What Is Dyspepsia ? Pain, discomfort, or a burning sensation, in the upper part of the abdomen is termed dyspepsia and it is generally (and falsely) attributed to indigestion. It is often described by some people as a feeling of fullness or gas accumulation.

Some people may feel the fullness even when they have not had any food. Others feel full with the consumption of very small portions, which is termed early satiety. Postprandial fullness is the condition when people feel as if they have overeaten after having a normal meal. This false feeling of fullness keeps people from eating even normal quantity of food. Paradoxically, some people feel more severe symptoms when they have not eaten anything, and they also get some relief when they eat some food. Nausea, lack of appetite, belching, flatulence, diarrhea and constipation are some of the common symptoms people have along with dyspepsia.

People get used to recurring episodes of dyspepsia which have mild symptoms and they often resort to home remedies unless their symptoms are very severe. Sometimes, when severe dyspepsia appears suddenly; it could be due to some serious disorder.

 Causes Of dyspepsia

Though the symptoms of dyspepsia are generally considered to be the indication of indigestion, in reality, it has nothing to do with digestion.

 Acute dyspepsia may appear soon after drinking alcohol or eating a big meal. Certain drugs such as iron supplements, NSAIDs, erythromycin or bisphosphonates are known to produce symptoms of dyspepsia. In some cases of coronary artery ischemia, resulting from the reduced blood supply to the heart muscle, people may feel it as a discomfort in the upper abdominal area, instead of the typical symptom of chest pain.

Recurrent dyspepsia may be due to the reasons given below:

• Abnormality of the esophageal muscle /achalasia
• Esophageal or stomach cancer
• Medications taken by the person
• Delayed emptying of the stomach
• GERD or gastro esophageal reflux disease
• Peptic ulcer disease or gastritis

Achalasia, which is an abnormality in the movement of the esophageal muscles, usually resulting from a problem with the relaxation of the lower esophageal muscle, causes dyspepsia in some people.

Delayed emptying of the stomach caused by connective tissue disorders, diabetes, or some neurologic abnormality of the stomach may be a reason for dyspepsia.

Dyspepsia is not caused by stress and anxiety but existing dyspepsia may appear to worsen during periods of stress mostly due to the people’s tendency to focus on negative sensations and discomfort.

When physical examination by the doctor, as well as the viewing of the interiors of the stomach and the esophagus thorough an endoscope, have not detected any abnormality in the upper part of the digestive tract, doctor may suspect functional dyspepsia. The reason behind this non-ulcer dyspepsia could be hypersensitivity to contractions of the stomach and the intestines.

Evaluation

When dyspepsia is mild and without any of the other warning symptoms, it may not need medical attention. But, when it is sudden, severe, or accompanied by warning signs, the dyspepsia may be due to some serious disorder which require immediate medical attention and emergency treatment.

Warning signs: the following symptoms, when present along with symptoms of dyspepsia, people may have to seek medical attention:

• Sweating, rapid heart rate and shortness of breath
• Increase in discomfort  with exertion, and relief on resting
• Nausea or vomiting
• Blood in the stool
• Pain or difficulty while swallowing
• Anorexia or lack of appetite
• Weight loss

When to see a doctor: Sudden occurrence of dyspepsia in people who have no previous history, is always a cause of concern. If a sudden episode is accompanied by certain other symptoms such as sweating, rapid heart rate, or shortness of breath, people should seek immediate medical attention as they may be having acute coronary ischemia which can lead to complications. Chronic dyspepsia, which recurs with physical exertion and disappears with rest, may be indicative of angina. People with this condition should consult a doctor as soon as possible to evaluate their condition and find the exact cause of dyspepsia.

If the dyspepsia appears along with any of the warning signs such as blood tainted stool, pain or difficulty while swallowing or vomiting, should visit a doctor as soon as possible. Severe weight loss and lack of appetite also should be brought to the notice of a doctor so that the reason behind them can be ascertained and treated as early as possible. If no warning signs are present but frequent recurrence of dyspepsia occurs, it should be brought to the attention of your doctor without much delay.

When a person visits the doctor with the complaint of dyspepsia, a physical examination is done. The doctor checks not only the abdomen for abnormal growths but also the general condition of the patient for signs of jaundice, heart disorders etc. The anus and rectum are also examined for evidence of bleeding. cachexia or wasting away of muscle mass and fat tissue, and pallor, are also noted. Doctor specifically checks for symptoms of heart disease such as sweating, rapid heartbeat and breathing difficulty.

The medical history of the patient is very important for making a diagnosis. The patient may be asked about any pre-existing disorder of the heart or the stomach and also about the drugs being taken. Doctor may want a detailed description about the symptoms, and the circumstances surrounding the episode, such as whether it occurred after a large meal or following alcohol consumption, or if difficulty in swallowing or nausea and vomiting are also present etc. Whether it occurred during exertion and subsided with rest, or whether antacids helped relieve the discomfort, are also relevant details.

Patient should tell the doctor if there was any of blood in the vomit or stool, lack of appetite, weight loss without dieting etc. Previous reports of routine investigations regarding diabetes, blood pressure, cholesterol levels etc., also help in deciding the tests required to detect the cause of dyspepsia.

Testing: 

Blood tests and upper endoscopy are usually done to diagnose the reason of dyspepsia. Cancer of the esophagus as well as that of the stomach may precipitate symptoms of dyspepsia. Hence, endoscopic examination of the upper portion of the digestive tract is done to detect the presence of abnormal growths, especially in patients above 45 years of age. If younger people have any symptoms indicative of esophageal or stomach cancer, upper endoscopy is done to rule out the possibility.

 Coronary ischemia, if present, requires emergency medical attention. Blood tests and ECG are done to assess the extent of damage to the heart tissue and appropriate medical treatment is given to minimize damage.

Helicobacter pylori bacteria are known to inhabit the highly acidic environment of the upper digestive tract and cause symptoms similar to dyspepsia. Stool test or breath test is conducted to detect H. pylori infection. Blood tests are also done to detect other abnormalities which may be causing the dyspepsia.

When gastro esophageal reflux disease (GERD) persists even after a few weeks of proton pump inhibitor treatment, an esophageal manometry may be necessary, and the pH of the esophagus is measured. Even after GERD and gastritis are detected and treated successfully, the dyspepsia may sometimes remain, if its cause was some other disorder.

Treatment

The main focus of treatment is treating the disorder which is found to be causing the dyspepsia. When no such disorders are detected, the doctor may explain to the patient that medications are not necessary. If dyspepsia is causing considerable discomfort, drugs which block acid production are prescribed. Histamine-2 [H₂] blockers and proton pump inhibitors prevent excess production of digestive acids.

Cytoprotective drugs are also given, which increase the mucus lining of the stomach wall, thereby protecting it against the action of acids and development of ulcers. Erythromycin and metoclopramide are prokinetic drugs usually prescribed to stimulate the muscles of the digestive tract. Some people may need antidepressants.

People usually self- medicate with over-the-counter antacids. Mistaking the symptoms of dyspepsia for indigestion, people may reduce food intake, resulting in weight loss. Food supplements may be necessary to overcome the deficit.

Dyspepsia Video Summary

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