run.
  • Eating a high-fiber diet.
  • A diet rich in fruits and vegetables has been found to help prevent indigestion, plus it also allows for better digestive health and overall wellness to boot.

Although many people have identified certain food that trigger dyspepsia, it has been seen to vary from one person to another. That is why no universal recommendation can be given at the moment, and avoidance of certain types of food is best done based on personal experience.

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