Gastric / Indigestion
Dr. Widjaja Luman
Consultant Gastroenterologist and General Physician
B Sc (St. Andrews), MB ChB (Man), MRCP (UK), M.D. (Edin),
CCST (UK), FRCP (Edin)
(Ahli penyakit pencernaan dan hepar)
What is indigestion?
Indigestion or “gastric” is a general term used to describe discomfort or pain in the upper abdomen. It is also described as “indigestion”. It occurs usually after meals. If it is a burning discomfort behind the breast bone, it is then described as “heartburn”. The medical term for all these symptoms is dyspepsia.
Possible causes
Dyspepsia can be caused by the following disorders:
- gastro-oesophageal reflux disease
- Functional dyspepsia (Sensitive stomach)
- Peptic ulcer disease
- Cancer (Stomach / Liver / Pancreatic)
- Angina or Heart attacks
Pain or discomfort in the upper abdomen occurs intermittently. For sufferers of peptic ulcer disease or gastritis, the pain or discomfort usually occurs on empty stomach and can be relieved by food. The pain or discomfort is described as “gnawing pain” or more severe pain than hunger pang. It can occur during the night and sufferers are often woken up by the pain; a warm cup of beverage is required in order to return back to sleep. Sufferers often experience weight gain because of the need to eat for symptomatic control. An ulcer is a break in the lining of the stomach or duodenum (the first part of the small intestine), resembling ulcers which some people get from time to time in the mouth. Because these ulcers are caused by both acid and a component of digestive juice, called pepsin, they are often described as a “peptic ulcer”. If there is only inflammation of the stomach lining, it is called as “gastritis”. Peptic ulcer disease or gastritis is often caused by infection with Helicobacter pylori or painkillers (Non steroidal anti inflammatory drugs ; NSAIDs). It can also occur as a result of over-indulgence in alcohol.
Some people experience the discomfort as sensation of fullness after meal so that it is difficult to finish a meal, or there may be an uncomfortable sense of fullness or bloating after a meal. Sufferers usually describe this symptom complex as “indigestion” or poor digestion. They may also experience nausea, retching or even vomiting after food. These symptom complex happen in individuals with functional dyspepsia (sensitive stomach). Similar to irritable bowel syndrome, functional disorder is often associated with emotional stress. When tests are performed and no cause is found, the term “nonulcer dyspepsia” is also often used inter-changeably with functional dyspepsia by your doctors. This means that no ulcer has been found to account for the symptoms.
Individuals who suffer from gastro-oesophageal reflux disease often describe their symptom as acidic or burning sensation that start from upper abdomen and which then radiate to lower part of breast bone (heartburn). This discomfort is usually brought on by heavy and spicy meals. If there is inflammation found on the oesophagus (gullet or food pipe), it is described as “oesophagitis”. This is usually caused by digestive juice (acid) repeatedly moving upward from the stomach to the gullet.
Most indigestion symptoms are harmless though annoying. Very often tests are not needed. However, if the pain is constant and becomes progressively more severe, it indicates serious disorders such as cancer of the stomach / liver or pancreas. There is often associated loss of appetite and weight loss. For cancer of the oesophagus, sufferer also experience difficulty with swallowing of solid food.
Pain from the heart (cardiac pain) is also felt in the chest and sometimes in the upper abdomen. There are two kinds of cardiac pain. The first is angina which is a pain in the chest caused by a temporary shortage of oxygen being carried in the blood to the heart muscle. Angina should be suspected if the chest pain is brought on by exercise and relieved by rest. The second is the more severe and prolonged pain of a heart attack. A heart attack should be suspected if the pain if the pain is felt intensely in the centre of the chest, spreading perhaps to one or both arms (especially the left) and into the lower jaw; or feels like a heavy pressure in the chest. Severe breathlessness and cold sweat are also common symptoms during heart attacks.
How can I avoid indigestion?
The following life style changes may help your symptoms:
- Do not smoke
- Eat meals at regular times. Eat your evening meal well before going to bed so that it has time to digest.
- Do not rush through your meals.
- Enjoy eating and drinking, but do so in moderation.
- Avoid taking over the counter anti-arthritis painkillers if at all possible; consult and discuss with your doctors.
- Try not to let stressful situations upset you.
When should I consult my doctor?
Many people who suffer from occasional indigestion and heartburn can obtain relief from simple antacids tablets which are available over the counter from the pharmacist.
You should see your doctor if:
- You suffer from heartburn or indigestion regularly (every week or every day)
- Your indigestion symptoms persist for more than two weeks, especially if this is a new symptom and does not respond to antacids.
- Your symptom interferes with work, leisure and /or sleep.
- You are over 45 years old.
- You have a family history of stomach or colon cancer.
- You Drink or smoke heavily.
- You Take aspirin or anti-arthritis pain killers regularly.
- You notice blood or altered blood (like coffee grounds) in your vomitus.
- You notice Black tarry stools (like uncooked pig’s liver).
- You experience rapid and unintentional weight loss.
- You suffer from recurrent vomiting.
- You experience difficulty in swallowing.
- You notice yellowing of the skin (jaundice).
- You suffer from abdominal pain with radiation to the back.
What investigations are necessary?
Many people do not require investigations, but as persistent indigestion may suggest a more serious underlying complaint, the doctor may decide to arrange for the following tests:
- Gastroscopy is a narrow, flexible tube containing a light source and a small camera at its tip. It is passed through the mouth and throat and on to the oesophagus and stomach. Gastroscopy is done under sedation and it enables your doctor to look into the lining of the stomach and gullet.
- A barium meal test which involves swallowing a liquid which enables the outline of the stomach to show up on X-ray
- An ultrasound scan – a technique using reflected sound waves to show the structure of abdominal organs. This technique does not involve passing any tubes into the body.
- a blood test to detect your blood counts or other abnormality.
What treatment is available?
General advice and reassurance may be all that is required. Advice will be given if there are factors in your lifestyle which may be contributing to the symptoms. Medicine may be prescribed, ranging from antacids to more powerful drugs, depending on the cause and severity of the problems. There are effective drugs for eradication of Helicobacter pylori gastritis if this is the finding from your investigations.