Dyspepsia, indigestion - Causes, symptoms and treatment. MF.

Dyspepsia is the most frequent reason for a patient to consult a therapist and gastroenterologist. Includes a complex of symptoms:

• pain or discomfort in the epigastrium( upper middle abdomen),
• rapid saturation,
• heartburn,
• burp,
• bloating( flatulence),
• nausea.

Symptoms may be related or not related to eating, physical activity.

The discomfort of is an unpleasant sensation that the patient does not regard as pain, but has many shades( a feeling of overflow, heaviness, heat).

Fast saturation of - a feeling of satiety after eating a small amount of food, which does not allow you to eat up to the end the usual daily portion of food.

Symptoms of dyspepsia not are associated with a violation of the function of the large intestine
( a decrease or disappearance of symptoms after defecation, a change in the frequency and nature of the stool).

Dyspepsia is not a specific syndrome and can occur both in functional disorders and in organic lesions of the gastrointestinal tract.

Common causes of dyspepsia:

- Hasty food. Digestive juices do not have time to stand out. The food is badly chewed, so it does not mix well with the digestive enzymes of saliva.

- Overeating.

- Certain products.

- Drinking certain drinks. Carbon dioxide and sugar in them can cause bloating and flatulence. Caffeine increases gastric acidity and irritates the inflamed areas( also alcohol acts), and in addition, stimulates the release of stress hormones.

- Stress. They deteriorate digestion, because they are associated with the release of hormones( in particular, adrenaline and cortisone), which redistribute the bloodstream from the digestive tract to the muscles. Stress also promotes swallowing of the air during meals( aerophagia).

- Exercise soon after eating. It redistributes the bloodstream from the digestive tract to the muscles.

- Admission of non-steroidal anti-inflammatory drugs.

Diseases accompanied by dyspepsia

Approximately half of patients with organic dyspepsia are more often associated with peptic ulcer, GERD( gastroesophageal flux disease), less often pancreatitis, cholelithiasis, cholecystitis, stomach and pancreatic tumors.

Organic dyspepsia( caused by the disease) differs from functional dyspepsia by the presence of: seasonal pains( exacerbation more often in the spring and autumn period), the appearance of night pains, dyspnoea, intense heartburn( more than 2 times a week), weight loss,in the diagnostic data.

For functional dyspepsia( "something is not eaten"), there are many complaints with a general satisfactory condition and a long, favorable course of the disease without progression.

In the emergence of functional dyspepsia, the following factors play a role:

1. Emotional overexertion, mental trauma, depression, stress.
2. Disruption of diet: irregular eating, overeating, "snacking" at night.
3. Smoking, drinking alcoholic beverages.
4. Infection of the gastric mucosa with H. pylori.
5. The impact of environmental factors: high air temperature, high atmospheric pressure, vibration.

The leading mechanism of development of dyspepsia is the violation of the nervous regulation of the motor function of the stomach and duodenum.

It is manifested by: casting the contents of the duodenum into the stomach, slowing down the emptying of the stomach, disturbing the gastroduodenal coordination, reducing the sensitivity of the gastric mucosa to stretching.

Diagnosis for dyspepsia:

1. PHAGS( fibrogastroduodenoscopy) with biopsy. It is performed to exclude peptic ulcer, GERD, esophagus tumors, stomach.
2. Ultrasound of internal organs. Excludes diseases of the liver, gall bladder, pancreas, thyroid gland.
3. Conduct a test to establish H. pylori infection.
4. Intragastric pH-metry( monitoring excludes GERD)
5. General blood test. Identification of anemia, inflammation.
6. Fecal occult blood test. Detects latent bleeding from the gastrointestinal tract.
7. Investigation of gastroduodenal motility - allows to investigate the motor-evacuator function of the stomach and to identify its disorders, in disputable cases:
- ultrasound determination of the rate of gastric emptying;
- 13C - octane respiratory test.

If after a thorough thorough examination of organic causes could not be established, then a functional dyspepsia is diagnosed. But, in spite of the absence of organic pathology, such patients suffer a significant quality of life, which requires long-term treatment.

Sometimes the examination of the patient himself, the demonstration of the survey data, indicating the absence of a serious disease, in itself gives a positive therapeutic effect.

To what doctors to address, if dyspepsia occurs:

To address it is necessary to the general practitioner( therapist).You may need to consult a gastroenterologist, an oncologist.

It is important to get a doctor on time if dyspepsia, anxiety symptoms, dysphagia( disorder, difficulty swallowing), multiple vomiting( especially with blood) occurs, a decrease or lack of appetite, weight loss, pallor of the skin, a risebody temperature, changes in laboratory parameters. For the first time, the appearance of symptoms of dyspepsia in persons over 45 years of age, usually indicate a serious organic pathology( complication of the disease) and require an immediate examination of a general practitioner - therapist, family doctor.

Treatment of dyspepsia:

It is recommended that individual dietary regimens be observed with the exception or restriction of individually intolerable products.

Cessation of smoking, drinking. A positive effect is given by walking 1-1.5 hours before going to bed, exercising in the gym, fitness, swimming, and other physical exercises that improve the patient's well-being.

If H. pylori infection is detected, eradication( complete destruction of the bacteria) is carried out under the supervision of a physician.

For the removal of symptoms of the disease, antisecretory drugs are used. Aluminum antacids( maalox Almagel gastrocid, Gaviscon), proton pump inhibitors( omeprazole, lansoprazole, pantoprazole, rabeprozol), peristalsis stimulators( domperidone) that eliminate pain neutralizing the action of hydrochloric acid. Antacids are applied 4 times a day 40 minutes after eating and with pain, but no more than 6 times a day. They are used for a week, if the phenomena of dyspepsia persist, you need to see a doctor, the dose of the proton pump inhibitor, prokinetics and the frequency of reception will be recommended by your doctor.

The efficacy of placebo( an externally positive therapeutic effect, which is not related to the effect of drugs but to the self-hypnosis of the patient) to 60% of in patients with functional dyspepsia confirms the role of neuropsychiating factors in its occurrence. Their elimination, normalization of relations in the family and at work, a rational mode of work and rest helps to get rid of this symptom. Various types of psychotherapy are shown, the use of antidepressants under the supervision of a psychotherapist.

Doctor therapist Vostrenkova IN