Health

Sunday April 30, 2006

Indigestion defined

Medicine Cabinet
By DIONG SWEE HOON



INDIGESTION is a general term used to describe pain or discomfort in the upper abdomen or chest that can develop after a meal. Sometimes a burning feeling is felt in the chest, and this is known as heartburn. Most people have suffered from indigestion after a large meal at some time, and up to 20% of people suffer from heartburn at least once a week.

Pain felt in the upper abdomen may come and go. For some people it can be relieved by food, especially if it feels like a hunger pain, although for others it can occur after eating. It can occur by day or at night, when it may be relieved by a snack or a drink of milk. Alternatively, it can occur without any relation to food at all.

The stomach may feel full soon after starting to eat, so that it is difficult to finish a meal, or there may be an uncomfortable sense of fullness or bloating after a meal.

The word “indigestion” may also be used to describe nausea, retching or even vomiting after food.

What causes indigestion?

The stomach produces a strong acid that helps digest food and protects against infection. A layer of mucous lines the stomach, oesophagus and intestines to act as a barrier against this acid. If the mucous layer is damaged, acid can irritate the tissues below.

With heartburn, the sphincter (valve) between the oesophagus and stomach does not work properly, allowing reflux of the stomach contents.

Some of the following things can make the symptoms worse:

       

  •        Overeating; eating too fast; eating fatty or greasy food; eating spicy food.

           

  •        Excessive caffeine intake.

           

  •        Excessive alcohol intake.

           

  •        Smoking.

           

  •        Irregular meals, because long gaps between meals allow the acid more time to act. Each meal neutralises the acid for a while.

           

  •        Stress and anxiety.

           

  •        Drugs such as aspirin and anti-inflammatory medication used to treat arthritis.

           

  •        Inflammation of the gallbladder.

           

  •        Pregnancy, which commonly causes heartburn, indigestion or vomiting.

           

  •        Peptic ulcer (stomach ulcer), which is a raw patch in the lining of the stomach or the small intestine.

    Other causes:

  •        Helicobacter pylori (H. pylori)

    This is a bacterium, which lives in the mucous layer of the stomach that can cause irritation (gastritis). It is present in about half the population, often without causing any symptoms. However, a high percentage of people who suffer from a stomach ulcer are found to carry the bug and about 15% of people who carry the bug will go on to develop an ulcer. It is possible that a small proportion of people who are affected will develop stomach cancer.

    If H. pylori is diagnosed, your doctor will give you a course of medication to eradicate this bacterium.

  •        Hiatus hernia

    This occurs when part of the stomach slides through the diaphragm, which is the muscular sheet that separates the lungs and chest from the abdomen. Normally, the stomach is completely below the diaphragm. But in some people, part of the stomach slides up into the chest cavity. This is called a hiatus hernia, and it causes pain and heartburn.

    Hiatus hernia is most likely to occur in pregnant women and people who are overweight. If the symptoms are severe, it can be repaired by an operation.

    When to seek medical treatment

  •        Your symptoms last longer than a  few days.

  •        The pattern of indigestion symptoms changes noticeably.

  •        You have sudden, severe abdominal pain.

  •        You have unexplained weight loss.

  •        Vomit blood or pass blood in the stool.

  •        You have jaundice (yellow colouring of the skin and eyes)

  •        Vomiting with specks of blood or blood that looks like coffee-grounds, or vomiting fresh, red blood.

    Lifestyle changes

    A number of lifestyle changes may reduce the symptoms of indigestion. These include:

  •        Dietary changes, such as reducing intake of fatty foods, tea, coffee and alcohol, and eating small regular meals.

  •        Stop smoking.

  •        Sleeping propped up on a pillow.

    Drug treatment

    Antacids: These can be taken either in liquid or tablet form. They often contain chalky compounds that work by neutralising the stomach acid. Some antacids contain an ingredient called alginate, which forms a barrier that floats on the top of the stomach contents to prevent them splashing back up into the gullet, thus preventing heartburn and reflux symptoms. Others contain magnesium or aluminum.

    Side-effects of antacids can include looseness of the bowels and constipation. Many of the popular antacids brands contain a mixture of more than one active ingredient.

    H2-antagonists: If antacids alone are ineffective, or if large quantities of antacids are needed, your doctor may recommend a more powerful medication called H2 antagonist.

    A chemical called histamine, produced naturally by the body, stimulates certain cells in the stomach to produce acid. It does this by attaching, or binding, to a particular site on those cells – known as an H2 receptor – which makes the cells produce more acid.

    The H2 antagonists work by binding to the H2 receptors without triggering acid production. The technical description for a medicine that blocks receptors in this way is “antagonist”. Examples are famotidine, cimetidine, nizatidine and ranitidine.

    Proton pump inhibitors: If symptoms continue, doctors can prescribe another type of drug called proton pump inhibitors. The proton pump inhibitors work by completely blocking the production of stomach acid. They do this by inhibiting (shutting down) a system in the stomach known as the proton pump. The full name for this system is “hydrogen-potassium adenosine triphosphate enzyme system”. Examples are omeprazole, pantoprazole, esomeprazole and lansoprazole.

    H. pylori can be treated with “triple therapy” which aims to eradicate the bacterial infection. This is usually a one-week course of a proton pump inhibitor combined with two different antibiotics.

    Other medications work by coating the stomach lining, to protect it against the acid-attack. These include bismuth and sucralfate.

    References:

    1. Medline Plus – A service of the U.S National Library of Medicine and the National Institutes of Health.

    2. CORE - Digestive Disorders Foundation, UK

    3. BUPA – British United Provident Association

    4. MIMs – 102nd Edition 2005

  • Diong Swee Hoon is a pharmacist. For more information, e-mail starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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