Half the patients who get you up in the middle of the night and think they are dying are suffering from wind!
FRANCIS YOUNG (1884–1954), ADVICE TO A YOUNGER DOCTOR
Dyspepsia or indigestion is a difficult, sometimes vague, symptom to define or evaluate and requires very careful questioning to clarify the exact nature of the complaint.
Dyspepsia embraces the following:
The discomfort can sometimes amount to pain. Diagnoses to consider in dyspeptic patients are summarised in TABLE 47.1.
Table 47.1Diagnoses to consider in dyspeptic patients1 |Favorite Table|Download (.pdf) Table 47.1 Diagnoses to consider in dyspeptic patients1
Gastro-oesophageal reflux, including hiatus hernia
Functional (non-ulcer) dyspepsia
Oesophageal motility disorders (dysmotility)
Upper GIT malignancies (e.g. oesophagus, stomach, pancreas)
Hepatobiliary disease (e.g. hepatitis, biliary dyskinesia, cholelithiasis)
Upper GIT inflammation:
Irritable bowel syndrome
Glossary of terms
Dyspepsia Pain or discomfort centred at the upper abdomen that is chronic or recurrent in nature.
Flatulence Excessive wind. It includes belching, abdominal bloating or passing excessive flatus.
Heartburn A central retrosternal or epigastric burning sensation that spreads upwards to the throat.
Organic disease uncommon
Due to air swallowing (aerophagy)
Common in anxious people who gulp food and drink
Make patient aware of excessive swallowing
Avoid fizzy (carbonated) soft drinks
Avoid chewing gum
Don’t drink with meals
Don’t mix proteins and starches
Eat slowly and chew food thoroughly before swallowing
Eat and chew with the mouth closed
If persistent: simethicone preparation (e.g. Mylanta II, Phazyme).
If desperate: place one small cork between the back teeth after meals for 30 minutes.
Flatus arises from two main sources:
Assess diet (e.g. high fibre, beans and legumes, cabbage, onions, grapes and raisins)
Avoid drinking with eating, especially with leafy vegetables
Cook vegetables thoroughly
Trial a lactose-free diet
Consider simethicone preparations (e.g. No Gas)
Key facts and checkpoints
Dyspepsia or indigestion is a common complaint; 80% of the population will have experienced it at some time.
Consider heartburn as ischaemic heart disease until proved otherwise.
The presence of oesophagitis is suggested by pain on swallowing hot or cold liquids (odynophagia).
All reflux is not due to hiatus hernia.
Many patients ...