Dyspepsia

5 mins read

Introduction
Dyspepsia refers to impaired digestion. It is usually characterized by symptoms, including bloating, abdominal pain, loss of appetite, and heartburn. Dyspepsia is a common gastrointestinal disorder, caused by gastritis or acid reflux.

Epidemiology
Dyspepsia is one of the common complaints of patients with gastric disorders. Various studies have indicated that prevalence of dyspepsia is more prominent in women and older adults as compared to men and young adults respectively. Additionally, Hispanics have typically increased prevalence of the disorder.

Etiology Of Dyspepsia
In older adults, recurrent dyspepsia is more common. Some of the common causes of dyspepsia include:

Gastrointestinal Disorders
Disorders such as gastritis or duodenitis often lead to the development of dyspepsia. However, severe inflammation of both stomach and duodenum is associated with greater risk of dyspepsia as compared to mild condition.

Ulcers
Ulcers often result in the development of dyspepsia. Pancreatic ulcers, gastric ulcers, and duodenal ulcers are some of the common types found in adult individuals.

Hernia
Hernia results in gastro-esophageal reflux disease, thereby affecting the normal digestion in the body.

Non-ulcer dyspepsia
This type of dyspepsia, also called as functional dyspepsia, occurs without a known cause. However, various studies have demonstrated Heliobacter pylori infection as the probable cause for functional dyspepsia.

Drugs
Drugs such as anti-inflammatory agents, calcium antagonists, iron, nitrates, steroids and antibiotics are known to cause inflammation and ulcers. 

Symptoms
Some of the common symptoms associated with mild and severe dyspepsia:

  • Abdominal pain and discomfort in the lower respiratory system
  • Fullness after a moderate amount of food
  • Bloating
  • Loss of appetite
  • Intense irritation in the abdominal region
  • Heartburn and burp

However, in severe dyspepsia, some of the commonly observed symptoms are:

  • Uncontrolled vomiting
  • Intense abdominal pain and discomfort
  • Gastrointestinal bleeding with clumps
  • Pain during swallowing
  • Swelling of the abdomen

Treatment strategies in dyspepsia

Treatment and management of dyspepsia focus on individual symptoms. Variety of drugs and lifestyle modifications have been recommended in dyspepsia.

Drugs
These are classified based on their effect on the symptoms.

Drugs such as H2-receptor antagonists and proton pump inhibitors (PPIs) are effective in reducing heartburn and burning sensation in the stomach. In this category, pantoprazole, esomeprazole, omeprazole, lansoprazole, and are some of the common PPIs used. Among H2-receptor antagonists, ranitidine, famotidine, and nizatidine are most commonly used.

Lifestyle Modifications
Changing lifestyle helps in relieving symptoms associated with dyspepsia. Following are some of the common strategies used in dyspepsia.

Diet

  • Eating more number of small meals is preferred over 2 or 3 full meals daily
  • After a meal, wait for 2-3 hours before sleep
  • Food ingredients such as chocolate, mint, spices, and beverages such as alcohol, beer, etc. worsen the symptoms
  • Adding fiber to the diet improves digestion
  • Excess water intake

Habits
Dyspepsia has been found to be severe in most of the smokers and alcoholics. Since alcohol loosens the valve between the stomach and esophagus, alcoholics are at an increased of complications associated with dyspepsia.

Posture
Excessive sitting in one place or continuous bending increases reflux. Thus, it is recommended to incorporate healthy sitting and lying postures.

Complications
Complications are associated with the severity of the condition. In most of the cases with severe dyspepsia, complications range from pyloric stenosis to esophageal stricture.

Pyloric stenosis
Long-term abrasion of internal lining of the gastrointestinal tract results in pyloric stenosis. Continuous irritation of the passage between pylorus and stomach leads to narrowing of the valve, thereby affecting the digestion of the food.

Esophageal stricture
It occurs when the acid in the stomach is refluxed in the esophagus. The acid caused irritation of the esophageal lining, thereby causing scarring. Esophageal stricture is associated with difficulty in swallowing, heartburn, abdominal irritation, and burning sensation.

Prevention
Some of the effective measures in preventing dyspepsia are:

  • Increased intake of water and liquid-based foods
  • Eating foods that are soft and easily digested
  • Reducing intake of alcohol, cigarettes, or any other alcoholic beverages
  • Including a healthy lifestyle, regular exercise, optimum amount of sleep, and time-bound activities in daily schedule

Conclusion
Dyspepsia is a common gastrointestinal disorder, which is characterized by acid reflux, heartburn, and abdominal pain. If left untreated, it can lead to pyloric stenosis and esophageal stricture. Lifestyle modifications and drugs such as PPIs and as H2-receptor antagonists are recommended in the treatment of dyspepsia.

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References
1. Petrarca L, Nenna R, Mastrogiorgio G, et al. Dyspepsia and celiac disease: Prevalence, diagnostic tools and therapy. World J Methodol. 2014 Sep 26;4(3):189–96.

2. Futagami S, Itoh T, Sakamoto C. Systematic review with meta-analysis: post-infectious functional dyspepsia. Aliment Pharmacol Ther. 2015 Jan;41(2):177–88.

3. Rejchrt S, Koupil I, Kopáčová M, et al. Epidemiology of dyspepsia. Vnitr Lek. 2014 Jul-Aug;60(7-8):649-56.

4. Chen SL. A review of drug therapy for functional dyspepsia. J Dig Dis. 2013 Dec;14(12):623–5.

5. Kamani F, Hessami R, Abrishami A. Benign duodenocolic fistula as a complication of peptic ulcer disease. Gastroenterol Hepatol Bed Bench. 2014 Winter;7(1):72–5.

6. Vasiliou C, Xiromeritou V, Kafiri G, Papatheodoridis G. Endoscopic and Histological Findings and Helicobacter pylori Status in Patients With Reflux and/or Dyspeptic Symptoms: A Recent Greek Cohort Study. Gastroenterol Nurs. 2014 Nov-Dec;37(6):431–8.

7. Mayanagi S, Kishino M, Kitagawa Y, Sunamura M. Efficacy of acotiamide in combination with esomeprazole for functional dyspepsia refractory to proton-pump inhibitor monotherapy. Tohoku J Exp Med. 2014;234(3):237–40.

8. Mouafo Tambo FF, Kouna Tsala IN, Ngowe Ngowe M, et al. Hypertrophic pyloric stenosis in infants: is it a congenital or acquired disorder? Reflections on 2 cases. Springerplus. 2014 Sep 24;3:555.

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