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Decoding Dyspepsia

By: Gwen Reyes-Amurao, M.D.Decoding Dyspepsia

The National Institute of Health defines dyspepsia as episodic or persistent abdominal pain or discomfort that is mainly referable to the upper gastrointestinal tract. Different descriptions such as organic, functional, reflux-like, and non-ulcer are often used to describe dyspepsia but when put simply, it is an uncomfortable feeling in the upper, middle part of the stomach which can lead to a feeling of bloatedness or fullness.

Dyspepsia symptoms

When people with dyspepsia are asked what they experience, they often report pain or discomfort described as gnawing or burning, accompanied by feeling bloated or gassy which can manifest as frequent burping or rumbling of the stomach, vomiting, early satiety, and postprandial fullness.

Etiology of dyspepsia

In an article written by dyspepsia specialist Dr. Norton Greenberger, he mentions several underlying conditions leading to dyspepsia such as Gastroesophageal Reflux Disease or GERD, peptic ulcer disease, intake of certain medications such as NSAIDs, iron and certain antibiotics, esophageal spasm, lactose intolerance, gallbladder disease, Irritable Bowel Syndrome or IBS, and malignancy. In a study published in the Scandinavian Journal of Gastroenterology, among all of these, GERD with or without esophagitis, peptic (duodenal and/or gastric) ulcer, and malignancy were the most common conditions associated with dyspepsia. Sadly, studies also reveal that more than 25% of the population experience such symptoms but never seek medical attention, and therefore never get the proper treatment.

Esophagitisis defined as the inflammation and irritation of the esophagus which often results from acid moving up from the stomach as a result of a condition known as GERD. Gastroesophageal Reflux Disease, on the other hand, is a digestive disorder that occurs when acidic stomach juices or food and fluids move back up from the stomach into the esophagus. It affects people of all ages and can even lead to irritation of airways in severe cases.

Gastric and duodenal ulcers are types of peptic ulcer diseases that affect different parts of the digestive tract. One can have either or both at the same time. Common causes of peptic ulcers include hyperacidity or excessive stomach acid production, bacterial infection, and intake of certain medications. Ulcers are described as open sores in the lining of the digestive tract that need medical treatment in order for them to heal properly. Patients with peptic ulcer disease with underlying Helicobacter pylori or H. pylori infection should be treated with antibiotics along with other medications to help eradicate the organism and manage the secretion of acid in those affected by it.

When it comes to malignancies, gastric and pancreatic types of cancer are the most commonly associated with dyspepsia. However, the American Family Physician Journal mentions there are 50 to 60% of patients who suffer from dyspepsia with no underlying medical condition or cause. In such cases, it is referred to as functional dyspepsia.

Functional Dyspepsia

Functional dyspepsia or FD is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract. Peristalsis, meanwhile, is the involuntary constriction and relaxation of the muscles of the intestine creating wave-like movements that push the contents of the canal forward or downward. These movements are observed from the esophagus down to the stomach and small intestines; and begins right after the food is ingested. In functional dyspepsia, there are no observable or measurable structural abnormalities to explain such symptoms. Other common terms used interchangeably with FD are non-ulcer dyspepsia, pseudo-ulcer syndrome, and gastritis.

Characteristic symptoms of FD

Just like dyspepsia in general, functional dyspepsia manifests as abdominal pain, fullness, and bloatedness, which typically leads to an inability to finish one’s meal. Other symptoms include heartburn, excessive burping, and nausea and vomiting, occurring intermittently with no known aggravating or alleviating factors.

Diagnosing dyspepsia

Once with symptoms of dyspepsia, a thorough medical history is important in order to determine the underlying condition leading to it. Since there are several diseases associated with dyspepsia, pertinent medical history should be carefully analyzed. Physical examination is often normal, except for occasional epigastric or mid-upper abdominal tenderness in severe cases. Once pallor, hypotension, or increased heart rate are noted, gastrointestinal bleeding should immediately be considered and confirmed through diagnostic tests and procedures. Palpable masses or enlargement of organs within the abdomen should always require further testing to rule out malignancy.

For chronic and nonspecific symptoms, routine tests such as complete blood count or CBC and other blood chemistries should be requested. This helps determine the presence of anemia which may be attributed to gastrointestinal bleeding, or other metabolic problems such as diabetes or liver problems which can present the same symptoms. Other tests that can later on confirm the initial assessment include stool examination, breath test (if H. pylori infection is suspected), X-ray of the upper abdomen, and other imaging studies to determine or rule out the presence of gallbladder disease and malignancy.

In dyspepsia, a definitive diagnostic tool often used is endoscopy. The American Digestive Health Foundation recommends endoscopy in dyspeptic individuals older than 50 years of age since malignancy is highly suspected in such cases specifically with a positive occult blood test of the stools. Esophageal manometry (which evaluates the motility of the gastrointestinal tract) and pH studies after an endoscopy are often recommended especially if the patient is unresponsive to treatment.

Treating dyspepsia

The American Academy of Family Physicians mentions two approaches in treating functional dyspepsia with medications. One is through neutralizing the acid that is produced in the stomach, the other is by blocking its production. Acid-neutralizers or antacids are the easiest and most accessible medications since most are over-the-counter (OTC). They are often a combination of aluminum and magnesium hydroxide and help prevent acid from rising into the esophagus. Although these antacids provide quick relief, they cannot prevent the recurrence of symptoms.

Acid secretion is mainly suppressed by histamine-2 receptor antagonists and proton-pump inhibitors (PPIs). The first type of medication blocks the effect of histamine, which is responsible for acid secretion in certain cells. Common examples include ranitidine, cimetidine, and famotidine. PPIs, on the other hand, work by blocking an enzyme responsible for acid secretion and are known as omeprazole, lansoprazole, and esomeprazole. 

To help facilitate gastric motility and reduce reflux, medications such as metoclopramide and domperidone may be indicated depending on the presenting symptoms. Although some medications may sound fairly familiar, consulting a specialist is important in order to determine which type of medication would be best.

In a consensus statement released by the American College of Gastroenterology, they suggest three general ways in managing dyspepsia in general: (1) endoscopy, (2) a trial of empiric anti-secretory drug therapy, and (3) non-invasive serologic testing for H.pylori infection followed by antibacterial treatment once the test is positive.

For specific types of illnesses leading to dyspeptic symptoms, once a diagnosis is confirmed, a specific plan of management can be determined. For GERD, treatment mainly lies in giving medications such as proton pump inhibitors, H2 blockers, antacids, and prokinetics. The same medications are given to those with ulcers, as well as protectants such as sucralfate. Once H.pylori infection is detected, antibiotics and PPIs are immediately given.

Preventing dyspepsia

Dyspepsia symptoms can be prevented by changing lifestyle habits and modifying one’s diet or food intake. Prevention can include:

   Smoking cessation

   Avoiding stressors or learning how to handle stress

   Sitting upright, standing or walking after meals to prevent acid reflux

   Avoiding unnecessary intake of anti-inflammatory medications and taking them only when needed

Although studies on certain types of food causing or leading to dyspepsia are limited, it would still be best to avoid them especially those that are known to increase the symptoms of dyspepsia. These include milk, alcohol, caffeine, fried or oily food, mint, tomatoes, and citrus fruits. Small frequent meals also help improve gastrointestinal tract motility, preventing reflux and indigestion. Overweight and obese individuals are advised to lose weight since increased abdominal girth (waistline) can lead to increased pressure in the stomach and lead to dyspepsia and its symptoms.

The National Institute of Health mentions dyspepsia as a fairly common condition found in approximately 45% of the global population and can affect most populations regardless of location. The sporadic and inconsistent symptoms of dyspepsia often lead to it being undermined by most, which leads to the detection and treatment of illnesses at a later stage, with the management of symptoms being much more difficult. To avoid complications arising from unaddressed dyspeptic symptoms, see a specialist right away.

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