Dyspepsia

Definition

Dyspepsia can be defined as painful, difficult, or disturbed digestion, which may be accompanied by symptoms such as nausea and vomiting, heartburn, bloating, and stomach discomfort.

Causes and symptoms

The digestive problems may have an identifiable cause, such as bacterial or viral infection, peptic ulcer, gallbladder, or liver disease. The bacteria Helicobacter pylori is often found in those individuals suffering from duodenal or gastric ulcers. Investigation of recurrent indigestion should rule out these possible causes.

Often, there is no organic cause for the problem, in which case dyspepsia is classified as functional or nonulcer dyspepsia. There is evidence that functional dyspepsia may be related to abnormal motility of the upper gastrointestinal tract (a state known as dysmotility in which the esophagus, stomach, and upper intestine behave abnormally). These patients may respond to a group of drugs called prokinate agents. A review of eating habits (e.g. chewing with the mouth open, gulping food, or talking while chewing) may reveal a tendency to swallow air. This may contribute to feeling bloated, or to excessive belching. Smoking, caffeine, alcohol, or carbonated beverages may contribute to the discomfort. When there is sensitivity or allergy to certain food substances, eating those foods may cause gastrointestinal distress. Some medications are associated with indigestion. Stomach problems may also be a response to stress or emotional unrest.

Diagnosis

A physical examination by a health care professional may reveal mid-abdominal pain. A rectal examination may be done to rule out bleeding. If blood is found on rectal exam, laboratory studies, including a blood count may be ordered. Endoscopy and barium studies may be used to rule out underlying gastrointestinal disease. Upper gastrointestinal x-ray studies using barium may allow for visualization of abnormalities. Endoscopy permits collection of tissue and culture specimens which may be used to further confirm a diagnosis.

Treatment

The treatment of dyspepsia is based on assessment of symptoms and suspected causative factors. Clinical evaluation is aimed at distinguishing those patients who require immediate diagnostic work-ups from those who can safely benefit from more conservative initial treatment. Some of the latter may require only reassurance, dietary modifications, or antacid use. Medications to block production of stomach acids, prokinate agents, or antibiotic treatment may be considered. Further diagnostic investigation is indicated if there is severe abdominal pain, pain radiating to the back, unexplained weight loss, difficulty swallowing, a palpable mass, or anemia. Additional work-up is also indicated if a patient does not respond to prescribed medications.

Prognosis

Statistics show an average of 20% of patients with dyspepsia have duodenalor gastric ulcer disease, 20% have irritable bowel syndrome, fewer than 1% of patients had cancer, and the range for functional, or nonulcer dyspepsia (gastritis or superficial erosions), was from 5–40%.

BOOKS

Suddarth, Doris. The Lippincott Manual of Nursing Practice. Philadelphia: J. B. Lippincott, 1991.

PERIODICALS

Goldfinger, S. E. "Sensitive Stomachs: Non-ulcer Dyspepsia." Harvard Health Letter (Jan. 1992): 4-5.

Talley, N. J. "Non-ulcer Dyspepsia: Current Approaches to Diagnosis and Management." American Family Physician (May 1993): 1407-1416.

OTHER

"Clinical Economics: Gastrointestinal Disease in Primary Care." 23 Apr. 1998 <http://www.avicenna.com>.

"Endoscopy for Dyspepsia." 4 Apr. 1998 <http://www.medmatrix.org>.

Graber, Mark A., and Rhea Allen. University of Iowa Family Practice Handbook. 23 Apr. 1998 <http://www.vh.org/providers/ClinRef/FPHandbook>.

Kathleen D. Wright, RN

KEY TERMS

Anemia—Diagnosed through laboratory study of the blood, a deficiency in hemoglobin or red blood cells, often associated with paleness or loss of energy.

Endoscopy—A diagnostic procedure using a lighted instrument to examine a body cavity or internal organ. Endoscopy permits collection of tissue and culture specimens.