Dyspesia, indigestion

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.

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

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.

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.

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.

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.

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.

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.

After history and examination your doctor may advised certain lab test, sonography and endoscopy to diagnose 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.

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.

Heartburn, acid regurgitation,

Rarely hoarseness, coughing, breathing and sinus problems, and dental erosions, difficulty swallowing

Two most common tests used are Upper endoscopy and Manometry.

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

Barrett’s esophagus which is a precursor of malignancy of lower food pipe and stricture of food pipe (leads to swallowing problems).

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.

In most cases no obvious cause is found. Obesity, strain over abdomen, trauma etc can cause or aggravate symptoms.

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.

By doing Endoscopy or barium swallow x-ray for heartburn, reflux, chest apin or other reason.

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.

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.

H. pylori infection is usually acquired by contaminated food, liquids and water.

In most cases there are no symptoms of infection. Few of the infected patient mat develop gastritis, ulcers and rarely stomach cancer.

It can be diagnosed by breath test, endoscopy and biopsy or stool antigen test.

H.pylori is treated by combination of antibiotics and acid suppressing drugs.

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.