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Indigestion is pain or discomfort in the upper abdomen. People may also describe the sensation as gassiness, a sense of fullness, or gnawing or burning. The sense of fullness may occur after a small meal (early satiety), be a feeling of excessive fullness after a normal meal (postprandial fullness), or be unrelated to meals. For more about severe abdominal discomfort, see Acute Abdominal Pain.
Because dyspepsia is usually a vague, mild discomfort, many people do not seek medical care until it has been present (or coming and going) for a long time. Sometimes, dyspepsia is a more sudden, noticeable (acute) sensation.
Depending on the cause of the dyspepsia, people may have other symptoms such as a poor appetite, nausea, constipation, diarrhea, flatulence, and belching. For some people, eating makes symptoms worse. For others, eating relieves symptoms.
Dyspepsia has many causes, which, despite common use of the term indigestion, do not involve a problem digesting food.
Acute dyspepsia may occur briefly after ingestion of
A large meal
Certain irritating drugs (such as bisphosphonates, erythromycin, iron, or nonsteroidal anti-inflammatory drugs [NSAIDs])
Also, some people having a heart attack or unstable angina (coronary artery ischemia) may feel only a sensation of dyspepsia, rather than chest pain (see Chest or Back Pain).
For recurrent dyspepsia, common causes include
Achalasia (see Achalasia) is a disorder in which the rhythmic contractions of the esophagus greatly decrease and the lower esophageal muscle does not relax normally.
Delayed gastric emptying is a situation in which food remains in the stomach for an abnormally long period of time. Delayed emptying is usually caused by a disorder (such as diabetes, a connective tissue disorder, or a neurologic disorder) that affects the nerves to the digestive tract.
Anxiety by itself does not cause dyspepsia. However, anxiety can sometimes worsen dyspepsia by increasing the person’s concern about unusual or unpleasant sensations, so that minor discomfort becomes very distressing.
In many people, doctors find no abnormality during a physical examination or after looking in the esophagus and stomach with a flexible viewing tube (upper endoscopy). In such cases, called nonulcer (functional) dyspepsia, the person's symptoms may be due to an increased sensitivity to sensations in the stomach or to intestinal contractions.
Not every episode of dyspepsia requires immediate evaluation by a doctor. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation.
In people with dyspepsia, certain symptoms and characteristics are cause for concern. They include
Shortness of breath, sweating, or fast heart rate accompanying an episode of dyspepsia
Loss of appetite (anorexia)
Nausea or vomiting
Blood in the stool
Difficulty swallowing (dysphagia) or pain with swallowing (odynophagia)
Dyspepsia that persists despite treatment with drugs such as proton pump inhibitors (PPIs)
People who have a single, sudden episode of dyspepsia should see a doctor right away, especially if their symptoms are accompanied by shortness of breath, sweating, or a fast heart rate. Such people may have acute coronary ischemia. People with chronic dyspepsia that occurs when they exert themselves but that goes away when they rest may have angina (see Angina) and should see a doctor within a few days.
People with dyspepsia and one or more of the other warning signs should see a doctor within a few days to a week. Those with recurrent dyspepsia and no warning signs should see a doctor at some point, but a delay of a week or so is not harmful.
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the dyspepsia and the tests that may need to be done (see Table: Some Causes and Features of Indigestion).
The history is focused on obtaining a clear description of the symptoms, including whether they are sudden or chronic. Doctors need to know the timing and frequency of recurrence, any difficulty swallowing, and whether the symptoms occur only after eating, drinking alcohol, or taking certain drugs. Doctors also need to know what factors make the symptoms worse (particularly exertion, certain foods, or alcohol) or relieve them (particularly eating or taking antacids).
Doctors also ask the person about gastrointestinal symptoms such as anorexia, nausea, vomiting, vomiting of blood (hematemesis), weight loss, and bloody or black stools. Other symptoms include shortness of breath and sweating.
Doctors need to know whether the person has been diagnosed with a gastrointestinal and/or heart disorder, has any heart risk factors (such as high blood pressure [hypertension] or an excessive amount of cholesterol in the blood [hypercholesterolemia]), and the results of previous tests that have been done and treatments that have been tried.
The physical examination usually does not give doctors clues to a specific diagnosis. However, doctors look for signs of chronic disease, such as very pale skin, wasting away of muscle or fat tissue (cachexia), or yellowing of the eyes and skin (jaundice). They also do a rectal examination to detect any blood. Doctors are more likely to recommend testing for people with such abnormal findings.
Some Causes and Features of Indigestion
Possible tests include
Because of the risk of cancer, doctors typically look in the esophagus and stomach with a flexible tube (upper endoscopy) in people who are over age 45 and in younger people with warning signs. Those who are younger and have no symptoms other than dyspepsia are often treated with acid-blocking drugs. If this treatment is unsuccessful, doctors usually do an endoscopy.
People with symptoms of acute coronary ischemia, particularly those with risk factors, should go to the emergency department for an immediate evaluation, including electrocardiography (ECG) and blood tests for damage to heart muscle cells.
People with chronic, nonspecific symptoms should undergo blood tests. If results of the blood tests are abnormal, doctors consider additional tests (such as imaging studies or endoscopy). Some doctors recommend screening for Helicobacter pylori infection with a breath test or a test of a stool sample.
Doctors do esophageal manometry (see Manometry) and pH (acidity) studies for people who still have reflux symptoms after they have undergone an upper endoscopy and have been taking a proton pump inhibitor (PPI) for 2 to 4 weeks.
Sometimes an abnormality found during testing (such as gastritis or gastroesophageal reflux) is not the cause of the person's dyspepsia. Doctors know this only when the disorder clears up but symptoms of dyspepsia do not.
The best way to treat dyspepsia is to treat any underlying disorders. People with no identifiable disorders are observed over time and reassured.
For people who do not appear to have a specific disorder, doctors often try treatment with acid-blocking drugs (such as proton pump inhibitors or histamine-2 [H 2 ] blockers) or drugs that combat ulcers by increasing the amount of mucus in the stomach (cytoprotective agents). Alternatively, doctors may give a drug that helps stimulate movement of the digestive tract muscles (prokinetic drugs—such as metoclopramide and erythromycin). Doctors may prescribe an antidepressant for some people.
People with severe “gas” discomfort in the upper abdomen or chest may have acute coronary ischemia.
People who have warning signs and who are over age 45 require an endoscopy.
People who have no warning signs and who are under age 45 are treated with an acid-blocking drug.
People whose symptoms do not lessen in 2 to 4 weeks require further evaluation.
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