Dyspepsia/Indigestion

Dyspepsia / Indigestion

Dyspepsia or indigestion is characterized by abdominal discomfort, bloating, and fullness, often related to eating behaviors such as overeating, eating too quickly, consuming oily or excessively spicy foods, and experiencing stress. Although these symptoms commonly indicate gastrointestinal issues, they can also signify other underlying conditions, such as heart failure, pulmonary tuberculosis, cancer, or uremia resulting from renal failure. Factors exacerbating dyspepsia include stress, fatigue, inadequate dietary intake, insufficient sleep, and lack of physical exercise. Persistent abdominal discomfort may also be a sign of more serious underlying conditions, hence early evaluation and treatment are crucial.

Prevention

• Modify Eating Habits
  • Avoid eating hurriedly.
  • Chew food slowly and thoroughly.
  • Avoid exercising immediately after eating.
• Avoid Trigger Foods and Beverages
  • Alcoholic or caffeinated drinks
  • High-fat and oily foods
  • Spicy foods
  • Acidic or sour foods and fruits

Management

• Maintain a healthy body weight; obesity can exacerbate symptoms of reflux.
• Opt for smaller, more frequent meals (5–6 small meals daily rather than 3 large meals).
• Avoid eating 3–4 hours before bedtime.
• Manage stress effectively, as it is a trigger for indigestion.
• Slightly elevate the head during sleep to prevent acid reflux.

When to See a Doctor

• Persistent or worsening symptoms
• Unexplained weight loss
• Sudden and severe abdominal pain
• Difficulty swallowing
• Jaundice (yellowing of skin or eyes)
• Vomiting or passing blood in stools

Treatment Options

1. Antacids, Antireflux Agents & Antiulcerants

• Antacids neutralize gastric acid, containing substances like Antacids, aluminium salts, magnesium salts, calcium carbonate, and sodium bicarbonate.
• Aluminium can cause constipation; magnesium may lead to diarrhea. Combination antacids reduce these side effects.
• Complex antacids (e.g., polymigel ) provide faster, longer-lasting relief.
• High sodium antacids (e.g., sodium bicarbonate) should be avoided in patients with hypertension, heart disease, kidney disease, or pregnancy.
• Antacids often include antiflatulents (e.g., simethicone, dimethicone ) to relieve bloating.
• Some antacids contain local anesthetics (e.g., sulcain, oxetacaine ) to relieve pain and burning sensations.
• Antiulcerants prevent or treat peptic ulcers by either reducing acid secretion or protecting gastric mucosa:
  • Antisecretory agents:
• H2-blockers (cimetidine, famotidine,ranitidine ): Short-term relief by binding histamine receptors in the stomach, reducing acid production.
• Proton pump inhibitors (PPIs) (omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole ): Stronger acid secretion inhibitors, acting by inhibiting H⁺/K⁺ ATPase enzyme.
• Potassium-competitive acid blockers (PCAB) (vonoprazan): Inhibit acid secretion by binding potassium ions in parietal cells.
• Cytoprotective agents (sucralfate, teprenone, bismuth-containing antacids): Protect and coat gastric mucosa.
• Misoprostol (prostaglandin E₁ analogue): Reduces gastric acid secretion; contraindicated during pregnancy.

2. GIT Regulators, Antiflatulents & Antispasmodics

• GIT Regulators (domperidone, itopride, metoclopramide, mosapride, tegaserod): Enhance gastrointestinal motility.
• Antiflatulents (simethicone, dimethicone): Relieve gas and bloating caused by indigestion.
• Antispasmodics: Relieve abdominal cramping and spasms.

3. Digestive Enzymes

• Digestive enzyme preparations (amylase, diastase, cellulase, lipase, protease, pancreatin) assist digestion, particularly when combined with gastric acid inhibitors like cimetidine, protecting enzymes from acid degradation.