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Indigestion

Indigestion

 


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Class
Gastro-intestinal system
Description
Indigestion, also called dyspepsia, is not a disease, but a term used to describe a collection of symptoms including fullness, discomfort or pain in the upper abdomen or chest, usually after meals.

Indigestion is a common condition affecting most people at some time during their life especially after eating or drinking too much, or after eating a large meal with a high fat content. Indigestion itself, although sometimes painful, is not life threatening. However, indigestion can be a symptom of more serious diseases affecting the stomach and digestive tract.

Heartburn is a form of indigestion, which is felt as a burning discomfort behind the breastbone (see separate article on heartburn).
Causes
The most common cause of indigestion is over indulgence; eating or drinking too much. The stomach is stretched by the large volume of food or drink, producing the sensation of fullness or being bloated. As it takes a long time to start to digest the large amount of drink and food, especially if the food has a high fat content, the release of the stomach contents into the intestine is delayed, prolonging the feeling of fullness. Gases trapped in the stomach, either through swallowing air when eating too quickly or given off during digestion, also increase the pressure in the stomach; pressure which is eased by burping.

Some people have frequent, recurring bouts of indigestion that are not related to over indulgence. This can be due to a number of different causes:

Gastric or peptic ulcer - Gastric or peptic ulcers occur in the stomach and duodenum (the first part of the intestine). They look similar to ulcers that appear in the mouth and can be the cause of severe stomach and abdominal pain. Cells in the stomach produce an acid called gastric acid that helps in the digestion of food, particularly of protein. Gastric acid also helps kill bacteria in the food and stimulates the release of digestive enzymes by the pancreas. A lining of mucus and an outer layer of cells normally protects the stomach and duodenum from attack by the body's own gastric acid and digestive enzymes. When there is a break in the protective lining, the underlying tissues are exposed to attack by the digestive secretions, resulting in the formation of an ulcer and causing pain. A bacterium called Helicobacter pylori or H. pylori has been shown to be responsible for most cases of gastric ulcer. It is thought that the bacteria may attack the protective lining of the stomach and duodenum exposing it to gastric acid which eventually leads to an ulcer.

Medicines and alcohol - Many medicines, but in particular medicines called non-steroid anti-inflammatory drugs (NSAIDs) used for the treatment of arthritis and pain relief, irritate the stomach and cause indigestion. Long term use of these medicines or an excessive alcohol consumption eventually damages the protective lining of the stomach and duodenum to produce ulceration.

Non-ulcer dyspepsia - Non-ulcer or functional dyspepsia is indigestion that arises through no obvious apparent cause.

Acid reflux or gastro-oesophageal reflux disease (GORD) - The tube connecting the mouth to the stomach is called the oesophagus. At the end of the oesophagus there is a small valve or sphincter that normally prevents the contents of the stomach passing back into the oesophagus. If the sphincter is weakened, the contents of the stomach, including the gastric acid and digestive enzymes, pass back or reflux into the oesophagus to irritate its delicate lining, causing a burning pain (see separate article on heartburn).
Symptoms
The most common symptoms of indigestion are fullness or bloating, discomfort and pain, nausea and vomiting. Symptoms may come and go. Some people feel a hunger-like pain, which is relieved by food, for some the pain will occur after eating, for others the symptoms are not related to food.
Treatment
There are a large number of medicines available that may help relieve the symptoms of indigestion.

Antacids such as aluminium hydroxide, calcium carbonate or magnesium hydroxide neutralise excess gastric acid and will quickly help ease mild indigestion. Some antacid tablets dissolve to make effervescent drinks that help release trapped stomach wind through burping. Dimeticone, an ingredient of some antacids, also helps release trapped wind by causing small bubbles of gas to combine together and be released easily.

Other medicines known as H2-receptor antagonists, such as cimetidine, famotidine, nizatidine and ranitidine, and proton pump inhibitors (PPIs), such as esomeprazole, omeprazole, lansoprazole, pantoprazole and rabeprazole, inhibit the formation of gastric acid in the stomach and so help reduce irritation if there is a gastric ulcer or if reflux should occur.

If H. pylori is suspected as a cause of indigestion or gastric ulcer, an antibiotic such as amoxicillin, clarithromycin or metronidazole may be prescribed, together with a PPI or H2-receptor antagonist, to kill the bacteria.

Cytoprotectants such as bismuth, sucralfate and misoprostol are used to increase the protective layer of the stomach. Bismuth and sucralfate coat the surface of the ulcer and act as a physical barrier against attack by gastric acid. Misoprostol improves blood flow in the surface layer of cells of the stomach and stimulates secretion of mucus. All agents are used in the treatment of gastric ulcer and may used to protect against gastric irritation caused by NSAIDs.
When to see your pharmacist
If you are troubled by indigestion, see your pharmacist. It is important that you describe your symptoms fully to your pharmacist to ensure that your indigestion is not confused with something more serious. Describe how long you have had the symptoms and when they tend to occur. Also tell your pharmacist your age, if you are pregnant, suffering from any other illnesses such as high blood pressure and if you are taking any other medicines. Many of the products for the relief of heartburn such as alginates and antacids are available over the counter without the need for a prescription. The H2-receptor antagonists famotidine and ranitidine, and the proton pump inhibitor omeprazole are also available over the counter but their use is restricted so your pharmacist will need to check whether they are suitable for you. If your pharmacist decides that you do have indigestion or reflux he or she will recommend a product that best suits you. If the over the counter medicines do not work, or if your pharmacist decides that your symptoms are too severe or it is inappropriate to treat yourself, you will be advised to see your doctor.

Many of the indigestion remedies containing alginates, antacids, dimeticone or bismuth can usually be purchased quite freely over the counter from your local pharmacy. The H2-receptor antagonists, famotidine and ranitidine, and the proton pump inhibitor omeprazole are also available over the counter but their use is more tightly controlled, so your pharmacist will need to check if they are right for you.
When to see your doctor
Indigestion can be confused with pain caused by angina or a heart attack. Angina should be suspected if the chest pain is brought on by exercise and relieved by rest. A heart attack should be suspected if the pain is intense and in the centre of the chest, spreading sometimes to one or both arms and the lower jaw, or if it feels like a heavy pressure. If you have any of these symptoms, see your doctor urgently.

You should also consult a doctor if you suffer from indigestion regularly, you have prolonged symptoms that are not relieved by antacids, you have a family history of gastric problems, or if you take regular medication such as NSAIDs. You should see your doctor urgently if you experience bloody and recurrent vomiting, black stools, difficulty in swallowing and rapid weight loss.
Living with indigestion
Some simple changes in lifestyle will help avoid the chances of getting indigestion.

Avoid eating late at night. Eating at least 2 to 3 hours before bedtime is much better for you. Try to go for a short walk after a meal, rather than sitting down or going straight to bed. Eat small portions at regular intervals rather than large meals. Try to avoid foods that you know have caused your indigestion before.

Limit the amount of alcohol that you drink, and try switching from red wine to white wine and from gassy beers. Drinking water with meals is much better for you and it will help dilute gastric acid.

Give up smoking, or if you cannot give up, avoid smoking after meals.
Advice for carers and family members
If you are cooking for someone that suffers from indigestion, give thoughts to meals and to meal times. Be aware of the types of meals that cause problems and try to avoid them. Reduce the size of meals and plan meal times so that you are not eating late at night.

Keep a check on the person, if you think that their symptoms are getting worse or have changed, persuade them to see their doctor in case there is anything more serious.
Useful Tips
  • Give up smoking - see give up smoking section
  • Eat little and often
  • Do not rush meals
  • Eat and drink in moderation
  • Avoid foods that you know upset you - greasy or spicy foods and coffee are common culprits
  • If aspirin brings on indigestion, try another painkiller but check with the pharmacist first
  • Try to avoid stressful situations before eating


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