Dyspepsia is defined as a repetitive and persistent feeling of discomfort, usually associated with food, in the upper-middle part of the abdomen, in the area between the two ribs called the epigastrium in medical terms, that is, in the region that fits the stomach. Dyspepsia is the name of the complaint, not the name of the disease.
What Are the Symptoms of Indigestion?
It consists of a combination of one or more of the complaints such as pain, tension, fullness, early satiety, belching, nausea, loss of appetite, varying from patient to patient. If patients have complaints such as burning in the chest and food coming back into the mouth after eating, this is considered as gastroesophageal reflux disease, not dyspepsia.
What is the Frequency of Indigestion in the Community?
Dyspepsia is seen in about 1/4 of adult people. In our country, 30% of the patients who applied to the family physician and about 50% of the patients who applied to the gastroenterology specialist were patients with dyspepsia (indigestion). Half of these patients may have lifelong recurrent complaints.
What are the causes of indigestion?
There are two main reasons for dyspepsia. These; Organic dyspepsia: Here, there is an organic disease that can be determined by the patient's complaints, primarily by endoscopic examination, and also by some other examinations. (eg ulcer, gastritis, stomach cancer, pancreas, gallbladder diseases, etc.).
Functional dyspepsia: With today's technological possibilities, a recognizable macroscopic (visible) pathology cannot be shown under the complaints. The presence of microscopic (invisible) gastritis in the stomach or movement irregularities of unknown origin in the stomach movements are also included in the definition of functional dyspepsia. Because there is no direct relationship between such situations and indigestion complaints.
What Causes Functional Indigestion?
The cause of FD is currently unclear. A number of factors are to blame. Among them:
- Between the sensory nerves of the intestinal nervous system and the central nervous system
- Interaction irregularities
- Bowel movement dysfunction
- Although many psychosocial and physiological changes such as organ perception disorders and psychological factors have been described, their importance is controversial today.
How Should the Patient with Indigestion Be Approached?
It is necessary to make a careful questioning and physical examination from patients with indigestion complaints. The age of the patient, the character of his complaints, whether or not he went to the doctor regarding these complaints before, if he went to the doctor, did he get a diagnosis, whether any examinations were made regarding his disease or not, are there any medications/drugs he has been using recently or for a long time should be carefully questioned. How is the patient's mental state (normal, restless, sad), does he have any other chronic (chronic) disease? Do you have any gastrointestinal disorders in your first degree relatives? How is the nutritional status? Do you have one or more of the complaints such as loss of appetite, weight loss, weakness, fatigue, fever? must be questioned.
After questioning, a careful physical examination should be performed. It should be determined whether the patient has a finding detected by examination. (Among these, it should be determined whether there is anemia, fever, jaundice, lymph node enlargement, abdominal tenderness, a palpable mass, and organ enlargement.)
Is Examination Necessary for Every Patient for Diagnosis?
If it is necessary to perform an examination to investigate the cause of the digestive problem, the most important examination is endoscopy. First of all, the age of the patient is important. Although there is no definite age limit for endoscopic examination in the diagnostic guidelines, it is determined by considering the incidence of gastric cancer in the region where the patient lives. For example, the guidelines of the American Gastroenterology Association accept the age of 60 or 65 as the threshold age at which endoscopy should be performed for all new dyspeptic patients, but state that the age limit of 45 or 50 may be reasonable. In the European consensus, it is recommended to perform endoscopy in adults over the age of 45 who present with persistent dyspepsia. In our country, mostly European consensus reports are taken into consideration. These recommendations are made by considering the characteristics of the patient's complaints, ethnic origin, family history, nationality and regional gastric cancer frequency. It is emphasized that the age limit may vary from patient to patient. The diagnostic yield of endoscopy increases with age. The region where gastric cancer is most common in our country is the North East Anatolia region. (Erzurum and Van regions) We found the incidence of gastric cancer to be around 4% in patients who underwent endoscopy with dyspepsia complaints in these regions.
What are the Alarm Symptoms in Patients with Indigestion Complaints?
Alarm complaints and signs are those that suggest an organic disease. These are: The patient's complaints for less than six months, difficulty in swallowing, nausea, vomiting, loss of appetite, weakness, any history of gastrointestinal disease in the patient's first degree relatives (mother, father, siblings) (ulcer, gastritis, stomach ache). -intestinal cancer), the presence of an organic disease finding such as anemia, fever, abdominal mass, organ enlargement, jaundice is considered as an alarm sign. In patients under 1-45 years of age, if there are no alarm complaints or signs, these patients are evaluated as functional indigestion, empirical treatment is given to these patients, and the patient is called for control after 50 weeks. If the patient has not fully benefited from the treatment or has benefited from the treatment but has recurred after a while, then this is considered an alarm sign, and upper endoscopy is performed on these patients.
In these patients undergoing endoscopy, 2 situations are encountered: 1-An organic disease can be seen in the stomach endoscopically (gastritis, ulcer, tumor or suspected tumor). In this case, necessary biopsies are taken. Endoscopically, there is no organic disease appearance. In these patients, biopsy samples are still taken both for the diagnosis of this pathological bacterium called Helicobacter Pylori and to investigate whether there is a microscopic pathology. If deemed necessary in these patients, other abdominal organs (pancreas, gallbladder, biliary tract, etc.) are also investigated in terms of whether there is a disease.
How Is Indigestion Treated?
If an organic disease is determined in the endoscopy in patients undergoing endoscopy, the treatment principles are determined according to the existing disease (such as ulcer, gastritis treatment). But if an organic disease is not detected in the endoscopy or if the complaints in patients under the age of 45-50 comply with the functional indigestion criteria, the treatment principles are determined accordingly. In patients under the age of forty-five-fifty, the diagnosis of FD is made according to the Roman diagnostic criteria.
According to the Roman diagnostic criteria, the medical treatment is determined according to whichever complaint the patient has in the foreground. Functional indigestion is examined under two headings according to the Roman criteria.
Post prandial (end of meal) stress syndrome
The patient's complaint is more than 6 months in at least the last 3 months and at least one of the indigestion complaints is seen, These complaints are: Postprandial (post-meal) discomforting feeling of fullness (always or at least a few times a week postprandial bloating despite eating a normal amount) Early satiety (continuous or at least a few times a week complaining of being prevented from finishing a normal meal)
functional pain syndrome
Having complaints of pain or burning in the stomach area lasting more than 6 months in at least 3 months before diagnosis. Pain or burning sensation (intermittent—at least once a week—not radiating to other abdominal regions—not relieved by defecation/flatulence—presence of pain that does not meet the criteria for gallbladder or biliary tract)
General Precautions and Diet Against Indigestion
What does functional indigestion mean? This concept should be explained to the patient and trust should be established.
- Among dietary measures: Maximum avoidance of coffee, cigarettes, alcohol, aspirin and other painkillers and rheumatic drugs with stomach side effects.
- avoiding oily, spicy foods
- Small, low-fat food intake for 6 meals a day
- To get psychological support if the patient has anxiety or depression. This group of patients benefit greatly from psychological treatment.
In drug therapy: If the patient has ulcer-like, post-meal pain and burning complaints, they are treated just like ulcer patients. If the patient's primary complaints are post-meal bloating and post-meal stress, such as quick satiety, then drugs that regulate stomach movements and accelerate gastric emptying are preferred. Psychiatric support is obtained from patients who do not benefit from these treatments.
Helicobacter Pylori treatment: There is no consensus on the treatment of Hp in functional indigestion. Treating the bacteria in patients with functional indigestion with this bacterium in their stomach does not make a significant contribution to the elimination of the patients' complaints. However, the World Hp working group (Mastrich working group) recommends that if there is no positive result from other treatments in these patients, the bacteria should be tested first and if the bacteria are present, they should be treated. However, 10-15% of the patients in this group who are given Hp treatment benefit from this treatment.
Stress/dyspepsia relationship: Stress was formerly seen as a major cause of stomach upset. However, nowadays, with the developments in medicine, revealing the role of Hp bacteria in the formation of ulcer/gastritis, the frequent use of drugs used in the treatment of painkillers and rheumatic diseases, the increase in smoking and alcohol use and the better understanding of the relationship between ulcer/gastritis formation, the role of stress and diet in the formation of indigestion has been restored pushed into plans. Today, stress is considered as a triggering and auxiliary factor in the formation of ulcer and gastritis. Likewise, stress triggers functional indigestion. However, it is not the leading factor in the emergence of the disease. At present, the exact cause of functional indigestion has not been elucidated. An increase in the blood level of some hormones that increase gastric acid secretion has been detected in stressed people (for example, gastrin, pepsinogen, neurotransmitters, thromboxan, etc.)
What are the drugs that damage the stomach and cause indigestion?
Many drugs cause stomach damage by disrupting the resistance of the mucous membrane, which is the inner layer of the stomach. Uncontrolled use of these drugs for a long time causes both exacerbation of functional indigestion complaints and organic diseases such as gastritis, ulcer stomach bleeding. One of these drugs is aspirin. Apart from aspirin, other painkillers and antirheumatic group drugs, which we call NSAIDs, cause stomach damage. Apart from this, iron pills, potassium salts, drugs that strengthen the bone structure (osteoporosis drugs), calcium-containing drugs used in anemia also cause damage to the gastric mucosa to varying degrees. Aspirin and NSAID group drugs reduce the blood flow in the stomach and the gastric protective secretions, especially the secretion called mucus. The risk of ulcer formation of NSAIDs is 10-20% for stomach ulcers and 2-5% for duodenal ulcers. Such drugs cause stomach ulcers more than duodenal ulcers. Again, the risk of stomach bleeding and perforation is just as high in these people. The risk of gastric ulcer is 80-100/1 when using low-dose aspirin (2-1000 mg/day). The risk of developing ulcers in the use of drugs called selective NSAIDs is 2-3 times lower than non-selective NSAIDs. The risk of ulcer formation of NSAIDs and ulcer-related complications are more common over 60 years of age. In addition, the risk is higher in patients taking aspirin + NSAID drugs or taking drugs containing cortisone together, blood-thinning drugs called anticoagulants.