Dyspepsia is a collective term for a variety of gastro-intestinal symptoms and includes:
- Upper abdominal pain (related or unrelated to food).
- Gastro-oesophageal reflux and heart burn.
- Anorexia, nausea and vomiting.
- Early repletion or satiety after meals.
- Feeling of abdominal distention or bloating.
- Flatulence (burping, belching).
Alarming Features
- Weight loss.
- Anaemia.
- Vomiting.
- Haematemesis and/or Malena.
- Dysphagia.
- Palpable abdominal mass.
Etiology
Upper Gastro-intestinal Disorders
- Peptic ulcer disease.
- Acute gastritis.
- Gall stones.
- Motility disorders such as oesophageal spasm.
- Functional causes : Non-ulcer dyspepsia and Irritable bowel syndrome.
Other Gastro-intestinal Disorders
- Pancreatic diseases such as cancer and chronic pancreatitis.
- Hepatic disease such as hepatitis.
- Colonic carcinoma.
Systemic disease
- Renal failure.
- Hypercalcemia.
Drugs
- NSAIDS.
- Iron and potassium supplements.
- Corticosteroids.
- Digoxin.
Other causes
- Alcohol.
- Psychological causes such as anxiety and depression.
Classification
Ulcer Dyspepsia
- There is localised abdominal pain referred to abdomen.
- Pain occurs only in empty stomach and is episodic in nature.
- Occurs at night and commonly awakes the patient from sleep.
- Pain is relieved by antacids and intake of food.
- Also relieved by vomiting and the patient can eat immediately.
- Includes the dyspeptic symptoms associated with peptic ulcer.
Non-ulcer or Functional Dyspepsia
- There is diffuse abdominal pain referred to more than one site.
- Pain in present throughout the day and not episodic in nature.
- Pain is provoked by food intake and is not relieved by antacids.
- Rarely awakes the patient from sleep at night.
- Not relieved by vomiting and patient cannot eat afterwards.
- Includes dyspepsia with unknown etiology.
Peptic Ulcer Disease
There is break in the mucosal lining of the stomach and / or duodenum (more than 5 mm, with depth to the submucosa), that leads to a local defect or excavation due to acute inflammation
Gastric Ulcers
- The pain is precipitated by food intake.
- Nausea and weight loss is more common.
Duodenal Ulcers
- Pain typically occurs 90 minutes to 3 hours after meal and frequently relieved by antacids or food.
- Two-third of the patients complain of pain at night (midnight to 3am), that awakes them from sleep.
Functional Dyspepsia
- Also known as Nervous, Non-ulcer or Non-organic dyspepsia.
- When the cause of dyspepsia could not be found for more than 3 months (even after detailed investigations), it is classified as functional dyspepsia.
- Symptoms are believed to be generated by disturbances in the motor function of the gastro-intestinal tract, that may occur due to psychological, neurological or gut peptide factors.
Clinical Findings
- Usually seen in young females (more than 40 years of age).
- History : Stress factors like worries, financial concerns, family affairs etc.
- Pain and nausea on walking in the morning (characteristic finding).
- Symptoms of IBS such as pellet-like stools and feeling of incomplete evacuation after defecation.
- Examination reveals inappropriate abdominal tenderness.
Investigations
- Organic Disorders : Blood count, ESR, occult blood in stools, Barium meal, Endoscopy.
- Liver function test to rule out alcoholism.
- Pregnancy tests to exclude pregnancy.
Management
- Counselling, Proper explanation and Reassurance to tackle stress factors.
- Stop cigarette smoking and alcohol abuse.
- Metoclopromide (10 mg TID) or Domperidone (10-20mg TID) before meals for nausea, vomiting and bloating.
- H2 receptor blockers or Protein-pump inhibitors.
References
- Harrison's Principles of Internal Medicine (17th edition), Fauci, Braunwald, Jasper, Hauser, Longo, Jameson, Loscalzo, The McGraw-Hill Companies.
*This article is an excerpt from the above mentioned book and Medical Sutras does not make any ownership or affiliation claims.