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Indigestion Health Article

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Patient history

Because indigestion is a nonspecific set of symptoms, patients who feel sick enough to seek medical attention are likely to go to their primary care doctor. The history does not always point to an obvious diagnosis. The doctor can, however, use the process of history-taking to evaluate the patient's mood or emotional state in order to assess the possibility of a psychiatric disturbance. In addition, asking about the location, intensity, timing, and recurrence of the indigestion can help the doctor weigh the different diagnostic possibilities.

An important part of the history-taking is asking about symptoms that may indicate a serious illness. These warning symptoms include:

weight loss
persistent vomiting
difficulty or pain in swallowing
vomiting blood or passing blood in the stools
anemia

Imaging studies

If the doctor thinks that the indigestion should be investigated further, he or she will order an endoscopic examination of the stomach. An endoscope is a slender tube-shaped instrument that allows the doctor to look at the lining of the patient's stomach. If the patient has indigestion of the esophagitis type or nonulcer type, the stomach lining will appear normal. If the patient has PUD, the doctor will be able to see breaks or ulcerated areas in the tissue. He or she may also order ultrasound imaging of the abdomen, or a radionuclide scan to evaluate the motility of the stomach.

Laboratory tests

BLOOD TESTS. If the patient is over 45, the doctor will have the patient's blood analyzed for a complete blood cell count, measurements of liver enzyme levels, electrolyte and serum calcium levels, and thyroid function.

TESTS FOR HELICOBACTER PYLORI. Doctors can now test patients for the presence of H. pylori without having to take a tissue sample from the stomach. One of these non-invasive tests is a blood test and the other is a breath test.

Treatment

Since most cases of indigestion are not caused by serious disorders, many doctors prefer to try medications and other treatment measures before ordering an endoscopy.

Diet and stress management

Many patients benefit from the doctor's reassurance that they do not have a serious or fatal disorder. Cutting out alcoholic beverages and drinks containing caffeine often helps. The patient may also be asked to keep a record of food intake, daily schedule, and symptom severity. Food diaries sometimes reveal psychologic or dietary factors that influence indigestion.

Medications

Patients with the esophagitis type of indigestion are often treated with H₂ antagonists. H₂ antagonists are drugs that block the secretion of stomach acid. They include ranitidine (Zantac) and famotidine (Pepcid).

Patients with motility disorders may be given prokinetic drugs. Prokinetic medications speed up the emptying of the stomach and increase intestinal motility. They include metoclopramide (Reglan) and cisapride (Propulsid). These drugs relieve symptoms in 60-80% of patients.

Removal of H. pylori

It is not clear that patients with H. pylori infections who have not developed gastric ulcers need to have the bacterium removed. Some studies indicate, however, that these patients may benefit from antibiotic therapy.

Herbal medicine

Practitioners of Chinese traditional herbal medicine might recommend medicines derived from peony (Paeonia lactiflora), hibiscus (Hibiscus sabdariffa), or hare's ear (Bupleurum chinense) to treat indigestion. Western herbalists are likely to prescribe fennel (Foeniculum vulgare), lemon balm (Melissa officinalis), or peppermint (Mentha piperita) to relieve stomach cramps and heartburn.

Homeopathy

Homeopaths tailor their remedies to the patient's overall personality profile as well as the specific symptoms. Depending on the patient's reaction to the indigestion and some of its likely causes, the homeopath might choose Gelsemium (Gelsemium sempervirens), Carbo vegetalis, Nux vomica, or Pulsatilla (Pulsatilla nigricans).

Other treatments

Some alternative treatments are aimed at lowering the patient's stress level or changing attitudes and beliefs that contribute to indigestion. These therapies and practices include Reiki, reflexology, hydrotherapy, therapeutic massage, yoga, and meditation.

Prognosis

Most cases of mild indigestion do not need medical treatment. For patients who consult a doctor and are given an endoscopic examination, 5–15% are diagnosed with GERD and 15–25% with PUD. About 1% of patients who are endoscoped have stomach cancer. Most patients with functional dyspepsia do well on either H₂ antagonists or prokinetic drugs, depending on the cause of their indigestion.

Prevention

Indigestion can often be prevented by attention to one's diet, general stress level, and ways of managing stress. Specific preventive measures include: