Dyspepsia, commonly known as indigestion, refers to a group of symptoms affecting the upper digestive tract. These symptoms include discomfort or pain in the upper abdomen, bloating, fullness, and nausea. Dyspepsia is a prevalent condition, affecting approximately 20-40% of the adult population worldwide at some point in their lives. This condition is important because it can significantly impact quality of life and may be a symptom of underlying serious conditions that require medical attention.
What is the most common cause of dyspepsia in adults?
Functional dyspepsia
The most common cause of dyspepsia is functional dyspepsia, which accounts for up to 70% of cases. Functional dyspepsia is a clinical syndrome characterized by persistent or recurrent pain or discomfort in the upper abdomen without an identifiable organic cause on routine clinical, laboratory, or endoscopic evaluation.
Functional dyspepsia is thought to result from a combination of factors, including abnormal gastric motility, visceral hypersensitivity, and psychosocial factors. It commonly presents in adults aged 20 to 50 years. Distinguishing features include epigastric pain, bloating, early satiety, and nausea. There is no definitive diagnostic test for functional dyspepsia; diagnosis is made based on symptom criteria and the exclusion of organic causes. Treatment involves dietary modifications, proton pump inhibitors (PPIs), prokinetics, and psychological therapies such as cognitive-behavioral therapy.
Other common medical conditions associated with dyspepsia in adults
Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD) is a chronic condition in which stomach acid flows back into the esophagus, causing irritation and symptoms of heartburn and regurgitation. GERD is more common in adults over 40 years old. Additional symptoms include a burning sensation in the chest, a sour taste in the mouth, and difficulty swallowing. Diagnostic clues include symptoms that worsen after eating or lying down. Treatment includes lifestyle modifications, antacids, and proton pump inhibitors.
Gastritis
Gastritis is inflammation of the stomach lining, often caused by infections, prolonged NSAID use, or excessive alcohol consumption. Gastritis can affect adults of all ages. Symptoms include upper abdominal pain, nausea, and vomiting. Diagnostic clues include endoscopic findings of inflammation. Treatment involves eliminating the causative factor, such as stopping NSAIDs or treating an infection, and using medications to reduce stomach acid.
Peptic ulcer disease
Peptic ulcer disease is characterized by sores that develop on the lining of the stomach, small intestine, or esophagus. It is typically caused by Helicobacter pylori infection or prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs). It affects adults of all ages but is more common in those over 50. Symptoms include burning stomach pain, bloating, and intolerance to fatty foods. Diagnostic clues include pain that is relieved by eating or taking antacids. Treatment involves antibiotics for H. pylori and medications to reduce stomach acid.
Gallstones
Gallstones are hardened deposits of digestive fluid that can form in the gallbladder, leading to pain and digestive issues. They are more common in adults over 40, especially in women and those with obesity. Symptoms include sudden and intense pain in the upper right abdomen, nausea, and vomiting. Diagnostic clues include pain triggered by fatty meals and imaging tests showing gallstones. Treatment may involve surgical removal of the gallbladder.
Food intolerances
Food intolerances occur when the digestive system is unable to properly digest certain foods, leading to symptoms such as bloating, gas, diarrhea, and abdominal pain. Common food intolerances include lactose intolerance and gluten intolerance. These intolerances can affect adults of all ages. Diagnostic clues include symptoms that occur after consuming specific foods and improvement when those foods are avoided. Treatment involves dietary modifications to avoid triggering foods.
Medications
A wide variety of commonly used medications, including NSAIDS, can cause dyspepsia. Symptoms are similar to peptic ulcer disease. The history of medication use is key to diagnosis. Switching medications or adding gastroprotective agents can be helpful.
Gastroparesis
Gastroparesis is a condition characterized by delayed gastric emptying without mechanical obstruction. It is commonly seen in adults with diabetes or after certain surgeries. Symptoms include nausea, vomiting, early satiety, and bloating. Gastric emptying studies confirm the diagnosis. Treatment involves dietary modifications, medications to enhance gastric motility, and, in severe cases, surgical interventions.
Celiac disease
Celiac disease is an autoimmune disorder in which the ingestion of gluten damages the small intestine. It can affect adults at any age, though it is often diagnosed in younger adults. Symptoms include diarrhea, weight loss, abdominal pain, and bloating. Diagnostic clues include positive blood tests for specific antibodies and confirmation with a biopsy of the small intestine. Treatment involves a strict gluten-free diet.
Less common but serious medical conditions associated with prolonged dyspepsia in adults
Inflammatory bowel disease (IBD)
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, causes chronic inflammation of the digestive tract. It can affect adults of any age but is more common in young adults. Symptoms include abdominal pain, diarrhea, and weight loss. Diagnostic clues include endoscopic findings and biopsy results. Treatment involves medications to reduce inflammation and manage symptoms.
Pancreatitis
Pancreatitis is inflammation of the pancreas, which can be acute or chronic. It is most commonly caused by gallstones or chronic alcohol use. Symptoms include severe upper abdominal pain that radiates to the back, nausea, and vomiting. Diagnostic clues include elevated pancreatic enzymes in blood tests and imaging studies showing inflammation. Treatment involves hospitalization, fasting to rest the pancreas, and medications to manage pain.
Gastric cancer
Gastric cancer is a malignant tumor that can develop in the lining of the stomach. It is more common in adults over 50 years old. Symptoms include persistent upper abdominal pain, unintentional weight loss, and early satiety. Diagnostic clues include endoscopic findings of abnormal growths and biopsy results confirming malignancy. Treatment involves surgical removal of the tumor, chemotherapy, and radiation therapy.
Esophageal cancer
Esophageal cancer is a malignant tumor that occurs in the esophagus. It typically affects adults over 50 years old. Symptoms include difficulty swallowing, unintentional weight loss, and chest pain. Diagnostic clues include imaging studies and biopsy results. Treatment includes surgery, chemotherapy, and radiation therapy.
Chronic mesenteric ischemia
Chronic mesenteric ischemia is a condition caused by reduced blood flow to the intestines due to narrowed or blocked blood vessels. It usually affects older adults with a history of cardiovascular disease. Symptoms include severe postprandial (after eating) pain, weight loss, and fear of eating. Diagnostic clues include imaging studies showing blood vessel abnormalities. Treatment involves revascularization procedures to restore blood flow.
Pancreatic cancer
Pancreatic cancer is a malignant tumor in the pancreas. It is more common in adults over 60 years old. Symptoms include upper abdominal pain, jaundice (yellowing of the skin and eyes), and unintentional weight loss. Diagnostic clues include imaging studies and biopsy results. Treatment includes surgery, chemotherapy, and radiation therapy.
Advice for patients
Adults with dyspepsia should consider seeing a doctor if their symptoms are severe, persistent, or accompanied by alarming signs such as unintentional weight loss, difficulty swallowing, persistent vomiting, or evidence of gastrointestinal bleeding (such as black or bloody stools). Initial management includes lifestyle modifications such as avoiding trigger foods, eating smaller meals, and reducing stress. Over-the-counter medications like antacids, proton pump inhibitors, and H2-receptor antagonists can help relieve symptoms. If symptoms persist, medical evaluation is necessary to rule out underlying conditions and determine appropriate treatment.
Summary
Dyspepsia, or indigestion, is a common condition characterized by upper abdominal discomfort and other digestive symptoms. Proper diagnosis and management are crucial, and adults experiencing severe or persistent symptoms should seek medical advice. Managing dyspepsia typically involves lifestyle modifications, dietary changes, and medications to alleviate symptoms.