About Functional Dyspepsia (Dyspepsia)
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Learn about the disease, illness and/or condition Functional Dyspepsia (Dyspepsia) including: symptoms, causes, treatments, contraindications and conditions at ClusterMed.info.
Functional Dyspepsia (Dyspepsia)
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Functional Dyspepsia (Dyspepsia) |
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Functional Dyspepsia (Dyspepsia) InformationAbdominal discomfort and excessive air in the stomachEveryone knows that when they have mild abdominal discomfort, belching often relieves the problem. This is because excessive air in the stomach often is the cause of mild abdominal discomfort; as a result, people force belches whenever mild abdominal discomfort is felt, whatever the cause. Unfortunately, if there is no excessive gas to be expelled, forced belches do nothing more than draw air into the esophagus. Usually this air is expelled during the same belch (referred to as a supradiaphragmatic belch), but the air also may enter the stomach, and itself result in excess gas that must be expelled with additional belching.If the problem causing the discomfort is not excessive air in the stomach, then belching does not provide relief. As mentioned previously, it even may make the situation worse by increasing air in the stomach. When belching does not ease the discomfort, the belching should be taken as a sign that something may be wrong within the abdomen, and the cause of the discomfort should be sought. Belching by itself, however, does not help the physician determine what may be wrong because belching can occur in virtually any abdominal disease or condition that causes discomfort. Antidepressants for indigestionPatients with functional disorders, including indigestion, are frequently found to be suffering from depression and/or anxiety. It is unclear, however, if the depression and anxiety are the cause or the result of the functional disorders or are unrelated to these disorders. (Depression and anxiety are common and, therefore, their occurrence together with functional disorders may be coincidental.) Several clinical trials have shown that antidepressants are effective in IBS in relieving abdominal pain. Antidepressants also have been shown to be effective in unexplained (non-cardiac) chest pain, a condition thought to represent a dysfunction of the esophagus. Antidepressants have not been studied adequately in other types of functional disorders, including indigestion. It probably is reasonable to treat patients with indigestion with psychotropic drugs if they have moderate or severe depression or anxiety.The antidepressants work in functional disorders at relatively low doses that have little or no effect on depression. It is believed, therefore, that these drugs work not by combating depression, but in different ways (through different mechanisms). For example, these drugs have been shown to adjust (modulate) the activity of the nerves and to have analgesic (pain-relieving) effects as well.Commonly used psychotropic drugs include the tricyclic antidepressants, desipramine (Norpramine) and trimipramine (Surmontil). Although studies are encouraging, it is not yet clear whether the newer class of antidepressants, the serotonin-reuptake inhibitors such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), are effective in functional disorders, including indigestion. Diet and indigestionDietary factors have not been well-studied in the treatment of indigestion. Nevertheless, people often associate their symptoms with specific foods (such as salads and fats). Although specific foods might worsen the symptoms of indigestion, they usually are not the cause of indigestion. (Intolerance to specific foods, for example, lactose intolerance [milk] and allergies to wheat, eggs, soy, and milk protein are not considered functional diseases like indigestion). The common placebo response in functional disorders such as indigestion also may explain the improvement of symptoms in some people with the elimination of specific foods.Dietary fiber often is recommended for patients with IBS, but fiber has not been studied in the treatment of indigestion. Nevertheless, it probably is reasonable to treat patients with indigestion with fiber if they also have constipation.Intolerance to lactose (the sugar in milk) often is blamed for indigestion. Since indigestion and lactose intolerance both are common, the two conditions may coexist. In this situation, restricting lactose will improve the symptoms of lactose intolerance, but will not affect the symptoms of indigestion. Lactose intolerance is easily determined by a milk challenge testing the effects of lactose (hydrogen breath testing) or trying a strict lactose elimination diet. If lactose is determined to be responsible for some or all of the symptoms, elimination of lactose-containing foods is appropriate. Unfortunately, many patients stop drinking milk or eating milk-containing foods without good evidence that it improves their symptoms. This often is detrimental to their intake of calcium which may contribute to osteoporosis.One of the food substances most commonly associated with the symptoms of indigestion is fat. The scientific evidence that fat causes indigestion is weak. Most of the support is anecdotal (not based on carefully done, scientific studies). Nevertheless, fat is one of the most potent influences on gastrointestinal function. (It tends to slow down the gastrointestinal muscles while it causes the muscles of the gallbladder to contract.) Therefore, it is possible that fat may worsen indigestion even though it doesn't cause it. Moreover, reducing the ingestion of fat might relieve symptoms. A strict low fat diet can be accomplished fairly easily and is worth trying. Additionally, there are other health-related reasons for reducing dietary fat.Other dietary factors, fructose, and other sugar-related foods (fermentable, oligo- di- and mono-saccharides and polyols or FODMAPs), have been suggested as a cause of indigestion since many people do not fully digest and absorb them before they reach the distal intestine. Fructose intolerance and perhaps also FODMAP intolerance can be diagnosed with a hydrogen breath test using fructose and treated by elimination of fructose and/or FODMAP containing foods from the diet. Unfortunately, fructose and FODMAPs are widespread among fruits and vegetables, and fructose is found in high concentrations in many food products sweetened with corn syrup. Thus, an elimination diet can be difficult to maintain. Indigestion definition (dyspepsia) and facts
Pro-motility medication for indigestionOne of the leading theories for the cause of indigestion is abnormalities in the way gastrointestinal muscles function. The function of muscles may be abnormally increased, abnormally decreased, or it may by uncoordinated. There are medications, called smooth muscle relaxants that can reduce the activity of the muscles and other drugs that can increase the activity of the muscles, called promotility drugs.Many of the symptoms of indigestion can be explained on the basis of reduced activity of the gastrointestinal muscles that results in slowed transport (transit) of food through the stomach and intestine. (It is clear, as discussed previously, that there are other causes of these symptoms in addition to slowed transit.) Such symptoms include nausea, vomiting, and abdominal bloating. When transit is severely affected, abdominal distention (swelling) also may occur and can result in abdominal pain. (Early satiety is unlikely to be a function of slowed transit because it occurs too early for slowed transit to have consequences.) Theoretically, drugs that speed up the transit of food should, in at least some patients, relieve symptoms of indigestion that are due to slow transit.The number of promotility drugs that are available for use clinically is limited. Studies of their effectiveness in indigestion are even more limited. The most studied drug is cisapride (Propulsid), a promotility drug that was withdrawn from the market because of serious cardiac side effects. (Newer drugs that have similar effects but lack the toxicity are being developed.) The few studies with cisapride for indigestion were inconsistent in their results. Some studies demonstrated benefits whereas others showed no benefit. Cisapride was effective in patients with severe emptying problems of the stomach (gastroparesis) or severely slowed transit of food through the small intestine (chronic intestinal pseudo-obstruction). These two diseases may or may not be related to indigestion.Another promotility drug that is available is erythromycin, an antibiotic that stimulates gastrointestinal smooth muscle as one of its side effects. Erythromycin is used to stimulate smooth muscles of the gastrointestinal tract at doses that are lower than those used for treating infections. There are no studies of erythromycin in indigestion, but erythromycin is effective in gastroparesis and probably also in chronic intestinal pseudo-obstruction.Metoclopramide (Reglan) is another promotility drug that is available. It has not been studied, however, in indigestion. Moreover, it is associated with some troubling side effects. Therefore, it may not be a good drug to undergo further testing in indigestion.Domperidone (Motilium) is a promotility drug that is available in the U.S., but requires a special permit from the US Food and Drug administration. As a result, it is not very commonly prescribed. It is an effective drug with minimal side effects. Psychological treatments for indigestionPsychological treatments include cognitive-behavioral therapy, hypnosis, psychodynamic or interpersonal psychotherapy, and relaxation/stress management. Few studies of psychological treatments have been conducted in indigestion, although more studies have been done in IBS. Thus, there is little scientific evidence that they are effective in indigestion, although there is some evidence that they are effective in IBS.Hypnosis has been proposed as an effective treatment for IBS. It is unclear exactly how effective hypnosis is, or how it works. Smooth muscle relaxants for indigestionThe most widely studied drugs for the treatment of abdominal pain in functional disorders are a group of drugs called smooth-muscle relaxants.The gastrointestinal tract is primarily composed of a type of muscle called smooth muscle. (By contrast, skeletal muscles such as the biceps are composed of a type of muscle called striated muscle.) Smooth muscle relaxant drugs reduce the strength of contraction of the smooth muscles but do not affect the contraction of other types of muscles. They are used in functional disorders, particularly IBS, with the assumption (not proven) that strong or prolonged contractions of smooth muscles in the intestine-spasms-are the cause of the pain in functional disorders. There are even smooth muscle relaxants that are placed under the tongue, as is nitroglycerin for angina, so that they may be absorbed rapidly.There are not enough studies of smooth muscle relaxants in indigestion to conclude that they are effective at reducing pain. Since their side effects are few, these drugs probably are worth trying. As with all drugs that are given to control symptoms, patients should carefully evaluate whether or not the smooth muscle relaxant they are using is effective at controlling the symptoms. If it is not clearly effective, the option of discontinuing the relaxant should be discussed with a physician.Commonly used smooth muscle relaxants are hyoscyamine (Levsin, Anaspaz, Cystospaz, Donnamar) and methscopolamine (Pamine, Pamine Forte). Other drugs combine smooth muscle relaxants with a sedative chlordiazepoxide hydrochloride and clidinium bromide (Donnatal, Librax), but there is no evidence that the addition of sedatives adds to the effectiveness of the treatment. How is indigestion (dyspepsia) diagnosed?Indigestion is diagnosed primarily on the basis of typical symptoms and the exclusion of non-functional gastrointestinal diseases (including acid-related diseases), non-gastrointestinal diseases, and psychiatric illness. There are tests for identifying abnormal gastrointestinal function directly, but they are limited in their ability to do so. How long does indigestion (dyspepsia) last?Indigestion is a chronic disease that usually lasts years, if not a lifetime. It does, however, display periodicity, which means that the symptoms may be more frequent or severe for days, weeks, or months and then less frequent or severe for days, weeks, or months. The reasons for these fluctuations are unknown. Because of the fluctuations, it is important to judge the effects of treatment over many weeks or months to be certain that any improvement is due to treatment and not simply to a natural fluctuation in the frequency or severity of the disease. Is burping (belching) a symptom of indigestion?It is appropriate to discuss belching in detail since it is a commonly misunderstood symptom associated with indigestion.
What are the complications of indigestion (dyspepsia)?The complications of functional diseases of the gastrointestinal tract are relatively limited. Since symptoms are most often provoked by eating, patients who alter their diets and reduce their intake of calories may lose weight. However, loss of weight is unusual in functional diseases. In fact, loss of weight should suggest the presence of non-functional diseases. Symptoms that awaken patients from sleep also are more likely to be due to non-functional than functional disease.Most commonly, functional diseases interfere with patients' comfort and daily activities. Individuals who develop nausea or pain after eating may skip breakfast or lunch because of the symptoms they experience. Patients also commonly associate symptoms with specific foods (for example, milk, fat, vegetables). Whether or not the associations are real, these patients will restrict their diets accordingly. Milk is the most common food that is eliminated, often unnecessarily, and this can lead to inadequate intake of calcium and osteoporosis. The interference with daily activities also can lead to problems with interpersonal relationships, especially with spouses. Most patients with functional disease live with their symptoms and infrequently visit physicians for diagnosis and treatment. What are the signs and symptoms of indigestion or upset stomach?We usually think of symptoms of indigestion as originating from the upper gastrointestinal tract, primarily the stomach and first part of the small intestine. These symptoms include:
What can a person expect during the diagnosis and treatment of indigestion (prognosis)?The initial approach to dyspepsia, whether it be treatment or testing, depends on the patient's age, symptoms and the duration of the symptoms. If the patient is younger than 50 years of age and serious disease, particularly cancer, is not likely, testing is less important. If the symptoms are typical for dyspepsia and have been present for many years without change, then there is less need for testing, or at least extensive testing, to exclude other gastrointestinal and non-gastrointestinal diseases.On the other hand, if the symptoms are of recent onset (weeks or months), progressively worsening, severe, or associated with "warning" signs, then early, more extensive testing is appropriate. Warning signs include loss of weight, nighttime awakening, blood in the stool or the material that is vomited (vomitus), and signs of inflammation, such as fever or abdominal tenderness. Testing also is appropriate if, in addition to symptoms of dyspepsia, there are other prominent symptoms that are not commonly associated with dyspepsia.If there are symptoms that suggest conditions other than dyspepsia, tests that are specific for these diseases should be done first. The reason is that if these other tests disclose other diseases, it may not be necessary to do additional testing. Examples of such symptoms and possible testing include:
What causes indigestion (dyspepsia)?Non-gastrointestinal causes of indigestionIt's not surprising that many gastrointestinal (GI) diseases have been associated with indigestion. However, many non-GI diseases also have been associated with indigestion. Examples of non-GI causes of indigestion include
What is indigestion (dyspepsia, upset stomach)? Is it common?Indigestion is one of the most common ailments of the bowel (intestines), affecting an estimated 20% of persons in the United States. Perhaps only 10% of those affected actually seek medical attention for their indigestion. Indigestion is not a particularly good term for the ailment since it implies that there is "dyspepsia" or abnormal digestion of food, and this most probably is not the case. In fact, another common name for dyspepsia is indigestion, which, for the same reason, is no better than the term dyspepsia! Doctors frequently refer to the condition as non-ulcer dyspepsia to distinguish it from the more common acid or ulcer-related symptoms.Dyspepsia (indigestion) is best described as a functional disease. (Sometimes, it is called functional dyspepsia.) The concept of functional disease is particularly useful when discussing diseases of the gastrointestinal tract. The concept applies to the muscular organs of the gastrointestinal tract, the esophagus, stomach, small intestine, gallbladder, and colon that are controlled y nerves. What is meant by the term, functional, is that either the muscles of the organs or the nerves that control the organs are not working normally, and, as a result, the organs do not function normally, and the dysfunction causes the symptoms. The nerves that control the organs include not only the nerves that lie within the muscles of the organs but also the nerves of the spinal cord and brain.Some gastrointestinal diseases can be seen and diagnosed with the naked eye, such as ulcers of the stomach and can be seen at surgery, on X-rays, and by endoscopy. Other diseases cannot be seen with the naked eye but can be seen and diagnosed under the microscope. For example, gastritis (inflammation of the stomach) can be diagnosed by microscopic examination of biopsies of the stomach. In contrast, gastrointestinal functional diseases cannot be seen with the naked eye or the microscope. Accordingly, and by default, functional gastrointestinal diseases are those that involve abnormal function of gastrointestinal organs in which the abnormalities cannot be seen in the organs with either the naked eye or the microscope.In some instances, the abnormal function can be demonstrated by tests (for example, gastric emptying studies or antro-duodenal motility studies). However, the tests often are complex, are not widely available, and do not reliably detect the functional abnormalities.Occasionally, diseases that are thought to be functional are ultimately found to be associated with abnormalities that can be seen by the naked eye or under the microscope. Then, the disease moves out of the functional category. An example of this would be Helicobacter pylori (H. pylori) infection of the stomach. Some patients with mild upper gastrointestinal symptoms who were thought to have abnormal function of the stomach or intestines have been found to have stomachs infected with H. pylori. This infection can be diagnosed under the microscope by identifying the bacterium in biopsies from the stomach. When patients are treated with antibiotics, the H. pylori and symptoms disappear. Thus, recognition of infections with Helicobacter pylori has removed some patients' symptoms from the functional disease category.The distinction between functional disease and non-functional disease may, in fact, be blurry. Thus, even functional diseases probably have associated biochemical or molecular abnormalities that ultimately will be able to be measured. For example, functional diseases of the stomach and intestines may be shown ultimately to be associated with reduced or increased levels of normal chemicals within the gastrointestinal organs, the spinal cord, or the brain. Should a disease that is demonstrated to be due to a reduced or increased chemical still be considered a functional disease? In this theoretical situation, we can't see the abnormality with the naked eye or the microscope, but we can measure it. If we can measure an associated or causative abnormality, should the disease no longer be considered functional, even though the disease (symptoms) are being caused by abnormal function? The answer is unclear.Despite the shortcomings of the term, functional, the concept of a functional abnormality is useful for approaching many of the symptoms originating from the muscular organs of the gastrointestinal tract. To repeat, this concept applies to those symptoms for which there are no associated abnormalities that can be seen with the naked eye or the microscope.While dyspepsia is a major functional disease(s), it is important to mention several other functional diseases. A second major functional disease is the irritable bowel syndrome, or IBS. The symptoms of IBS are thought to originate primarily from the small intestine and/or colon. The symptoms of IBS include abdominal pain that is accompanied by alterations in bowel movements (defecation), primarily constipation or diarrhea. In fact, indigestion and IBS may be overlapping diseases since up to half of patients with IBS also have symptoms of indigestion. A third distinct functional disorder is non-cardiac chest pain. This pain may mimic heart pain (angina), but it is unassociated with heart disease. In fact, non-cardiac chest pain is thought to often result from a functional abnormality of the esophagus.Functional disorders of the gastrointestinal tract often are categorized by the organ of involvement. Thus, there are functional disorders of the esophagus, stomach, small intestine, colon, and gallbladder. The amount of research that has been done with functional disorders is greatest in the esophagus and stomach (for example, non-cardiac chest pain, indigestion), perhaps because these organs are easiest to reach and study. Research into functional disorders affecting the small intestine and colon (IBS) is more difficult to conduct, and there is less agreement among the research studies. This probably is a reflection of the complexity of the activities of the small intestine and colon and the difficulty in studying these activities. Functional diseases of the gallbladder (referred to as biliary dyskinesia), like those of the small intestine and colon, also are more difficult to study, and at present they are less well-defined. Each of the functional diseases is associated with its own set of characteristic symptoms.Picture of the organs and glands in the abdomen What natural or home remedies are used to treat dyspepsia (indigestion)?Studies of natural and home remedies for indigestion are few. Most recommendations for natural and home remedies have little evidence to support their use. Several potential remedies, however, deserve mention including:
What other diseases or conditions mimic indigestion (dyspepsia)?Exclusion of non-functional gastrointestinal diseaseAs always, a detailed history from the patient and a physical examination frequently will suggest the cause of dyspepsia. Routine screening blood tests often are performed looking for clues to unsuspected diseases. Examinations of stool also are a part of the evaluation since they may reveal infection, signs of inflammation, or blood and direct further diagnostic testing. Sensitive stool testing (antigen/antibody) for Giardia lamblia would be reasonable because this parasitic infection is common and can be acute or chronic. Some physicians do blood testing for celiac disease (sprue), but the value of doing this is unclear. (Moreover, if an EGD is planned, biopsies of the duodenum usually will make the diagnosis of celiac disease.) If bacterial overgrowth of the small intestine is being considered, breath hydrogen testing can be considered.There are many tests to exclude non-functional gastrointestinal diseases. The primary issue, however, is to decide which tests are reasonable to perform. Since each case is individual, different tests may be reasonable for different patients. Nevertheless, certain basic tests are often performed to exclude non-functional gastrointestinal disease. These tests identify anatomic (structural) and histological (microscopic) diseases of the esophagus, stomach, and intestines.Both X-rays and endoscopies can identify anatomic diseases. Only endoscopies, however, can diagnose histological diseases because biopsies (samples of tissue) can be taken during the procedure. The X-ray tests include:
What research is ongoing for treatments to cure indigestion (dyspepsia)?The future of dyspepsia will depend on our increasing knowledge of the processes (mechanisms) that cause dyspepsia. Acquiring this knowledge, in turn, depends on research funding. Because of the difficulties in conducting research in dyspepsia, this knowledge will not come quickly. Until we have an understanding of the mechanisms of dyspepsia, newer treatments will be based on our developing a better understanding of the normal control of gastrointestinal function, which is proceeding more rapidly. Specifically, there is intense interest in intestinal neurotransmitters, which are chemicals that the nerves of the intestine use to communicate with each other. The interactions of these neurotransmitters are responsible for adjusting (modulating) the functions of the intestines, such as contraction of muscles and secretion of fluid and mucus.5-hydroxytriptamine (5-HT or serotonin) is a neurotransmitter that stimulates several different receptors on nerves in the intestine. Examples of experimental drugs for intestinal neurotransmission are sumatriptan (Imitrex) and buspirone (Buspar). These drugs are believed to reduce the responsiveness (sensitivity) of the sensory nerves to what's happening in the intestine by attaching to a particular 5-HT receptor, the 5-HT1 receptor. The 5-HT1 receptor drugs, however, have received only minimal study so far and their role in the treatment of dyspepsia, if any, is unclear.Promotility drugs similar to cisapride, as previously discussed, are being pursued actively.Another area of active research is relaxation of the muscles of the stomach for the treatment of dyspepsia. Normally when food enters the stomach, the stomach relaxes to accommodate the food and the secretions it stimulates. Many patients with dyspepsia have been found to have reduced relaxation of the stomach when food enters, and it is possible that this results in discomfort. Drugs that specifically relax the muscles of the stomach are being developed, but more clinical trials showing their benefit are needed. What treatments relieve and cure indigestion (dyspepsia)?The treatment of indigestion is a difficult and unsatisfying topic because so few drugs have been studied and have been shown to be effective. Moreover, the drugs that have been shown to be effective have not been shown to be very effective. This difficult situation exists for many reasons including:
Which specialties of doctors treat indigestion (dyspepsia)?Since indigestion is very common, almost all doctors see and treat patients with indigestion, especially family practitioners, internists and even pediatricians. If these generalists are unable to provide adequate treatment, the patient usually is referred to a gastroenterologist, an internist or pediatrician with specialty training in gastrointestinal diseases. |
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