What is Indigestion? (often called ‘dyspepsia’ by doctors!)
‘Indigestion’ is the term most frequently used by patients to describe any abnormal
sensations thought to be arising from the upper part of their gut (i.e. the oesophagus,
stomach and duodenum). It is an old English word meaning lack of digestion. The
symptoms most commonly described include heartburn (burning pain behind the breast
bone) and pain or discomfort in the upper abdomen (tummy!), often occurring after
meals.They may vary in frequency and severity, but often settle spontaneously.
How common is indigestion/dyspepsia?
It is common, a recent survey showing that 40% of adults experience indigestion
annually. Approximately 10% of the population seek advice for dyspeptic symptoms
from their doctor each year, but only 10% of them need to be referred to a specialist
because of continuing or severe symptoms.
What are the main causes of dyspepsia?
The main diagnostic categories for dyspepsia are as follows:
Gastro-oesophageal reflux disease (GORD)
GORD is usually caused by stomach acid passing backwards (refluxing) from the stomach
into the lower part of the oesophagus. This causes heartburn and can lead to inflammation
of the gullet lining, known as oesophagitis.
Peptic ulcer
A peptic ulcer is a break in the lining of the stomach (then referred to as a ‘gastric
ulcer’) or duodenum (referred to as a ‘duodenal ulcer’). They are called ‘peptic
ulcers’ after the digestive juice found in the stomach named ‘pepsin’. Infection
of the stomach lining by a bacterium called Helicobacter pylori (H. pylori) is the
major cause of ulcers. Ninety five per cent of duodenal ulcers and 70% of gastric
ulcers are caused by H. pylori. Killing of this bacterium leads to healing of the
ulcers in the majority of cases.
NSAID - induced dyspepsia
Dyspepsia can be caused by NSAIDs (Non-steroidal anti-inflammatory drug eg. aspirin,
ibuprofen) which are commonly taken for arthritis. These medicines are known to
cause irritation of the lining of the stomach and duodenum, possibly leading to
ulcers. As there is usually a need for the patient with arthritis to continue with
NSAID medication, it is often necessary for them to take an ulcer healing agent
to relieve dyspepsia symptoms and prevent ulcers.
Functional dyspepsia
This category covers patients who have been investigated for their dyspeptic symptoms,
but no medical cause has been found. The type of functional dyspepsia can be qualified
according to the patient's main symptom:
Functional ulcer-like dyspepsia: Patient mainly suffers from pain in the
stomach area (upper abdomen).
Functional dysmotility-like dyspepsia: Patient mainly experiences discomfort
(i.e. bloating and feeling of fullness) in the stomach area shortly after a normal
meal.
Functional reflux-like dyspepsia: Patient mainly complains of heartburn.
The majority of patients (60%) with dyspepsia are functional dyspeptics i.e. no
medical cause is found on investigation. GORD is found in 15-25% of patients. Ulcers
are also found in 15-25% of patients.
Future information
This first and future issues of the GastroClub newsletter will provide further information
on the categories of acid-related disorders outlined above. Each disorder will be
considered from various of the following aspects:
- The principles of drug treatment and lifestyle modification
- Anticipated responses to treatments and lifestyle changes
- Compliance with medication and lifestyle alterations
- Expected long term outcomes.
This further information and advice is provided to help you manage your condition
best, so that you are able to live a normal healthy life.