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Dyspepsia
Last reviewed: 23.04.2024
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[What causes indigestion?
The main causes of dyspepsia include peptic ulcer, motor disorders, gastroesophageal reflux, medications (eg, erythromycin, non-steroidal anti-inflammatory drugs, alendronate) and malignant diseases of the esophagus and stomach. However, many patients do not have any organic abnormalities (functional or non-ulcer dyspepsia). Others have diseases (eg, duodenitis, pyloric dysfunction, motor disability, gastritis caused by Helicobacter pylori, lactose deficiency, cholelithiasis) that do not correlate well with symptoms (i.e., treatment of the cause does not eliminate dyspepsia).
Symptoms of dyspepsia
Symptoms of dyspepsia are sometimes considered as signs that correspond to peptic ulcer disease, motor disorders, reflux disease; these symptoms suggest, but do not confirm the etiology. Signs similar to peptic ulcer include pain that is confined to the epigastric region and is often observed before meals or decreases after ingestion of food, antacids or H 2 -blockers. Signs reminiscent of motor disability include discomfort, but not pain, along with a sense of rapid satiety, bursting after eating, nausea, vomiting, bloating and symptoms worsening after eating. Symptoms of dyspepsia, like reflux disease, include heartburn or regurgitation of acid. At the same time, these symptoms are often combined.
Periodic constipation and diarrhea with dyspepsia suggest irritable bowel syndrome or misuse by non-prescribed laxatives or antidiarrheal drugs.
"Symptoms of anxiety" for dyspepsia include anorexia, nausea, vomiting, weight loss, anemia, blood in the stool, dysphagia, swallowing pain and a negative result for standard therapy, for example the use of H 2 -blockers.
Where does it hurt?
Diagnosis of dyspepsia
Physical examination
The examination rarely allows to establish the cause of dyspepsia, however, the detection of hidden blood in the stool indicates the need for further research.
Examination
Routine tests include a general blood test, a fecal occult blood test (to exclude gastrointestinal bleeding), and a routine biochemical blood test. If the results of the study demonstrate changes, additional studies are indicated (eg, instrumental examination, endoscopy). Because of the risk of malignancy, patients over 45 years of age and persons with new anxiety symptoms should complete endoscopy of the upper gastrointestinal tract. For patients younger than 45 years without anxious symptoms, some authors recommend empirical therapy with antisecretory or prokinetic drugs followed by endoscopy with ineffective treatment. Other authors recommend screening for H. Pylori infection with a respiratory test with C 14 urea or stool examination. However, a differentiated evaluation of the results obtained is necessary in the proof of H. Pylori or the identification of any other non-specific signs to explain the existing symptoms.
Esophageal manometry and gastric pH research are indicated with persistent symptoms of reflux after endoscopy of the upper gastrointestinal tract and preventive use of proton pump inhibitors within 2-4 weeks.
What do need to examine?
What tests are needed?
Who to contact?
Treatment of dyspepsia
Specific conditions require treatment. Patients without an established diagnosis should be observed for a long time and be sure of success. Dyspepsia requires the use of proton pump inhibitors, H 2 -blockers and cytoprotective agents (eg, sucralfate). Prokinetic drugs (eg, metoclopramide, erythromycin) in the form of a liquid suspension can be used in patients with dyspepsia and symptoms similar to motor disorders. However, there is no evidence of a different effect of the class of the drug on specific symptoms (eg, antireflux if motor damage occurs). Misoprostol and anticholinergic agents are ineffective in functional dyspepsia. Drugs that alter sensory perception (eg, tricyclic antidepressants) may be effective.