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Dyspesia, indigestion

Dyspesia, indigestion, gas, bloating, gastritis, peptic ulcer, reflux, GERD, hiatal hernia or lax LES


1What is Dyspepsia and what is GERD?
This is a very common disoder and affects almost one fourth of adult male and females. In laymen words, dyspesia means indigestion. By defination it means pain or discomfort in upper abdomen. Fullness after eating or without eating which may or may not be accompanied by heartburn or regurgitation (symptoms of gastroesophageal reflux disease – GERD) or with change in bowel habits (Irritable bowel syndrom-IBS). Dyspepsia is very common and it can be constant or in intervals.

Associated symptoms like bloating, nausea, burping, and a feeling of fullness soon after eating are very common in dyspepsia. In lack of structural explanation for these symptoms , it is known as "functional dyspepsia"

Dyspepsia is often confused with GERD, where acid in the stomach refluxes backs up into the food pipe. Pain or burning due to reflux is in the chest instead of the abdomen.
2What are the causes Dyspepsia?
In many cases its difficult to pin point one cause and thus its multifactorial instaed. A lot of reseach is going on especially to understand Functional Dyspesia. Few causes are as below

  • Ulcers in the stomach or duodenum
  • Medications, such as aspirin, ibuprofen and naproxen
  • Helicobacter pylori (H. pylori) infection in stomach
  • Abnormal muscle function or relaxation of the stomach
  • Abnormal neural function or sensitivity
  • Very rarely due to cancer
  • 3How is dyspepsia diagnosed and what are the treatment options?
    It is diagnosed clinically and by certain criteria to define functional dyspepsia. Based on your symptoms, doctore will determine whether or not you need any tests to check for possible associated problems with your lungs or heart, or anemia. You will be encouraged to stop behaviors that are known to be possible causes of dyspepsia like

  • Fatty food/fast foods: They remain in the stomach longer than proteins and can cause distention, discomfort or pain.
  • Keep a diary of foods that bothers you and avoid it
  • Iconsider losing weight if you are overweight
  • Avoid taking aspirin, ibuprofen etc
  • Consider the possibility that other drugs you are taking may have a side effect of dyspepsia
  • Eating small, frequent meals can be helpful (for example, 5-6 small meals per day)

  • Treating gastrophysician may use acid suppressing and stomach motility improving drugs.

    He may order an endoscopy (in case your symptoms are not improving), a procedure in which a flexible tube is passed into your stomach. Endoscopy allows a specialist to inspect your esophagus and stomach to look for any inflammation or ulcers.
    4Why I produce lots of gas?
    Everyone of us has gas and thus burping or “passing gas” is normal. We swallow air every time we eat or drink. You may swallow air when you’re nervous, eat too fast, chew gum or drink through a straw, use arrated drinks. Most of the gas that we burp out is the one that we swallow. On the other hand most lower intestinal gas is produced when bacteria in your colon ferment carbohydrates that aren’t digested in your small intestine.
    5How is it treated?
    Bothersome gas is generally treated with dietary measures and lifestyle modifications:

  • Cut down on foods that cause gas: beans, brussel sprouts, broccoli, cabbage, cauliflower, onions, artichokes, asparagus, pears, apples, peaches, prunes, sugar-free candies, chewing gum, carbonated beverages, beer, fruit drinks, wheat bread, and bran, fried and fatty foods
  • Reduce the use of dairy products such as cheese and ice-cream
  • Reduce the amount of air you swallow during meals by eating slowlly and properly, avoiding chewing gum and eating hard candy.
  • 6What is gastritis?
    In simple words, gastritis means swelling/inflamation of stomach wall lining. Its of two types, acute or sudden and chronic or long standing. In most cases its a beningn condition but in rare cases it can lead to ulcers and even cancer.
    7What are the causes gastritis?
    In most cases no obvious cause is found. Certain painkillers, blood thinners, alcohol, smoking and other drugs can cause gastritis. H. pylori infection, surgery, bile reflux and stress can also lead to gastritis.
    8What are the symptoms of gastritis?
    Burning or pain in upper abdomen are the most common symptoms of gastrits. Nausea, vomiting, loss of appetite, or weight loss may be the symptoms of gastritis.
    9How is gastritis diagnosed?
    After history and examination your doctor may advised certain lab test, sonography and endoscopy to diagnose gastritis.
    10What are the treatment options for gastritis?
    Gastroenterologist will advice you to modify life style by avoiding certain food, smoking, stress ceratin medicines like pain killers, alcohol, tobacco or smoking. He may also prescribe certain medicine for infection or acid suppression.
    11What is GERD (Gastroesophageal Reflux Disease)?
    Normaly the food pipe which constitue of specialised muscle act as a one way tube and thus not allow the food or acid to reflux back in food it from stomach. In GERD the lower part of food pipe relaxes excessively or is weak allowing the acid to enter in food pipe. This in turn leads to swelling/inflamation of lining of food pipe which gives burning sensation or pain in chest.
    12What are the symptoms of GERD?
    Heartburn, acid regurgitation,

    Rarely hoarseness, coughing, breathing and sinus problems, and dental erosions, difficulty swallowing
    13How is GERD diagnosed?
    Two most common tests used are Upper endoscopy and Manometry.
    14What is the treatment for GERD?
    Lifestyle changes is mainstay of initial management which includes avoiding foods like caffeinated drinks, chocolate, tomato based products, spicy foods, citrus, garlic, onions, peppers, fatty foods, and mint/peppermint. The reason is that they either leads to more relaxation of the musle of lower food pipe or increased acid production.

  • Eat smaller meals, avoid vigrous exercise or goingto bed for 3 hours after meals
  • Avoid using tobacco products or alcohol, painkillers, wearing tight cloths around stomach.
  • Elevate the head of your bed by using 4-6 inch blocks to help prevent acid from rising up at night.
  • If you are overweight, lose some weight.
  • Meications like antacids, medicines that reduce acid production are used to treaat gastritis.
  • Endoscopic and surgical treatment are reseved for those who does not respond to above treatments
  • 15What are the complications of GERD?
    Barrett’s esophagus which is a precursor of malignancy of lower food pipe and stricture of food pipe (leads to swallowing problems).
    16What is a hiatal hernia?
    A large dome shaped muscle(Diaphragm) seprates your chest and stomach. In hiatal hernia, the top portion of the stomach pushes through a weakened opening in the diaphragm where the food pipe (esophagus) joins your stomach (called the hiatal opening)in to chest.
    17What causes a hiatal hernia?
    In most cases no obvious cause is found. Obesity, strain over abdomen, trauma etc can cause or aggravate symptoms.
    18What are the symptoms of a hiatal hernia?
    Small hiatal hernia are usually asymptomatic and are diagnosed incidently when you getevaluated for other reasons. Large hiatal hernia can allow food and stomach acid to back up into your esophagus, leading to heartburn, chest pain, belching and nausea.
    19How is a hiatal hernia diagnosed?
    By doing Endoscopy or barium swallow x-ray for heartburn, reflux, chest apin or other reason.
    20How is a hiatal hernia treated?
    In most cases with small haital hernia, no treatment is needed but one with persistant symptoms may need following treatments which is similiar to that for GERD:

  • Weight loss if over weight
  • Avoid fatty, spicy foods, caffeine, chocolate, onions and citrus.
  • Eat smaller meals. Avoid eating 3 hours before bed.
  • Antacids, Acid reducing medications, pro kinetic/motility drugs.
  • If medications, deits and lifestyle fails to improve symptoms, surgery to repair a hiatal hernia may be needed.
  • 21What is H. pylori?
    Its a bacteria called Helicobacter pylori and is commonly found in the stomach. It is found in approximately 70 to 80 % of Indian population and 50% of the world’s population. Its one of the most common cause of ulcer and gastritis. Rarely it can also lead to stomach cancer.
    22What causes H. pylori?
    H. pylori infection is usually acquired by contaminated food, liquids and water.
    23What are the symptoms of H. pylori?
    In most cases there are no symptoms of infection. Few of the infected patient mat develop gastritis, ulcers and rarely stomach cancer.
    24How is H. pylori diagnosed?
    It can be diagnosed by breath test, endoscopy and biopsy or stool antigen test.
    25How is H. pylori treated?
    H.pylori is treated by combination of antibiotics and acid suppressing drugs.
    26When to seek medical advice in above problems?
    Many naturopathic and alternative medicine therapies are awailable in market but they not only lack evidence but even the safety of such treatments is unclear.

    Functional dyspepsia/GERD/Gas/Dyspepsia often comes back over time and therefore, treatment may need to be modified or adapted to improve the ability to cope with these ongoing symptoms which can not be entirely eliminated in many cases.

    A normal human passes gas 10- 20 times per day or 700 ml per day. In case gas is asssociated with other symptoms like pain in your abdomen, nausea, vomiting, bleeding, weight loss, fever or chest pain. In addition, if it interfere with your ability to live a normal life, consult a gastroenterologist.

    Consult a gastroenterologist if you have Persistant symptoms, unusal symptoms like blood vomit or black stool, weight loss etc.

    If your GERD/ hiatal hernia/gastritis symptoms occur often or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, contact your health care provider.

    A Centre for Comprehensive GI Care