Chapter 47: Dyspepsia (indigestion)

INTRODUCTION

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:

• nausea

• heartburn/regurgitation

• upper abdominal discomfort

• lower chest discomfort

• acidity

• epigastric fullness, bloating or unease

• abdominal distension

The discomfort can sometimes amount to pain. Diagnoses to consider in dyspeptic patients are summarised in TABLE 47.1.

FLATULENCE

Excessive belching

• Usually functional

• Organic disease uncommon

• Due to air swallowing (aerophagy)

• Common in anxious people who gulp food and drink

• Associated hypersalivation

Management tips

• 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.

Excessive flatus

Flatus arises from two main sources:

• swallowed air

• bacterial fermentation of undigested carbohydrate

  Exclude:

• malabsorption

• irritable bowel syndrome

• anxiety → aerophagy

• drugs, especially lipid-lowering agents

• lactose intolerance

Management

• 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)