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Role of diet in Dyspepsia

Indigestion, also known as dyspepsia or troubled stomach, is an umbrella term that characterizes a cluster of gastrointestinal symptoms. These symptoms typically include experiencing pain, a burning sensation, or distress in your upper abdomen if you become full too quickly.

According to how many times it occurs, indigestion could be divided as:

  • Occasional: Occurring infrequently Chronic — Occurring frequently for a few weeks or months
  • Functional: Having Chronic Symptoms Without a Specific Cause

Chronic dyspepsia can be caused by diseases of the digestive tract, such as peptic ulcer disease, gastritis, and stomach cancer. However, most physicians are unaware of the causes of chronic dyspepsia. Functional dyspepsia can lead to chronic gastritis in the absence of a health condition or digestive tract disease that could explain symptoms.

Different forms of functional dyspepsia

Certain medical professionals divide functional dyspepsia symptoms into two categories:

  • The only symptoms associated with epigastric pain syndrome (EPS) are upper abdominal discomfort and heat.
  • Postprandial distress syndrome (PDS) only refers to symptoms that occur after a meal, such as early satiety, bloating, and vertigo.

Symptoms do not always fall precisely into these two categories, but when they do, it helps healthcare professionals treat them as a group.

Why does functional dyspepsia occur?

The term “indigestion” implies that your digestive system is malfunctioning. However, this could be many things. The causes of functional dyspepsia are a mystery to doctors, but they do have a few hypotheses. Some examples include:

  1. Impaired gastric capacity and evacuation: Normally, the stomach should relax and expand to accommodate food, but this function may be impaired in some individuals, resulting in a persistent sensation of fullness. In gastroparesis, the signals that instruct the stomach to discharge food into the small intestine may also be impaired. This can cause food to back up, flatulence to accumulate, and bacteria to multiply excessively if food remains in the stomach for too long.
  2. Food sensitivities: If you have an undiagnosed food allergy, it may be causing inflammation in your digestive tract. Some individuals with FD have elevated white blood cell counts, indicating that the gastrointestinal immune system is activated. Some also report having food sensitivities, especially to wheat. Nausea, dyspepsia, and inflammation could be attributed to an allergic response. Pain and puffiness could be caused by inflammation.
  3. Pylori: This prevalent bacterial infection can cause chronic inflammation (gastritis) and erode the epithelial lining that protects the stomach from gastric acid in some individuals. Infection with H. pylori can cause a variety of adverse effects, so healthcare providers will test for it if you have unexplained gastrointestinal symptoms. Some patients with FD improve after receiving H. pylori treatment.
  4. Hypersensitivity of the viscera: Some individuals have exceptionally sensitive nervous systems. These individuals may exhibit a physical reaction to tension and emotional factors, such as constriction and rigidity of the digestive organs. Some of these individuals may also have visceral hypersensitivity, a condition in which the normal expansion and contraction of the digestive organs is experienced as excessive or unpleasant.

Functional Dyspepsia and Food Intake

  • It has been demonstrated that hypersensitivity to gastric distension is one of the most important pathophysiological factors in patients with functional dyspepsia during fasting and after eating. 
  • It was demonstrated that gastric distension induces more intense symptoms in patients than in controls, and also reproduces spontaneous symptoms. 
  • Postprandial fullness and bloating received the highest symptom severity scores, while epigastric heat received the lowest score. In addition, gastric distension was linked to impaired gastric adaptation to meals. 
  • As consuming a meal is a significant factor in the onset of functional dyspepsia symptoms, patients frequently request dietary advice that can alleviate these symptoms. 

Trends of food intake and Functional Dyspepsia

In our daily lives, aberrant eating behaviors, such as rapid or large meal ingestion (conditions that are reproduced during the rapid drinking test), may overburden the gastric accommodation process, thereby causing symptoms. Studies have noted that irregular meal patterns and moderate-to-rapid consumption rates were significantly associated with untreated chronic dyspepsia. 

Indigestion Diagnosis

Your physician diagnoses dyspepsia based on your medical history, physical exam, upper gastrointestinal (GI) endoscopy, and other diagnostic procedures.

Medical Records

  • The physician will evaluate your symptoms and medical history. 
  • The physician will inquire about your eating and drinking habits, over-the-counter and prescription medication use, and smoking status.
  • The physician will evaluate your symptoms and medical history.
  • Physical checkup

During a physical examination, the physician may:

  • Examine for puffiness
  • Tap your abdomen with a stethoscope and listen to the sounds in your abdomen to check for tenderness, pain, and tumors.
  • investigate any yellowing of your eyes or skin

Upper GI endoscopy

Your physician may perform an upper gastrointestinal endoscopy to diagnose diseases and conditions, such as ulcers, gastritis peptic ulcer disease, and stomach cancer that may be causing your dyspepsia.

A physician may recommend an upper GI endoscopy for:

  • Patients with dyspepsia who are 55 or older
  • Patients with indigestion of any age who have a history of esophagitis.
  • A history of cancer in the family 
  • Difficulty ingesting 
  • Evidence of gastrointestinal hemorrhage 
  • Frequent vomiting 
  • Weight loss

During an upper GI endoscopy, your physician can remove small fragments of tissue from the lining of your stomach and duodenum using microscopic instruments inserted through the endoscope. This is referred to as an upper GI biopsy. A physician will examine the tissue samples for diseases and conditions of the digestive tract, including Helicobacter pylori (H. pylori) infection.

Other Exams

  • Imaging examinations: Your doctor may use imaging tests such as x-rays, computed tomography (CT) scans, and ultrasound to search for diseases and conditions in your digestive tract that could be causing your dyspepsia.
  • Testing for H. pylori contamination: Your physician can detect an H. pylori infection using blood, stool, or breath tests, or by conducting an upper gastrointestinal (GI) biopsy.
  • Blood examination: A medical professional may extract a blood sample from you and submit it to a laboratory to test for H. pylori infection symptoms.
  • Stool test: Your physician may conduct stool tests to search for indications of H. pylori infection. Your doctor may also use a stool test to determine if H. pylori has been eliminated by treatment.
  • Urine urea test: Your physician may administer a urea breath test to detect H. pylori infection. The presence of H. pylori in your digestive tract will be confirmed if the test detects the labeled carbon atoms. A physician can also use this test to determine if H. pylori has been eliminated by treatment.

How is functional dyspepsia treated?

If you have tested positive for a bacterial infection, you will first be treated with antibiotics. However, if functional dyspepsia persists and no other direct cause is identified, the remaining treatment options focus on symptom management. This is an iterative procedure. Medication may consist of:

Acid suppression

  • Typically, physicians will prescribe a brief course of medication to suppress or neutralize gastric acid. This will allow your stomach lining to recover and repair, thereby reducing acid reflux symptoms. 
  • Proton pump inhibitors (PPIs) and H2 receptor antagonists are commonly prescribed medications. Typically, these are prescribed for two to three months before being reevaluated. 
  • You may also use over-the-counter antacids to manage your symptoms, but you should consult a healthcare professional if you use them frequently for more than a few weeks.

Prokinetic agents

  • If something is delaying or impeding your motility, which is the movement of food through your digestive system, prokinetic agents can be of assistance. 
  • These medications encourage the stomach to discharge food into the small intestine without holding it for too long, and they reduce the tendency for food or liquids to travel back up the esophagus.

Phytotherapy

  • Some people’s symptoms have been successfully treated with botanical preparations. Using multiple plant extracts to treat various symptoms appears to be more effective than using a single extract alone. 
  • One of the most commonly prescribed formulations for stimulating motility while also calming and sedating the digestive system is a combination of peppermint and caraway oil. Iberogast®, a commercial compound with nine listed constituents, has also performed well in clinical trials.

Tricyclic antidepressants (TCAs)

  • Some individuals whose symptoms appear to be nervous system-related benefit from a class of medications known as low-dose antidepressants. 
  • In much lower doses than those used to treat depression, these medications may help to reduce the perception of pain and discomfort and modulate psychological triggers. 
  • Some aid in gastric relaxation during digestion, allowing the stomach to expand to accommodate more food.

These medications may be effective if they target the underlying causes of your symptoms. However, functional dyspepsia is frequently more complicated than that, and medications are only moderately effective at treating FD.

The following are some additional symptom-management strategies:

  • Acupuncture: Results are inconclusive, but some studies and individuals report improvement after a course of several weeks of consistent treatments.
  • Certain mind-body techniques may help alleviate symptoms that cannot be treated with medication alone. Biofeedback, psychotherapy, and relaxation techniques may all contribute to a more regulated nervous system and digestive system.
  • Consider maintaining a food journal to record how your body reacts to various meals, or attempt an elimination diet to systematically test various food categories. Additionally, eating smaller portions and digesting more thoroughly can be beneficial.
  • Some people find that modifying their lifestyle by losing weight, engaging in more physical activity, getting enough sleep, and reducing their stress levels improves their digestive symptoms.

Takeaway

Functional dyspepsia (FD) is a highly prevalent disorder characterized by persistent or recurrent upper abdominal pain or discomfort in the absence of an organic disease that could explain the symptoms. A functional disorder is a persistent issue with physiological functions that cannot be explained by somatic causes. Doctors can observe your symptoms, but they are unable to identify a mechanical cause for them. 

If you experience frequent symptoms of dyspepsia, your healthcare providers will examine your gastrointestinal tract for any abnormalities, such as an ulcer or structural defect. If they cannot, your condition will be diagnosed as functional dyspepsia (FD). FD is sometimes referred to as uneasy dyspepsia, non-ulcer dyspepsia, or pseudo-ulcer syndrome.

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