FUNCTIONAL
DYSPEPSIA
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 DEFINITION
OF DYSPEPSIA
Dyspepsia
is defined as a pain or discomfort centred in the upper
abdomen. The term ‘discomfort’ refers to non-painful sensations
including fullness, early satiety, bloating and nausea.*
* Talley NJ et al. Gastroenterology International
1991; 4:145 - 160
PREVALENCE
OF DYSPEPSIA
Dyspepsia
is a common gastrointestinal disorder with prevalence
ranging from 20 - 49%. Consequently, these GI symptoms
are associated with significant economic and quality of
life impact.1,2,3
1. Talley NJ et al. Gastroenterology International
1991; 4:145-60
2. Locke GR III et al. Gastroenterology 1997; 112: 1448-56
3. Talley NJ et al. Digestive Dis Sci 1995; 40:584-9
Prevalence
of dyspepsia (and/or reflux) in the general population
= 20–49%
Only
8–10% of patients with dyspepsia have an ulcer
Patients
with dyspepsia may have underlying structural disease
Patients
with dyspepsia may have underlying structural disease
e.g peptic ulcer disease, reflux oesophagitis, gastritis,
cancer.
However, the majority of dyspeptic patients have no structural
disease. Most of them have problems with the functioning
of the organs e.g stomach, colon.
Patients with gastointestinal symptoms with no underlying
structural disease is said to be suffering from Functional
Dyspepsia. |
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| WHAT
ARE THE SYMPTOMS OF FUNCTIONAL DYSPEPSIA? |
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Abdominal
pain |
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Heartburn
( burning pain at the centre of the chest ) |
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Regurgitation
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Early
satiety ( unable to finish a normal meal ) |
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Bloating
( a gassy, swollen feeling in your stomach ) |
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Belching
(feeling that you are burping gas ) |
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Nausea
/ Vomiting ( feeling sick to your stomach while
eating, or feeling like you want to throw |
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up
after a meal ) |
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| THE
PROCESS OF NORMAL DIGESTION |
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In
normal digestion, food goes from your mouth into
your oesophagus. Food is then moved down |
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your
oesophagus by muscle contractions ( called peristalsis
) that squeeze the food until it is |
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pushed
into your stomach. |
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At
the bottom of your oesophagus, a tight ring of muscles
( called the sphincter ) acts like a plug, |
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preventing
the food in your stomach from going back into your
oesophagus and mouth |
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(
regurgitation ). |
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The stomach’s job is to store, grind and digest
the food you eat. At the bottom of your stomach,
a |
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second
sphincter stops food from going into your small
intestines until it is properly digested. |
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| WHY
ARE YOU HAVING SYMPTOMS? |
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Digestion
normally works so well that we don’t even notice
it. But if we don’t pay attention to how |
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we
treat our digestive system, it can act up and cause
pain and discomfort. |
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Pain
and discomfort can be caused by too much acid being
produced in the stomach. But most |
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people
do not produce too much acid -- it’s just that the
acid gets into the wrong place. |
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If
food sits for a long time in your stomach, it can
cause bloating, gas, belching, stomach fullness
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and
pain. Sometimes, this partially digested food (
and acid ) gets pushed back into your |
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oesophagus.
You feel heartburn and discomfort if this acid remains
too long in contact with the |
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delicate
lining of your oesophagus. |
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| FOODS
THAT CAN CAUSE SYMPTOMS |
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Fatty
or greasy foods |
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Fatty
meats ( e.g pork,
bacon, luncheon
meats, hotdogs ) |
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Chocolate
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Drinks
with caffeine ( e.g. coffee, tea, cola drinks ) |
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| Peppermint
or spearmint |
| Alcohol |
| Spicy
foods |
| Citrus
juice (e.g. orange, tomato) |
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Acidic
fruits and vegetables (e.g. tomatoes, apples, green
peppers) |
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| Carbonated
beverages |
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| ACTIVITIES
AND CONDITIONS THAT CAN CONTRIBUTE TO SYMPTOMS |
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Bending
over (especially after a meal) |
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| Lying
down after |
| eating
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| Large
meals |
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| Bedtime
snacks |
| Tight
clothing or belts |
| Obesity
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| Pregnancy
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| Alcohol
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| Tobacco
smoking |
| Certain
foods ( See above ) |
| Medications
( See below ) |
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| COMMON
NON-PRESCRIPTION AND PRESCRIPTION DRUGS THAT CAN CAUSE
SYMPTOMS |
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Aspirin |
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Non-steroidal
anti-inflammatory drugs (NSAIDs) |
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Some
heart medications. See your doctor if you have heartburn
while taking any of these |
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| medications
for heart disease. |
| Some
drugs for anxiety or insomnia |
| Oral
contraceptives |
| Vitamin
C |
| Potassium
supplements |
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Antibiotics
(e.g. tetracycline, doxycycline, clindamycin) |
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Iron
supplements |
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| SOME
SIMPLE STEPS THAT MAY RELIEVE YOUR SYMPTOMS |
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Eat
smaller, well balanced meals. |
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| Don't
lie down for 2 or 3 hours after eating. |
Avoid
fatty or greasy
foods. |
| Avoid
troublesome foods. |
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| Stop
smoking. |
| Try
to lose weight. |
| Avoid
tight-fitting clothing. |
| Elevate
the head of your bed. |
| Avoid
medications if you can. |
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DRUG
THERAPIES
If
the changes to your diet and lifestyle don't alleviate
your symptoms, it is time to talk to your doctor about
where you need to proceed to drug therapy treatment.
Medications that may relieve symptoms of poor digestion
What these drugs are trying to do is:
• relieve your symptoms
• heal any damaged that may be causing your symptoms
• reset your "digestive clock" so that your digestion
returns to normal.
Drug Options
Your doctor may prescribe one of the following drugs:
• a drug that reduces the amount of acid in your
stomach
• a drug that normalizes slow digestion
• a drug that protects the lining of your stomach
Reducing stomach acid
The drugs that reduce the amount of acid in your stomach
(acid suppressing drugs) may be used to treat heartburn.
Acid suppressing drugs were first used to treat stomach
ulcers, but they can be used for heartburn. Within 4-8
weeks, your heartburn pain should be lessened, i.e. you
should have fewer episodes of pain and less overall pain.
But you should know that the pain may come back in six
months or one year. You will then need to go back to your
doctor for a new eight-week prescription. If you don't
feel better after taking this drug, you should see your
doctor as soon as possible. He/she may want to investigate
you further or refer you to a specialist for another examination.
If you are the type of person who has a long history of
heartburnwhich keeps coming back, you may need to keep
taking this kind of drug on and off whenever your symptoms
come back.
All acid suppressing drugs are considered to be safe and
effective for the pain of heartburn. A very small number
of people have side effects when they take these drugs.
If you noticed any side effects, report them to your doctor
immediately. He/she may want you to take fewer pills or
put you on a new medication.
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| Resetting
your "digestive clock" |
A
second category of drugs normalizes digestion and
resets your "digestive clock". These drugs, called
motility drugs or prokinetic drugs, work by strengthening
the sphincter (the "plug") separating your
oesophagus and stomach. They also normalize muscle
contractions that help move food and acid through
the digestive track.
Prokinetic drugs are used to normalize digestion
so that food doesn't sit heavily in your stomach,
causing you to feel bloated, uncomfortable, nauseous,
or "full" even when you haven't eaten a complete
meal. If |
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partially
digested food (and acid) remains in your stomach too long,
it can also get pushed back into your Esophagus and cause
heartburn - caused by the acid irritating the lining of
the esophagus. By moving the food and acid through your
digestive system, prokinetics ensure that acid isn't able
to irritate the stomach and/or lining of the esophagus.
With a prokinetic drug, your heartburn and stomach symptoms
should be better within 4-8 weeks. However, if your symptoms
are just as bad as before, see your doctor. He/she may
want to do some more tests or refer you to a specialist.
Prokinetic drugs are considered to be safe and effective
for relief of the pain of heartburn when it is accompanied
by stomach symptoms, or when your major problem is stomach
symptoms alone. A very small number of people have side
effects when they take these drugs. If you notice any
side effects, report them to your doctor. He/she may want
you to take fewer pills or put you on a new medication.
Protecting your stomach
Some drugs act primarily by protecting the lining of our
stomach and esophagus. These can coat your stomach and
esophagus, protecting them from stomach acid. They are
used mostly for people with ulcers but they can be effective
for heartburn pain. However, they are not useful for people
who have stomach symptoms such as bloating, gas, stomach
pain or difficulty finishing a meal.
This group of drugs is not usually your doctor's first
choice for heartburn pain but they can be used if other
drugs haven't improved your symptoms, or if your doctor
finds that you actually have an ulcer.
These drugs are safe for heartburn pain. A very
small number of people will have side effects, which should
be reported to your doctor.
A
note about your prescription
All drugs have the potential to interact with other drugs
you are taking (even aspiin). So it is important |
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to tell your doctor and pharmacist about any other
drugs you are taking. This will ensure that you
get the full effectiveness of your medications,
and will reduce the chance of having a bad reaction
to a drug. |
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| A
NOTE ABOUT SERIOUS SYMPTOMS |
The
pain of heartburn can be severe, so painful, in
fact, that some people are afraid they are having
a heart attack. If in doubt, call your doctor immediately.
A heart attack requires urgent medical attention.
Hesitating can mean the difference between life
and death.
Only a doctor can tell the difference between heartburn
and a heart attack. If you are older, or have a
history of high blood pressure or heart problems,
see your doctor immediately.
Many people with continuing or severe symptoms of
heartburn or stomach pain worry that they have cancer.
Obviously this is a serious matter to consider and
one that should never be taken lightly.
It may be comforting to know that stomach cancer
is relatively rare - fewer than 1 in 100 adults
will have stomach cancer. As with all cancers, early
detection improves your chances of recovery and
everyone should be on the alert for "suspicious"
symptoms that may indicate a more serious problem.
These more serious symptoms include: |
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Sudden,
severe symptoms in people over 40 years of age. |
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Recent
weight loss (more than 5-10 pounds or 2-4 kg)
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Frequent
vomiting after meals |
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Any
sign of blood when you go to the bathroom (such
as blood in your stools or in the toilet bowl, |
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bloodstains
on the bathroom tissue. |
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Increasing
discomfort when swallowing. |
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Any
or all of these symptoms should be described in
full to your physician |
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