Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen. Indigestion is common in adults and can occur once in a while or as often as every day. Most people with indigestion experience more than one of the following symptoms:
Fullness during a meal: The person feels overly full soon after the meal starts and cannot finish the meal.
Bothersome fullness after a meal: The person feels overly full after a meal—it may feel like the food is staying in the stomach too long.
Epigastric pain: The epigastric area is between the lower end of the chest bone and the navel. The person may experience epigastric pain ranging from mild to severe.
Epigastric burning: The person feels an unpleasant sensation of heat in the epigastric area.
Other, less frequent symptoms that may occur with indigestion are nausea and bloating—an unpleasant tightness in the stomach. Nausea and bloating could be due to causes other than indigestion.
H. pylori infection occurs when a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach. This usually happens during childhood. This can be a cause for peptic ulcers, H. pylori infection may be present in more than half the people in the world and often positive in the stomachs of general population.
Most people don't realize they have H. pylori infection, because they never get sick from it. If you develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H. pylori infection, because it can be treated with antibiotics.
Most people with H. pylori infection will never have any signs or symptoms. Often the infection remains silent and can cause ulceration or even cancer of stomach in few susceptible individuals. When signs or symptoms do occur with H. pylori infection, they may include:
An ache or burning pain in your abdomen
Abdominal pain that's worse when your stomach is empty
Loss of appetite
Unintentional weight loss
Chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. Though occasional constipation is very common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement.
Treatment for chronic constipation depends in part on the underlying cause. However, in many cases, a cause is never found. Improper bowel training during childhood can lead to chronic constipation in adult life.
Signs and symptoms of chronic constipation include one or more of following:
Passing fewer stools than normal
Having lumpy or hard stools
Straining to have bowel movements
Feeling as though there's a blockage in your rectum that prevents bowel movements
Feeling as though you can't completely empty the stool from your rectum
Needing help to empty your rectum, such as using your hands to press on your abdomen and using a finger to remove stool from your rectum
Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard and dry.
Irritable bowel syndrome (IBS) is a common, chronic bowel disorder in which there is abdominal pain associated with change in consistency and frequency of stool. There are 3 different patterns of this disorder namely IBS- C (Constipation predominant) , IBS – D (Diarrhoea predominant) and IBS – M (Constipation + Diarhoea). The same patient can have different patterns at different times
You may also experience abdominal bloating, mucus in the stool and the sensation of incomplete emptying after defecation. IBS is a chronic condition, although there may be times when the signs and symptoms are worse and times when they improve or even disappear completely. Similar symptoms can also occur in other serious bowel diseases especially if there is presence of blood in stool , weight loss, fever, loss of appetite and if the symptoms occur for the first time after the age of 50 years. If any of these are present then you must consult your doctor immediately.
IBS is a multifactorial disorder where there is interplay of intestinal hypersensitivity , psychological stress and gut bacteria . This leads to abnormal intestinal movements and associated symptoms.
Symptoms can be reduced by managing diet, lifestyle and stress. Certain drugs may be prescribed to alleviate your symptoms. Your doctor may advise certain laboratory investigations and colonoscopy to rule out a more serious disease. IBS is a chronic but not a life threatening disease and does not cause cancer.
Triggers vary from person to person
Stimuli that don't bother other people can trigger symptoms in people with IBS — but not all people with the condition react to the same stimuli. Common triggers include:
Foods: The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods have been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few. Stress: Most people with IBS find that their signs and symptoms are worse or more frequent during (periods) of increased stress. While stress may contribute to symptoms It is not the sole cause. Hormones: Researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods. Other illnesses: Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.
Peptic ulcers occur when acid in the digestive tract injures or eats away the inner surface of the stomach and duodenum. The acid can create a painful open wound that can lead to complications.
The digestive tract normally produces acid for digestion and is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus protection is decreased, can lead to ulcer formation. The most common symptom of a peptic ulcer is upper abdominal burning or pain.
Peptic ulcers include:
Gastric ulcers that occur in the stomach.
Duodenal ulcers occur in the first part small intestine (duodenum)
The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and certain other painkillers, such as ibuprofen and others. Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse. Smoking or tobacco in any form can lead to ulcer.
What is Gastroesophageal reflux (GERD) ?
Gastroesophageal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. People will experience heartburn when excessive amounts of acid from the stomach refluxes into the esophagus.
Many describe heartburn as a feeling of burning discomfort, localized behind the chest, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating food and even mimics a heart attack.
All of us may have occasional heartburn. However, frequent heartburn (two or more times a week), Food sticking, blood in throat or weight loss may be associated with a more severe GERD.
Most people will experience heartburn if the lining of the esophagus comes in contact with too much stomach juice for too long a period of time. This stomach juice consists of acid and digestive enzymes, . The prolonged contact of acidic stomach juice with the esophageal lining injures the esophagus and produces a burning discomfort. Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or "LES" keeps the acid in the stomach and out of the esophagus.
In GERD the LES relaxes too frequently, which allows stomach acid to reflux, or flow backward into the esophagus.
GERD can also have extra-esophageal manifestations like chest pain, asthma, chronic cough, ear, nose and throat problems which often avoid detection.
What Is SIBO?
Small intestinal bacteria overgrowth (SIBO) is exactly what it sounds like: too much bacteria in the small intestine. Everyone has bacteria in their gut; they play a key part in digestion. But if things get out of balance, problems can happen.
SIBO can be treated, and sometimes lifestyle changes are all it takes.
SIBO usually starts when the small intestine doesn’t move food along well enough. This lets bacteria grow and stick around too long. If the “good” bacteria that help you digest food can’t keep up with the harmful bacteria, the “bad” germs can multiply too fast, and then you’ve got an imbalance that could cause SIBO symptoms.
Early signs are pain in your abdomen, queasiness, fatigue, feeling bloated, passing a lot of gas, and diarrhea or constipation. Many things can cause those problems, so you can’t know that it’s SIBO just based on how you feel.
If you have SIBO and it worsens, your small intestine might not absorb enough food or nutrients. This could lead to weight loss or anemia, with your body not getting enough fuel or iron.
Things that can make you more likely to develop SIBO include:
Age. Older adults are more likely to have SIBO because they may make less of the gastric acid that breaks down food and are more likely to have diverticulosis.
Anatomy. You may have a small intestine with an unusual shape. Differences in the structure or anatomy of your gut can make food move more slowly than normal and allow bacteria to grow. These may stem from diverticulosis (pouches in the small intestine), procedures like Roux-en-Y gastric bypass surgery, scar tissue from radiation or abdominal surgery, or a buildup of protein called amyloid in your small intestine. Blockages in the GI tract can cause SIBO, too.
Chronic diseases such as diabetes, lupus, and connective tissue disorders like scleroderma can keep your small intestine from working right. An immune system weakened by HIV, immunoglobulin A deficiency, or other reasons can let too much bacteria grow where it shouldn’t.
SIBO seems to be particularly common in people with inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
Medicines are sometimes at the root of SIBO. Narcotics can slow things down, as can drugs that treat irritable bowel syndrome. Proton pump inhibitors that curb acid in your stomach and antibiotics that affect the bacteria living in your intestines can lead to SIBO.
If you’ve had SIBO-like symptoms that don’t go away, see a gastroenterologist. This type of doctor specializes in the digestive system.
At your appointment, you’ll probably take “ Glucose H2 Breath test” ( GHBT ) First, you’ll drink a 75 gram glucose mix. Then, over the next 3 hours, you will breathe into LACTOFAN - 2 machine 20 minutes interval. This air will be tested to see if it has high levels of hydrogen or methane to suggest SIBO.
To treat SIBO, you’ll want to get your gut bacteria back in balance. That should ease your symptoms and help your body to better absorb more nutrients from your food.
The treatment you’ll get depends the results of the breath test you took. If your sample had a lot of hydrogen in it, the main treatment is the antibiotic rifaximin. If your test showed high levels of methane, you’ll likely take rifaximin plus the antibiotic neomycin.
It’s rare, but some people may need surgery if their SIBO stems from a problem with their intestine’s structure. If this causes your SIBO, you’ll need to see your doctor regularly after the operation to check on your digestive health.
Lifestyle Changes to Help
If you don’t have SIBO because of an anatomical problem, a simple step is to cut out sugary foods and drinks. This may be all it takes to feel better. You can also try quitting foods that seem to make your symptoms worse, then wait 3 days before bringing them back on your menu. This way, you’ll know whether a certain food triggers your symptoms. And avoid taking fiber supplements as well as any liquid medications (such as cough syrup) that use sugar alcohols for flavor.
Your doctor may recommend a low-FODMAP diet. FODMAPs are a type of carbohydrate (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.). Not every carb is a FODMAP. You’ll want to talk to a nutritionist or a doctor who’s knowledgeable about nutrition so you can know what you can eat and how to meet your nutritional needs on this plan.
You might want to ask your doctor whether prebiotics and probiotics could help. You can get probiotics in fermented foods like yogurt (look for “live, active cultures” on the label), kefir (a yogurt-based drink), and kimchi (a traditional Korean relish). To get more prebiotics from foods, include lots of fruits, veggies, and whole grains. If you’re thinking about taking prebiotics or probiotics in supplements, talk with your doctor first to make sure they’re a good choice for you. Foods are always a good first step, since you’ll get lots of other nutrients that are good for you.
Dr. Amitava Roy
MBBS, MD (Medicine), PDCC (Gastro), FACG (member) USA Life member SGEI,IMA,API,IACM