Indigestion Diagnosis

  • Diagnosis

    Indigestion is a common problem that causes pain/ discomfort in the upper abdomen with a feeling of fullness or bloating Figure 01. Indigestion, medically referred to as “dyspepsia,” can occur after eating a meal. While it is usually associated with eating large meals, indigestion can occur even after eating smaller ones.

    A variety of disorders can cause symptoms of indigestion, including ulcers, gastroesophageal reflux disease (GERD), and less commonly, cancer. In about half of cases brought to a doctor's attention, however, no identifiable underlying problem can be determined; doctors refer to such cases as “functional dyspepsia.” Many different medications are available to treat indigestion, even when the underlying causes cannot be identified.

    Click to enlarge: Anatomy of the Digestive System

    Figure 01. Anatomy of the Digestive System

    Recurrent indigestion accounts for about 5% of primary care doctor visits.

    Many different conditions can cause indigestion. The most common include:

    • Overeating
    • Eating too fast
    • Eating fatty or greasy foods
    • Overindulgence in alcohol
    • Eating spicy foods
    • Emotional trauma or nervousness
    • Gastroesophageal reflux disease (GERD), in which acidic stomach contents back up into the delicate esophagus, causing the burning pain known as “heartburn”
    • Medications including iron, nonsteroidal anti-inflammatory drugs (NSAIDS), antibiotics, corticosteroids, alendronate (Fosamax), and orlistat (Xenical)

    Other more serious conditions can also cause indigestion.Figure 02.

    • A motility disorder: either too rapid or too slow emptying of stomach contents and passage through the intestines
    • An ulcer in the stomach or the first part of the small intestine (duodenum)
    • Liver disease
    • An inflammation of the lining of the stomach that occurs suddenly and can be a result of extreme stress, medications, ingestion of corrosive material or other illnesses (acute gastritis)
    • Inflammation of the gallbladder, which can be the result of a long-term battle with gallstones (chronic cholecystits)
    • An inflammation of the lining of the stomach that occurs gradually, usually the result of long-term nonsteroidal anti-inflammatory drug (NSAID) use (chronic gastritis)
    • An inflammation of the pancreas often caused by alcohol abuse (chonic pancreatitis)
    • Cancers of the stomach, esophagus, pancreas, or ovaries

    Click to enlarge: Gastric and Duodenal Ulcers

    Figure 02. Gastric and Duodenal Ulcers

    Your indigestion could be due to an ulcer. Ulcers can occur in the stomach (gastric ulcer) or in the first part of the small intestine (duodenal ulcer).

    In up to 60% of cases, the cause cannot be determined, and doctors refer to the condition as “functional dyspepsia.” Between 30% and 60% of people with functional dyspepsia are found to carry Helicobacter pylori, a bacterium associated with ulcer disease. Many people without symptoms also carry these bacteria as part of their normal intestinal makeup, and it is not clear whether it is actually the cause of indigestion.

    Because it is not usually possible to diagnose the exact cause of functional dyspepsia, various medications may be tried to see if they bring relief.

    Indigestion is characterized by pain or discomfort in the upper abdominal area (below the breastbone and above the belly button). Heartburn feels like a burning sensation in the center of the chest or behind the breastbone. Symptoms are persistent or recurring, and may include:

    • Pain or discomfort in the upper abdomen
    • Burning chest pain beginning behind the breastbone that may move upward to the neck and throat
    • Excessive burping
    • A bloated, gassy feeling
    • A feeling of fullness after only small meals
    • Nausea and/or vomiting

    If you have “sour belches” or burning pain that occurs when you lie down and improves when you sit up, your heartburn may be caused by gastroesophageal reflux disease (GERD).

    Abdominal pain that improves with eating may indicate an ulcer.

    Bowel habits are usually not affected. If diarrhea or constipation is the main symptom, it usually indicates another problem, such as a bowel disorder.

    Risk factors for heartburn and indigestion include being overweight, smoking, and heavy drinking.

    Eating large and high-fat meals may lead to indigestion and those who do so regularly are at increased risk.

    High intake of caffeine is also associated with indigestion. Drinking coffee, tea, or colas (drinks which contain caffeine) is also considered to be a risk factor.

    The doctor will perform a physical exam to gather clues about your condition. People who have “functional dyspepsia” usually have no physical signs, except for possible abdominal tenderness.

    Your doctor will ask questions about your symptoms and your medical history. He or she will also ask about your eating habits, your alcohol consumption, and your level of activity. A careful history is important because specific details about symptoms may suggest a diagnosis.

    The doctor may order a variety of tests, depending on what problem is suggested by the history and physical exam. Diagnostic tests may include:

    • A test for blood in the stool
    • A blood test for anemia (indicating that blood has been lost through the intestines because of an ulcer or bowel disease)
    • X-ray exams to check for ulcers or bowel disease
    • A blood test or breath test for infection

    You may undergo additional tests, if your doctor thinks they are necessary, based on your symptoms or the results of the first tests.

    During the exam, be sure to tell your doctor all of the symptoms you are experiencing. Certain symptoms may reveal to your doctor that your indigestion could be due to something other than GERD or an ulcer. Examples of symptoms that may indicate more serious conditions are:

    • Pain that arises or is aggravated with activity or radiates to the jaw or left arm are symptoms of heart disease.
    • Dark yellow urine or yellowing of the whites of the eyes suggests liver disease.
    • Pain in the upper abdomen on the right side following fatty meals may indicate gallbladder disease.

    The doctor will check for signs of cancer, such as enlarged lymph nodes or a mass in the abdomen. If your indigestion is a result of cancer, you may experience the following symptoms:

    • Unexplained weight loss
    • Blood in the stool
    • Vomiting
    • Trouble swallowing

    If your indigestion is persistent, painful, and accompanied by nausea, vomiting or difficulty swallowing (dysphagia), a procedure called endoscopy may be used to examine your upper gastrointestinal tract. Endoscopy is more accurate than x-rays for detecting inflammation, ulcers and tumors of the esophagus, stomach and duodenum.

    During an endoscopy procedure, a thin, flexible tube called an endoscope, which has its own lens and light source, is inserted through the mouth and into the esophagus, stomach, and the first part of the small intestine (duodenum). The endoscope allows the doctor to view images of your gastrointestinal tract on a video monitor. This test allows the examiner to determine if an ulcer or a cancer is present. Evidence of irritation of the esophagus, indicating GERD, can also be seen. You are given a sedative to relax before the procedure, and the back of the throat is numbed with an anesthetic spray.

    If the doctor cannot find any structural disorders that are causing indigestion, he or she will diagnose the condition as “functional dyspepsia”.

    To avoid getting indigestion, try to limit the foods and habits that are known to trigger the problem in some people.

    • Stay away from foods associated with indigestion. These include oily food, coffee, chocolate, spicy food, peppermint, and alcoholic beverages.
    • Decrease meal size.
    • Eat slowly
    • Get regular exercise
    • Lose weight if you are overweight
    • Avoid eating before bed and late night snacking.
    • Learn stress reduction techniques

  • Prevention and Screening

    To avoid getting indigestion, try to limit the foods and habits that are known to trigger the problem in some people.

    • Stay away from foods associated with indigestion. These include oily food, coffee, chocolate, spicy food, peppermint, and alcoholic beverages.
    • Decrease meal size.
    • Eat slowly
    • Get regular exercise
    • Lose weight if you are overweight
    • Avoid eating before bed and late night snacking.
    • Learn stress reduction techniques

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