Dyspepsia and Indigestion Overview

Created by

@ExaltingRhinoceros

Study Notes

Dyspepsia

Dyspepsia is an umbrella term for upper abdominal symptoms.
Common symptoms include vague abdominal discomfort, belching, bloating, flatulence, a feeling of fullness, nausea and/or vomiting, and heartburn.
Most cases of dyspepsia arise from five major conditions:
- Non-ulcer dyspepsia/functional dyspepsia (indigestion)
- Gastro-esophageal reflux disease (GERD, heartburn)
- Gastritis
- Duodenal ulcers
- Gastric ulcers
Gastritis, duodenal ulcers, and gastric ulcers are potential red flags for referrals.
These conditions are usually associated with Peptic Ulcer Disease (PUD).

Indigestion

Also known as functional dyspepsia or non-ulcer dyspepsia.
There is usually no specific reason for symptoms in indigestion.
Indigestion is different from GERD.
GERD is caused by a decreased muscle tone in the lower esophageal sphincter, leading to lower esophageal sphincter incompetence.
This allows stomach acid to reflux back into the esophagus, causing irritation.

Gastritis

Means inflammation of the stomach.
Common causes include Helicobacter pylori infection or acute alcohol ingestion which can lead to an inflammatory cascade resulting in increased acid production.
Increased stomach acid can slowly digest the gastric lining, causing ulcerations if the protective mucosal layer is damaged.
H.pylori (with a helical structure) can penetrate the mucosa due to its screw-like motion, allowing stomach acid to erode the stomach lining.

Medicine-Induced Conditions

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and mefenamic acid, and aspirin can decrease prostaglandin synthesis responsible for producing mucosal layers.
This decreases the protection of stomach linings, making them more prone to the effects of stomach acids.

PQRST & Red Flags for Referral

Pain:
- Indigestion: Often brought on by specific foods (e.g., caffeine, spicy/fatty foods, chocolate, alcohol), pain shortly after eating (1-3 hours) relieved by food or antacids, pain waking the patient at night, and pain worse when the stomach is empty.
- Other Diagnoses: Pain shortly after eating (1-3 hours) relieved by food or antacids, pain waking the patient at night, and pain worse when the stomach is empty.
Quality: Indigestion: Aching or discomfort pain. Other Diagnoses: Gnawing, sharp, or stabbing pain.
Region: Indigestion: Pain above the umbilicus and centrally located in the epigastric area. Other Diagnoses: Pain below the umbilicus, pain behind the sternum (breastbone), pain in a specific area of the abdomen, or radiating pain.
Severity: Indigestion: Pain described as debilitating or severe.
Timing: Indigestion: Bouts of excessive drinking, eating food on the move or too quickly.

Red Flags for Referral:

Persistent vomiting with or without blood
Black and tarry stools
Young adults
Referred pain (not usually GI in nature, but suggests cardiovascular issues)
Heart pain (emergency care needed)
If the patient can point to a specific area of the abdomen (may indicate a potential underlying cause)
Pain radiating to other areas (may indicate a potential underlying cause)

Description

Explore the key concepts related to dyspepsia and indigestion, including symptoms, major conditions, and potential red flags. Understand the differences between non-ulcer dyspepsia and GERD, and their association with Peptic Ulcer Disease. This quiz will test your knowledge on these common gastrointestinal issues.