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IndigestionWhat is indigestion? The other name for indigestion is dyspepsia! Indigestion or Dyspepsia (or, as it frequently is referred to by physicians, non-ulcer dyspepsia) is one of the most common ailments of the bowel (intestines). Perhaps only 10% of those affected actually seek medical attention for their dyspepsia. Indigestion is best described as a functional disease. The concept of functional disease is particularly useful when discussing diseases of the gastrointestinal tract. The concept applies to the muscular organs of the gastrointestinal tract-esophagus, stomach, small intestine, gallbladder, and colon. What is meant by the term, functional, is that either the muscles of the organs or the nerves that control the organs are not working normally, and, as a result, the organs do not function normally. The nerves that control the organs include not only the nerves that lie within the muscles of the organs but also the nerves of the spinal cord and brain. Some gastrointestinal diseases can be seen and diagnosed with the naked eye, such as ulcers of the stomach. Thus, ulcers can be seen at surgery, on x-rays, and at endoscopies. Other diseases cannot be seen with the naked eye, but can be seen and diagnosed under the microscope. For example, gastritis (inflammation of the stomach) is diagnosed by microscopic examination of biopsies of the stomach. In contrast, gastrointestinal functional diseases cannot be seen with the naked eye or with the microscope. In some instances, the abnormal function can be demonstrated by tests (e.g., gastric emptying studies or antro-duodenal motility studies). However, the tests often are complex, are not widely available, and do not reliably detect the functional abnormalities. Accordingly, and by default, functional gastrointestinal diseases are those that involve the abnormal function of gastrointestinal organs in which the abnormalities cannot be seen in the organs with either the naked eye or the microscope. Occasionally, diseases that are thought to be functional are ultimately found to be associated with abnormalities that can be seen. Then, the disease moves out of the functional category. An example of this would be Helicobacter pylori infection of the stomach. Some patients with mild upper gastrointestinal symptoms who were thought to have abnormal function of the stomach or intestines have been found to have stomachs infected with Helicobacter pylori. This infection can be diagnosed under the microscope by identifying the bacterium. When patients are treated with antibiotics, the Helicobacter and symptoms disappear. Thus, recognition of infections with Helicobacter pylori has removed some patients' diseases from the functional category. Despite the shortcomings of the term, functional, the concept of a functional abnormality is useful for approaching many of the symptoms originating from the muscular organs of the gastrointestinal tract. To repeat, this concept applies to those symptoms for which there are no associated abnormalities that can be seen with the naked eye or the microscope. What are the symptoms of indigestion? We usually think of symptoms of indigestion as originating from the upper gastrointestinal tract, primarily the stomach and first part of the small intestine. These symptoms include upper abdominal pain (above the navel), belching, nausea (with or without vomiting), abdominal bloating (the sensation of abdominal fullness without objective distention), early satiety (the sensation of fullness after a very small amount of food), and, possibly, abdominal distention (swelling). The symptoms most often are provoked by eating, which is a time when many different gastrointestinal functions are called upon to work in concert. It is appropriate to discuss belching in detail since it is a commonly misunderstood symptom associated with indigestion. The ability to belch is almost universal. Belching, also known as burping or eructating, is the act of expelling gas from the stomach out through the mouth. The usual cause of belching is a distended (inflated) stomach that is caused by swallowed air or gas. The distention of the stomach causes abdominal discomfort, and the belching expels the air and relieves the discomfort. The common reasons for swallowing large amounts of air (aerophagia) or gas are gulping food or drink too rapidly, anxiety, and carbonated beverages. People often are unaware that they are swallowing air. Moreover, if there is not excess air in the stomach, the act of belching actually may cause more air to be swallowed. "Burping" infants during bottle or breastfeeding is important in order to expel air in the stomach that has been swallowed with the formula or milk. Excessive air in the stomach is not the only cause of belching. For some people, belching becomes a habit and does not reflect the amount of air in their stomachs. For others, belching is a response to any type of abdominal discomfort and not just to discomfort due to increased gas. Everyone knows that when they have mild abdominal discomfort, belching often relieves the problem. This is because excessive air in the stomach is often the cause of mild abdominal discomfort. As a result, people belch whenever mild abdominal discomfort is felt-whatever the cause. If the problem causing the discomfort is not excessive air, then belching does not provide relief. As mentioned previously, it even may make the situation worse by increasing the air in the stomach. When belching does not ease the discomfort, the belching should be taken as a sign that something may be wrong within the abdomen and that the cause of the discomfort should be sought. Belching by itself, however, does not help the physician determine what may be wrong because belching can occur in virtually any abdominal disease or condition that causes discomfort. What causes indigestion? It's not surprising that many gastrointestinal diseases have been associated with indigestion. However, many non-gastrointestinal diseases also have been associated with indigestion. Examples of the latter include diabetes, thyroid disease, hyperparathyroidism (overactive parathyroid glands), and severe kidney disease. It is not clear, however, how these non-gastrointestinal diseases might cause indigestion. A second important cause of indigestion is drugs. It turns out that many drugs are frequently associated with indigestion, e.g., non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), antibiotics, and estrogens). In fact, most drugs are reported to cause indigestion in at least some patients. Other diseases and conditions can aggravate functional diseases, including indigestion. Anxiety and/or depression are probably the most commonly-recognized exacerbating factors for patients with functional diseases. Another aggravating factor is the menstrual cycle. During their periods, women often note that their functional symptoms are worse. This corresponds to the time during which the female hormones, oestrogen and progesterone, are at their highest levels. What is the course of indigestion? Indigestion is a chronic disease that usually lasts years, if not a lifetime. It does, however, display periodicity, which means that the symptoms may be more frequent or severe for days, weeks, or months and then less frequent or severe for days, weeks, or months. The reasons for these fluctuations are unknown. Because of the fluctuations, it is important to judge the effects of treatment over many weeks or months to be certain that any improvement is due to treatment and not simply to a natural fluctuation in the frequency or severity of the disease. What are the complications of indigestion? The complications of functional diseases of the gastrointestinal tract are relatively limited. Since symptoms are most often provoked by eating, patients who alter their diets and reduce their intake of calories may lose weight. However, loss of weight is unusual in functional diseases. In fact, loss of weight should suggest the presence of non-functional diseases. Symptoms that awaken patients from sleep also are more likely to be due to non-functional than functional disease. Most commonly, functional diseases interfere with patients' comfort and daily activities. Persons who develop nausea or pain after eating may skip breakfast or lunch. Patients also commonly associate symptoms with specific foods (e.g., milk, fat, vegetables). Whether or not the associations are real, these patients will restrict their diets accordingly. Milk is the most common food that is eliminated, often unnecessarily, and this can lead to inadequate intake of calcium and osteoporosis. The interference with daily activities also can lead to problems with interpersonal relationships, especially with spouses. Most patients with functional disease live with their symptoms and infrequently visit physicians for diagnosis and treatment. How is indigestion treated? The treatment is a difficult and unsatisfying topic because so few drugs have been studied and have shown to be effective. Moreover, the drugs that have been shown to be useful have not been substantially effective. Indigestion is not a life-threatening illness and has received little research funding. Because of the lack of research, an understanding of the physiologic processes (mechanisms) that are responsible for indigestion has been slow to develop. Effective drugs cannot be developed until there is an understanding of these mechanisms. Different subtypes of indigestion (e.g., abdominal pain and abdominal bloating) are likely to be caused by different physiologic processes (mechanisms). It also is possible, however, that the same subtype of indigestion may be caused by different mechanisms in different people. What's more, any drug is likely to affect only one mechanism. Therefore, it is unlikely that any one medication can be effective in all-even most-patients with indigestion, even patients with similar symptoms. This inconsistent effectiveness makes the testing of drugs particularly difficult. Indeed, it can easily result in drug trials that demonstrate no efficacy (usefulness) when, in fact, the drug is helping a subgroup of patients. The lack of understanding of the physiologic processes (mechanisms) that cause dyspepsia has meant that treatment usually cannot be directed at the mechanisms. Instead, treatment usually is directed at the symptoms. For example, nausea is treated with medications that suppress nausea but do not affect the cause of the nausea. On the other hand, the psychotropic drugs (antidepressants) and psychological treatments (such as cognitive behavioural therapy) treat hypothetical causes of indigestion or dyspepsia (e.g., abnormal function of sensory nerves and the psyche) rather than the symptoms. Treatment for indigestion or dyspepsia often is similar to that for irritable bowel syndrome (IBS) even though the causes of IBS and indigestion/dyspepsia are likely to be different. Diet Dietary factors have not been well-studied in the treatment of indigestion. Nevertheless, patients often associate their symptoms with specific foods (such as salads and fats). Although specific foods might worsen the symptoms of indigestion, it is clear that they are not the cause of dyspepsia. The common placebo response in functional disorders such as indigestion also may explain the improvement of symptoms in some people with the elimination of specific foods. Dietary fiber often is recommended for patients with IBS, but fibre has not been studied in the treatment of dyspepsia. Nevertheless, it probably is reasonable to treat patients with indigestion with fibre if they also have constipation. Intolerance to lactose (the sugar in milk) often is blamed for dyspepsia. Since indigestion and lactose intolerance both are common, the two conditions may coexist. In this situation, restricting lactose will improve the symptoms of lactose intolerance, but will not affect the symptoms of dyspepsia. Lactose intolerance is easily determined by testing the effects of lactose (hydrogen breath testing) or trying a strict lactose elimination diet. If lactose is determined to be responsible for some or all of the symptoms, elimination of lactose-containing foods is appropriate. Unfortunately, many patients stop drinking milk or eating milk-containing foods without good evidence that it improves their symptoms. This often is detrimental to their intake of calcium. One of the food substances most commonly associated with the symptoms of dyspepsia is fat. The scientific evidence that fat causes dyspepsia is weak. Most of the support is anecdotal (not based on carefully done, scientific studies). Nevertheless, fat is one of the most potent influences on gastrointestinal function. (It tends to slow down the gastrointestinal muscles while it causes the muscles of the gallbladder to contract.) Therefore, it is possible that fat may worsen dyspepsia even though it doesn't cause it. Moreover, reducing the ingestion of fat might relieve symptoms. A strict low fat diet can be accomplished fairly easily and is worth trying. Additionally, there are other health-related reasons for reducing dietary fat. Psychotropic drugs Patients with functional disorders, including indigestion/dyspepsia, are frequently found to be suffering from depression and/or anxiety. It is unclear, however, if the depression and anxiety are the cause or result of the functional disorders or are unrelated to these disorders. (Depression and anxiety are common and, therefore, their occurrence together with functional disorders may be coincidental.) Several clinical trials have shown that antidepressants are effective in IBS in relieving abdominal pain. Antidepressants also have been shown to be effective in unexplained (non-cardiac) chest pain, a condition thought to represent a dysfunction of the oesophagus. Antidepressants have not been studied adequately in other types of functional disorders, including dyspepsia. It probably is reasonable to treat patients with dyspepsia with psychotropic drugs if they have moderate or severe depression or anxiety. Psychological treatments Psychological treatments include cognitive-behavioural therapy, hypnosis, psychodynamic or interpersonal psychotherapy, and relaxation/stress management. Few studies of psychological treatments have been conducted in indigestion/dyspepsia, although more studies have been done in IBS. Thus, there is little scientific evidence that they are effective in indigestion/dyspepsia, although there is some evidence that they are effective in IBS. Aromatherapy treatments can work for indigestion in two ways. The first is that massage and the use of essential oils can help anyone who is tense, anxious or stressed and therefore help the person to relax. For oils which can help see anxiety, relaxation, stress. Essential oils of Basil, Bergamot, Black Pepper, Carrot Seed, Chamomile Roman, Chamomile German, Coriander Seed, Dill, Fennel, Ginger, Juniper, Lavender, Lemon, Marjoram, Peppermint, Rose, Rosemary, Sage and Spearmint can help. A gentle massage over the stomach with a soothing and comforting oil such as Chamomile Roman, Lavender or Marjoram is recommended. Alternatively make a hot compress using these oils can put over the stomach. Drinking Chamomile, Fennel and peppermint herbal infusions can sometimes bring relief Make a hot compress of
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