-IBIS-1.5.0-
tx
digestive system
indigestion/heartburn
diagnoses

definition and etiology

definition:
gnawing or burning pain/belching/bloating after eating, felt in the stomach, upper abdomen and/or esophagus

etiology: most common causes of indigestion:
• hypochlorhydria: pain, belching, bloating
• hyperchlorhydria: heartburn
• decreased bile production: worse after fatty meals
• decreased pancreatic enzymes: pain, bloating, belching
• poor eating habits: not chewing food well, eating too fast
• anxiety, tension causing increased sympathetic NS activity
• intolerance to ingested foods: allergies, sensitivities
• hiatal hernia: pain worse lying down after a meal, bloating, belching
• gastritis
• esophageal pathology: e.g. reflux
• poor food choices: food high in preservatives, chemicals, coffee, refined foods, spices (irritants to the GI tract)
• insufficient yin or yang (Easley)

signs and symptoms

signs and symptoms: after eating
• belching, upper GI bloating, borborygmi
• substernal or epigastric pain, heartburn, regurgitation of the stomach contents into the mouth
• feeling of a "stone in the stomach" or that digestion is slow
• symptoms are > with antacids and </> eating and < lying down or eating big meals
• possible change in bowel habits: tendency to constipation (more often) or diarrhea
• reliance on OTC or prescription medications

lab findings:
• (+) breath hydrogen test for undigested carbohydrates reaching the colon
• stool analysis: for undigested food, stool pH, etc.
• urinary indican: toxemia from undigested protein in the colon
• Heidelberg Gastric Capsule Analysis: to test stomach pH
• food allergy testing
• amino acid analysis: HCl is needed to absorb phenylalanine, tryptophan and tyrosine
• upper GI barium study
• endoscopy
• Bernstein acid perfusion test: to replicate the symptoms of heartburn

course and prognosis

Indigestion is usually a functional disorder, and rarely a sign of serious disease, but it should always be fully investigated to rule out ulcers, cancer and other major pathology when the signs and symptoms are chronic, severe, not previously investigated, or unrelenting.

In uncomplicated cases of indigestion, where no severe pathology is uncovered, the prognosis is usually good once the correct diagnosis of cause is made and proper treatment initiated.

see: bowel toxemia

differential diagnosis

• cardiac ischemia
• diffuse esophageal spasm
• gastroesophageal reflux
• peptic ulcer disease
• cholecystitis
• anxiety
• aerophagia from excess consumption of carbonated beverages
• lactose intolerance


footnotes