A Family Doctor's Tale -DYSPEPSIA

DOC I HAVE DYSPEPSIA

Dyspepsia is a symptom of discomfort or indigestion in the upper abdomen often associated with heartburn, nausea, regurgitation and flatulence.

Two main causes are
1. Diseases of the upper digestive system:
a.esophagus-esophagitis, GERD (gastroesophageal reflux disease), hiatus hernia
b.stomach -gastritis, peptic ulcer, stomach cancer
c.duodenum -duodenal ulcer

2.Diseases of the gallbladder, biliary and pancreatic system
a.gallbladder -cholecystitis, gallstone
b.biliary system - obstrion in the bile duct
c.pancreas -pancreatitis, cancer of pancreas

Other causes:
3.Mechanical factors such as overeating, rapid eating,faulty chewing of food

4.Excessive irriation of gastic mucosa such as
a.food - caffiene, alcohol, poorly digested spices, nuts
b.food that relax lower esophageal sphincter such as chocolates
.
5.Psychogenic causes of excessive production of acidic gastric juice such as stress and anxiety which automatically increase the production of the acid as a result of sympatheic nervous reaction

6.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, steroids

7.systemic diseases, such as pernicious anemia,heart failure with ascites, uremia and diabetes

8.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastitis while Blood group A has a tendency towards stomach cancer.

9.smoking has been associated with increased acid formation
and indigestion

The most common symptoms of dyspepsia are
1.upper abdominal upset or epigastric pain.

2. belching, abdominal bloating,

3.nausea, and vomiting

4.burning sensation in the upper abdomen or in the chest(heart burn).

5.regurgitation

Dyspepsia is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.
The doctor eases an gastroscope, a thin tube containing a tiny camera, through your mouth  and down into your stomach to look at the stomach lining.
The doctor will check for inflammation and may remove a tiny sample of tissue for tests(biopsy). The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells. In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.

2.X-rays of the stomach -barium meal or
gallbladder-cholecystography

3.Ultrasound scan of liver, pancreas, gallbladder

4.Blood test. The doctor may check your blood for any evidence of H.pylori infection and pancreatic enzymes to exclude pancreatic causes

Urea breath test can also determine whether you have H.pylori infection

The main Treatment of Dyspepsia is usually
1.reduce stress

2.reorganization of work in such a way as to be able to handle the pressure of work better as well as to have regular meals

3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.

4. Take more frequent and smaller meals.

5. Avoid alcohol and smoking

6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production

Regulate eating habits  using small meals, sitting up, walking after food

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)

2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

3. Antispasmodics: anticholinergic drugs like buscopan,  librax reduce the spasm in the stomach and duodenum

4.If your Dyspepsia is caused by an infection, that problem may be treated as well. For example, the doctor might prescribe antibiotics to clear up H. pylori infection. Once the underlying problem disappears, the Dyspepsia usually does too. Talk to your doctor before stopping any medicine or starting any Dyspepsia treatment on your own.

5.Surgery may be required in cancer of stomach, pancreas, gallstones

The Complications of untreated Dyspepsia are:
gastric ulcers and strictures
bleeding

Prognosis :
good to excellent except for cancer of stomach and pancreas