Dyspepsia or Indigestion is the most common gastrointestinal complaint encountered by the general physicians and specialists in their routine practice. Although dyspepsia is a layman term, it refers to an acute, chronic, or recurrent pain or discomfort centered in the upper abdomen, may be associated with a number of symptoms such as, anorexia, nausea, vomiting, fullness, bloating, early satiety, belching, regurgitation, or simply indigestion.
An international committee of clinical investigators has defined dyspepsia as epigastric pain or burning, early satiety, or postprandial fullness. Etiologically some symptoms of dyspepsia are arising outside of the digestive system. The symptoms are often found stress-related & in many cases no ulceration could be detected.
Dyspeptic symptoms which are related to peptic ulcer, are often termed as ulcer-dyspepsia.
The causes of dyspepsia may be organic or functional.
- Organic causes: Upper gastrointestinal disorders- peptic ulcer disease, acute gastritis, gastric carcinoma, peptic oesophagitis, oesophageal spasm; Other gastrointestinal disorders- chronic cholecystitis, cholelithiasis, hepatic disease, pancreatic disease, crohn’s disease, irritable bowel syndrome, colonic carcinoma; Systemic diseases- renal failure, hypercalcemia; Some drugs like NSAIDs, corticosteroids, antibiotics, digoxin, iron & potassium supplements, alcohol abuse etc.
- Functional causes.
Careful history taking is very important-, This may help in eliciting-
- Typical symptoms of specific disorder (e.g peptic ulcer);
- Alarming symptoms (such as, weight loss, anemia, hematemesis melena, dysphagia, palpable abdominal mass), requiring urgent investigations;
- Atypical symptoms suggestive of other systemic disorders.
Serological test: Anti H. pylori IgG, if positive, indicates Ulcer in the GIT.
- Renal function tests- urea, creatinine- To exclude Renal Diseases.
- Electrolytes: Electrolyte imbalance could cause the symptoms.
3. ECG: To exclude valvular heart disease, MI or any other underlying cause.
4. X-ray chest: To exclude Tb and any underlying cause.
5. Endoscopy: Upper endoscopy is the choice of diagnosis in suspected ‘typical gastro-intestinal disorders & in alarming features’. It is also indicated in all patients of dyspepsia over age 45 years.
6. Liver function tests & Ultrasonogram: To exclude hepatobiliary & pancreatic problems.
N.B: In young patients «45 yrs or <55 yrs-) with dyspepsia endoscopic examination is usually not necessary, because significant g.i pathology is very uncommon in them. But, serological test for H. pylori should be done & if positive then endoscopy could advice.
- Explanation regarding the problem and reassurance.
- Treatment of specific organic disease (if any).
- Preventive measures- i) Overeating, excessive sweets & faulty foods should be avoided. ii) Meals should be taken regularly. iii) Food items those produce allergy should be avoided. iv) Gas forming foods like cauliflower, cabbage, beans, melons, cucumbers, onions, green peppers etc, should be omitted from the menu.
- Patients with anxiety and tension should have rest and relax.
Selection of homeopathic medicine is individual, so physician should make the selection according to symptoms similarity. Various repertories suggests many drugs for this condition. Few of them are- Aconite, Acid Sulph, China, Carbo veg, Chelidonium, Hydrastis, Lycopodium, Nux Vomica, Sulphur etc.
If the patient require surgical solution he or she must be refer to the surgeon for necessary management.