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Chronic indigestion Chronic indigestion is a functional disease in which the organs of the gastrointestinal (GI) tract, especially the stomach and the first part of the small intestine (and sometimes the esophagus), function abnormally. Read on to learn the causes, symptoms and treatment.

Chronic indigestion

• It is a chronic disease in which symptoms fluctuate in frequency and severity usually over several months or years, and may occur every day or intermittently for days or weeks, each time followed by days or weeks of rest (a pattern referred to as cyclicity).
• Chronic indigestion is best described as a functional disease, (sometimes called functional indigestion). The concept of functional disease is particularly useful when discussing diseases of the digestive system.
• This concept applies to the muscular organs in the digestive system, the esophagus, stomach, small intestine, gallbladder, and colon, which are controlled by nerves.
• What is meant by the term (functional) is that the muscles of the organs or the nerves that control the organs do not work normally, and as a result the organs do not function normally, and the dysfunction leads to the appearance of symptoms.
• The nerves that control the organs include not only the nerves located within the muscles of the organs but also the nerves of the spinal cord and brain.

Causes of chronic indigestion

• Theories for the cause of indigestion include abnormal input from the intestinal sensory nerves, abnormal processing of input from the sensory nerves, and abnormal stimulation of the intestine by motor nerves.
• There are causes of indigestion that are not related to the digestive system.
• Pregnancy may be a cause of indigestion.
• Pregnant women suffer from indigestion, however, most of the time the symptoms are heartburn caused by acid reflux.

Symptoms of chronic indigestion

• Chronic indigestion symptoms arise from the upper part of the digestive tract, the stomach and the upper part of the small intestine.
• The primary symptoms of chronic indigestion are:
• Pain in the upper abdomen or discomfort in the lower chest.
• Nausea with or without vomiting, flatulence, and belching.
• Early satiety, which is the feeling of being satisfied after eating only a small amount of food.
• Abdominal bloating and swelling, and sometimes vomiting.
• Symptoms are often triggered by food intake, a time when many different digestive system functions are called upon to work together.
• This tendency for symptoms to occur after meals is what has led to the misconception that indigestion may be caused by a defect in the digestion of food.

Diagnosis of chronic indigestion

• Chronic indigestion is diagnosed on the basis of typical symptoms and the absence of other gastrointestinal diseases.
• Especially acid-related diseases (acid indigestion, esophagitis, gastritis, ulcers) and non-gastrointestinal diseases may lead to symptoms.
• Because the heart is located close to the stomach, there is often confusion about the cause of lower chest or upper abdominal pain.
• Therefore, indigestion should be considered in anyone with lower chest pain, and heart attack should be considered in anyone with upper abdominal pain.
• Sometimes, discomfort from indigestion can be felt in the back.
• Indigestion testing is primarily intended to rule out the presence of other infectious diseases and non-infectious diseases. Some people may need specific testing for certain digestive system functions.
• It is important to rule out other causes of indigestion because its treatment will be different from indigestion without an obvious cause.

Treatment of chronic indigestion

• Indigestion for which there is no other cause is treated primarily with education as well as smooth muscle relaxants and strengthening medications.
• There may also be a role for antidepressant medications and dietary changes. Since gastric acid reflux is so common, a trial of effective stomach acid suppression is often used as initial treatment.
• Many people are able to identify specific foods that cause their indigestion.
• Despite this fact, there are a few foods that can be universally recommended to be avoided as not all people with indigestion have problems with the same foods.
• There are also no foods or diets that can be recommended to prevent indigestion other than those that eliminate foods that trigger symptoms.
• There is no evidence that home remedies or natural remedies prevent indigestion.
• Future developments in the treatment of indigestion depend on a clearer understanding of its many causes.

How common is indigestion?

• Indigestion is one of the most common bowel diseases, affecting an estimated 20% of people in the United States.
• Perhaps only 10% of sufferers actually seek medical care for chronic indigestion.
• Dyspepsia is not a particularly good term for this disease because it suggests there is “indigestion” or abnormal digestion of food, which is most likely not the case.
• In fact, there is another common name for indigestion which, for the same reason, is no better than the term indigestion.
• Doctors often refer to the condition as nonulcer indigestion to distinguish it from the more common acidic or ulcer-related symptoms.

Indigestion and belching

• It is appropriate to discuss burping in detail because it is a common and misunderstood symptom associated with indigestion.
• Burping is the process of expelling gases from the stomach out through the mouth. The ability to burp is almost universal.
• The usual cause of belching is distension (inflation) of the stomach caused by swallowing air or gas.
• Stomach bloating causes abdominal discomfort, and burping expels air and relieves the discomfort.
• People often don’t realize they are swallowing air when they eat too quickly, drink soft drinks, or even become anxious.
• Everyone knows that when they have mild abdominal discomfort due to excess air in the stomach, they resort to burping.
• As a result, people are forced to burp whenever they feel mild abdominal pain, whatever the reason.
• Unfortunately, if there is no excessive gas to expel, forced burping does nothing more than draw air into the esophagus.
• This air is usually expelled during the same burping (referred to as supra-diaphragmatic burping), but air may also enter the stomach, which itself causes more gas to be expelled with additional burping.
• When burping does not relieve discomfort, burping should be considered a sign that something is wrong in the abdomen, and the cause of the discomfort should be sought.
• However, belching in itself does not help the doctor determine what might be wrong, because belching can occur in any abdominal disease or condition that causes discomfort.
• Burping infants while breastfeeding is important in order to expel air in the stomach that has been swallowed with formula or formula.

Duration of chronic indigestion

• Indigestion is a chronic disease that usually lasts for years, if not a lifetime.
• However, it occurs cyclically, meaning that symptoms may be more frequent or severe for days, weeks, or months and then less frequent or severe for days, weeks, or months.
• The reasons for these fluctuations are unknown.
• Because of the variability, it is important to judge the effects of treatment over several weeks or months to ensure that any improvement is due to treatment and not just a natural fluctuation in disease frequency or severity.

Non-gastrointestinal causes of indigestion

• Not surprisingly, many gastrointestinal diseases are associated with indigestion, however, many non-gastrointestinal diseases have also been associated with indigestion.
• Examples of non-gastrointestinal causes of indigestion include:
• Diabetes and thyroid disease.
• Hyperparathyroidism (overactive parathyroid glands), severe kidney disease.
• However, it is not clear how these non-communicable diseases can cause indigestion.
• Another important cause of indigestion that is not related to the digestive system is medications.
• Many medications are often associated with indigestion, for example, non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, antibiotics and estrogens).
• In fact, most medications are said to cause indigestion in at least some people with functional symptoms.

Antidepressants are a treatment for chronic indigestion

• Patients with functional disorders, including dyspepsia, often suffer from depression and/or anxiety.
• However, it is unclear whether depression and anxiety are a cause, a consequence, or unrelated to functional disorders.
• Depression and anxiety are common, so their co-occurrence with functional disorders may be a coincidence.
• Many clinical trials have shown that antidepressants are effective in irritable bowel syndrome and in relieving abdominal pain.
• Antidepressants have also been shown to be effective for unexplained (noncardiac) chest pain, a condition thought to represent esophageal dysfunction.
• Antidepressants have not been adequately studied in other types of functional disorders, including dyspepsia.
• It may be reasonable to treat patients with chronic dyspepsia with psychotropic medications if they have moderate or severe depression or anxiety.
• Antidepressants work in functional disorders in relatively low doses that have little or no effect on depression.
• It is therefore believed that these drugs do not work by combating depression, but in different ways (through different mechanisms). For example, these drugs have been shown to regulate (modulate) nerve activity and have analgesic (pain relief) effects as well.
• Common psychoactive drugs include the tricyclic antidepressants desipramine (Norpramin) and trimipramine (Sormontil).
• Although studies are encouraging, it is not yet clear whether the newer class of antidepressants, serotonin reuptake inhibitors such as Prozac, Zoloft, and paroxetine, are effective for functional disorders, including dyspepsia.

Diet and chronic indigestion

• Most often, chronic indigestion patients link their symptoms to eating certain foods, such as fats.
• Or intolerance to certain foods, for example, lactose (milk) intolerance and allergies to wheat, eggs, soy and milk protein are not considered functional diseases like indigestion.
• Dietary fiber is often recommended for patients with irritable bowel syndrome, but fiber has not been studied in the treatment of indigestion. However, it may be reasonable to treat patients with indigestion with fiber if they also have constipation.

Lactose and chronic indigestion

• Lactose intolerance (the sugar found in milk) is often the cause of indigestion, and since both indigestion and lactose intolerance are common, the two conditions may coexist.
• In this case, restricting lactose improves the symptoms of lactose intolerance, but will not affect the symptoms of indigestion.
• If lactose is determined to be responsible for some or all of the symptoms, it is appropriate to eliminate foods containing lactose.
• Unfortunately, many patients stop drinking milk or eating foods containing milk without good evidence that it improves symptoms. This is often detrimental to their calcium intake, which may contribute to osteoporosis.

Fat and chronic indigestion

• Fat is one of the nutrients most associated with indigestion symptoms. Scientific evidence that fat causes indigestion is weak.
• Most of the support is anecdotal (not based on carefully conducted scientific studies).
• However, fat is one of the strongest influences on digestive function.
• It tends to slow down the muscles of the digestive system while causing the muscles of the gallbladder to contract.
• Therefore, it is possible that fats may worsen indigestion even though they do not cause it.
• Furthermore, reducing fat intake may relieve symptoms.
• A strict low-fat diet can be easily followed. Additionally, there are other health-related reasons to reduce dietary fat.

Bowel restriction medications for chronic indigestion

• One of the main theories for the cause of indigestion is that there is a defect in the way the muscles of the digestive system work.
• Muscle function may be abnormally increased, abnormally decreased, or uncoordinated.
• There are drugs called smooth muscle relaxants that can reduce muscle activity and other drugs that can increase muscle activity, called stimulant drugs.
• Many symptoms of indigestion can be explained on the basis of decreased activity of the digestive muscles which slows down the transport (transit) of food through the stomach and intestines.
• Obviously, as discussed previously, there are other causes for these symptoms in addition to slowed transit of food, and these symptoms include nausea, vomiting, and flatulence.
• When food transit is severely affected, abdominal distension (swelling) may also occur and can lead to abdominal pain.
• Early satiety is unlikely to be due to slow transit because it occurs so early that slow transit of food has consequences.
• In theory, drugs that speed up the transit of food should, in at least some patients, relieve the resulting symptoms of indigestion, to slow the transit.
• The number of generics available for clinical use is limited, and studies on their effectiveness in dyspepsia are even more limited.

Cisapride as a treatment for chronic indigestion

• The most studied drug is cisapride (Propulsid), a stimulant drug that was withdrawn from the market due to serious cardiac side effects. Newer drugs are being developed that have similar effects but without the side effects.
• The few studies that have been done on cisapride for indigestion have been inconsistent in their results. Some studies showed benefits while other studies showed no benefit.
• Cisapride has been effective in patients with severe stomach emptying problems (gastroparesis) or very slow passage of food through the small intestine (chronic intestinal pseudo-obstruction), both of which may or may not be associated with indigestion.

Other medicines to treat indigestion

• Another drug available for promotion is erythromycin, an antibiotic that stimulates gastrointestinal smooth muscle as one of its side effects.
• Erythromycin is used to stimulate smooth muscles in the digestive tract in doses lower than those used to treat infections.
• There are no studies on erythromycin in dyspepsia, but erythromycin is effective in gastroparesis and perhaps also in chronic intestinal pseudo-obstruction.
• Domperidone (Motilium) is a promotional drug available in the United States, but requires special authorization from the US Food and Drug Administration.
• As a result, it is not commonly prescribed. It is an effective medication for treating chronic indigestion with few side effects.

Chronic indigestion has no proven cure, but managing uncomfortable symptoms and avoiding anxiety and stress may mitigate its ill effects.

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