Dyspepsia

Dyspepsia

What is Dyspepsia?

Heartburn, acid regurgitation, excess of burping/belching, increased abdominal bloating, nausea, a feeling of abnormal or slow digestion, or early satiety are all symptoms that can be described by the term "dyspepsia". The cause of dyspepsia is unknown but is usually aggravated by eating and symptoms may suddenly disappear without an obvious remedy.

Having dyspepsia can have a significant impact on life at home and work. People with chronic upper gastrointestinal disorders have absenteeism rates nine times higher than healthy people. In addition, the productivity when individuals suffering from symptoms of dyspepsia are at work is eight times lower than those who are unaffected.

Managing dyspepsia

Sometimes symptoms can be helped by changes in lifestyle.

Get Enough Rest

Getting enough rest is so important! Studies have shown that people
with erratic sleeping patterns run the risk of disrupting their microbiome,
and running the risk of developing inflammatory diseases. Try to make
sure that you get at least 8 hours of sleep a night.

Get Moving

Your microbes feel that if they’re working hard to keep you healthy, then you should be working hard too! The microbiomes of physically active people are more healthy and diverse. It also has to be said that
one of the best ways to de-stress after a long day is by working out. Even just walking for 30 minutes a day could really impact your gut health, and help these little microbes continue to make sure that your
stress-levels are managed and your mental health stays intact.

De-stress

Make time for you!
Say ‘no’ more often, explore meditation, mindfulness, yoga, or tai. Establishing balance in your life will support your mental and emotional health and optimize your gut and overall health. Stress can negatively affect your microbiome and you need a healthy microbiome to manage help you manage your stressors. If you’re not careful, and you may get caught in an unhealthy cycle if you do not give yourself time to re-energize.

Suggested lifestyle changes for those living with dyspepsia

  • eat healthy foods
  • stop smoking
  • consider any correlation of symptoms with certain types of foods such as spicy foods, and alcohol.
  • Elevate your head while sleeping - Raising the head of the bed may help some patients who have mostly reflux.
  • Certain drugs such as aspirin and arthritis medication as well as pain killers (except acetominophen) may worsen injury to the stomach, and discontinuation or change of these medications may sometimes help.
  • Stress does not usually cause dyspepsia but can worsen GI symptoms and heighten our awareness of those symptoms. In some cases, appropriate strategies to cope with stress can be helpful.

Statistics

  • Dyspepsia is an umbrella term used to describe persistent pain or burning sensation in the upper middle part of the stomach, feeling of abdominal fullness and early satiety.
  • Possible undelying causes of dyspepsia include peptic ulcer disease, H. pylori infection, gastroparesis, gatroesophageal cancer, pancreatitis, pancreatic cancer and Crohn’s disease. As well, more than 70% of patients have "functional dyspepsia", where there is the exclusion of a structural gastrointestinal disease. (Talley et al. 2015)
  • About a fifth of people are affected at some point in their lives, however most people do not seek medical care. (Ford et al. 2013)
  • Recognition of dyspepsia is poor. Globally, dyspepsia is uninvestigated in about 20% of cases. (Ford et al. 2015)
  • While dyspepsia does not affect survival, it is responsible for substantial quality of life impairment and health care costs.

Citations

Ford AC and Moayyedi P. Dyspepsia. BMJ. 2013 Aug 29;347:f5059.

Ford AC et al. Global prevalence of, and risk factors for, uninvestigated dyspepsia: A meta-analysis. Gut. 2015 Jul;64(7):1049-57.\

Talley NJ and Ford AC. Functional dyspepsia. N Engl J Med. 2015 Nov 5;373(19):1853-63.

Signs and Symptoms

Most patients who have dyspepsia as a result of stomach cancer will have worrisome symptoms in addition to simply having dyspepsia. These are called "alarm symptom."

Alarm symptoms of dyspepsia

  • persistent vomiting
  • evidence of bleeding (red or black stools)
  • anemia
  • unexplained weight loss
  • difficulty swallowing
  • a mass in the abdomen found by the physician.

If you have any of these alarm symptoms or if you are older and have new symptoms, you should not ignore your dyspepsia but should promptly seek medical attention.

Based on your history and what the physician finds when he/she examines you, it may be necessary for you to have one or more tests to determine what the cause of your dyspepsia is.

It should be stressed, however, that most persons with dyspepsia do not need investigations, and their dyspepsia can be quite appropriately and adequately treated by a family physician/general practitioner

Risks Associated with Dyspepsia

The most common cause of heartburn and dyspepsia is gastroesophageal reflux disease (GERD). This is a condition in which the acid that is normally present in the stomach to help digest our food flows back up the swallowing tube (esophagus). In some persons this causes heartburn and regurgitation, and in others it may cause these symptoms as well as also cause inflammation (redness and swelling) or sores (erosions) in the esophagus. A small number of persons suffering from dyspepsia may have an ulcer in the stomach (gastric ulcer) or in the first part of the intestine (duodenal ulcer).

The gastric or duodenal ulcer may be caused by an infection in the stomach (Helicobacter pylori), or by taking aspirin or arthritis-treating medications (non-steroidal anti-inflammatory drugs). Other persons with dyspepsia will not have any identifiable disease in the esophagus, stomach or duodenum. These persons are said to have "functional dyspepsia" or "non-ulcer dyspepsia".

Tests and Treatment

A variety of tests may be undertaken to try to determine the cause of dyspepsia. In some cases however, the doctor may choose to treat patients on the basis of his/her clinical assessment of symptoms before ordering tests.

Certain symptoms such as bleeding, weight loss, trouble swallowing, persistent vomiting or new symptoms in older patients will usually indicate a need for tests.

Barium X-ray (upper GI series):

This is an X-ray test that outlines the esophagus, the stomach and the duodenum. For many years this was one of the only tests available to investigate these types of symptoms and is still used as a screening test. However, in the majority of cases more accurate tests are now used.

Helicobacter pylori tests:

for the bacteria can sometimes be done in the doctor's office. These would include blood tests that determine previous exposure to the bacteria but do not determine the actual presence of the bacteria. For the most part these tests have been replaced by the urea breath test (UBT). This test can be done in the doctor's office or at the hospital. The patient drinks a chemical and if the bacteria are present in the stomach, this chemical is broken apart by the bacteria. The by-products are released in the patient's breath which are collected and tested. A positive test indicates that the bacteria are actually present at that time. This test can be done to confirm that the bacteria are present, or that they have been eliminated after treatment.

A second group of tests for this bacteria can be done at the time of endoscopy with biopsies (tissue samples). Small pieces of stomach can be subjected to the same chemical reaction as noted above for the breath test or the tissue can be examined under a microscope to look for the bacteria.

Gastroscopy (upper GI endoscopy):

This test is commonly done for patients with dyspepsia as it is a very accurate way of finding or ruling out the presence of injury to the lining in the upper GI tract. A tube through which the stomach can be seen is passed through the mouth.

This test can be done in the doctor's office in some cases, but is usually done in the hospital.

24-Hour pH study:

While endoscopy is able to determine the presence of injury to the lining of the gut from reflux, many patients may have reflux without such visible injury. The 24-hour pH test is done to try and correlate the patient's symptoms with the actual presence of acid in the esophagus. This test involves passing a thin tube through the nose into the esophagus. The tube is left in place and continuously records the acid level in the esophagus for a period of 24 hours. A computer program then correlates the patient's symptoms with the presence of acid in the esophagus.

Treating dyspepsia

Medications

Medications are listed below in general order of potency but the order does not necessarily reflect the order in which the doctor may choose to begin treatment.

Antacids Antacids:

are useful as short-term therapy but are usually used for infrequent or "breakthrough" symptoms that may occur when the patient experiences symptoms while on other medications. In general, antacids would not be used as a regular form of therapy.

H2-receptor antagonists (H2-RAs)

This class of drugs has been available for over 25 years and was the first truly effective form of acid-reducing medicine. These pills provide a moderate decrease in acid produced by the stomach and are helpful for milder cases of reflux. They are effective in healing ulcers, although at a somewhat slower rate than the proton pump inhibitor class of drugs (see below). These drugs are very safe. Rare side effects may include skin rash, diarrhea, liver test abnormalities, and kidney problems. These medicines are accepted as safe for long-term therapy if necessary

Proton Pump Inhibitors (PPIs)

This class of drugs has been available for over 10 years and provides the most effective acid suppression currently available. These are the most effective pills for more severe reflux symptoms and are effective at healing ulcers somewhat more rapidly than H2-RAs. In general, the best medicine is the one that adequately controls symptoms. These pills are also considered safe for longterm treatment

if necessary. Use of this type of drug is often combined with antibiotics to treat Helicobacter pylori. Side effects with this class of medication are also infrequent and may include skin rash, diarrhea and a variety of other minor side effects. Rarely, interference with other drugs has to be considered by the doctor.

Helicobacter pylori Therapy

The most common type of therapy used now includes two antibiotics plus a PPI drug. It is important that all the pills be taken as scheduled in order to obtain the greatest chance of eliminating the bacteria.

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