Dyspepsia is upper abdominal pain that is persistent and associated with bloating, heartburn, nausea or vomiting


Dyspepsia (indigestion/acidity) is a common health problem all over the world. About one of four adults suffers from dyspepsia at some time. Dyspepsia as an upper abdominal pain or discomfort that is episodic or persistent and often associated with belching, bloating, heartburn, nausea or vomitting.

These symptoms are believed to have their cause in the upper part of the gastro-intestinal tract. Usually, the symptoms are believed to originate from either the esophagus, stomach or first part of the intestine.

Most of the affected persons do not seek medical care. Nonetheless, dyspepsia is responsible for substantial health care costs and considerable time lost from work.

Do you have dyspepsia?

Common symptoms encountered in patients suffering from dyspepsia are:
- Pain or discomfort in the upper abdomen (below the breast bone but above the belly button)
- Excessive burping or belching
- Heartburn (burning sensation behind chest bone)
- A bloated feeling
- Inability to finish a normal meal
- Feeling full quickly while eating
- Nausea
- Regurgitation/ vomitting
- Bad breath
- Intolerance to certain foods, especially spicy and fatty foods

What causes dyspepsia?

Dyspepsia can arise from various underlying conditions like acid reflux disease, gastritis, ulcers in stomach/duodenum, esophageal/stomach cancer, pancreatic diseases, biliary tract disease and liver disorders.

Often, dyspepsia is caused by a stomach ulcer or acid reflux disease. Some medicines, like aspirin, nonsteroidal anti-inflammatory agents can cause dyspepsia. In 50 to 60 per cent of patients, a specific etiology is not identified (i.e., "functional" or nonulcer dyspepsia).

Many of these patients are believed to have an exaggerated perception of visceral pain. Rarely, dyspepsia is caused by serious medical condition like peptic ulcer, esophageal/stomach cancers, therefore this problem needs thorough evaluation and appropriate management .

When to seek advice for dyspepsia?

Though many individuals may experience occasional indigestion a few of them seek medical advice. Some of the important guidelines that may be of some help in seeking medical advice includes:
- Age more than 45 years.
- Persistent/frequent indigestion.
- Weight loss
- Blood/coffee coloured vomitus
- Recurrent vomitting
- Difficulty/pain in swallowing
- Chest pain
- Severe abdominal pain
- Loss of appetite
- Presence of anaemia
- Yellowness of eyes
- Abdominal pain radiating to back
- Feeling of mass in abdomen.
- Frequent user of aspirin/ NSAID (analgesics)
- Heavy smoker/drinker.

Evaluation

A thorough clinical evaluation by a qualified physician is important to evaluate a patient with dyspepsia, although it may not be enough in establishing a specific diagnosis.

Endoscopic evaluation of upper gastrointestinal tract is the procedure of choice for diagnostic evaluation because of its ease, reliability, diagnostic accuracy and the option of taking biopsies and performing therapeutic procedure, if indicated. In addition some patients may need additional investigations like liver function tests, ultrasound abdomen, barium studies, tests for helicobacter pylori, CT scan etc.

Majority of the patients with dyspepsia if evaluated and treated properly recover completely and can live a normal, healthy life.


Dr Samir Mahindra is a gastro-enterologist at Belhoul Apollo Hospital, Dubai