INDIGESTION SYMPTOMS

Physical causes

The symptoms associated with indigestion have a variety of possible physical causes, ranging from commonplace food items to serious systemic disorders:

• Diet. Milk, milk products, alcoholic beverages, tea, and coffee cause indigestion in some people because they stimulate the stomach's production of acid.
• Medications. Certain prescription drugs as well as over-the- counter medications can irritate the stomach lining. These medications include aspirin, NSAIDs, some antibiotics, digoxin, theophylline, corticosteroids, iron (ferrous sulfate), oral contraceptives, and tricyclic antidepressants.
• Disorders of the pancreas and gallbladder. These include inflammation of the gallbladder or pancreas, cancer of the pancreas, and gallstones.
• Intestinal parasites. Parasitic infections that cause indigestion include amebiasis, fluke and tapeworm infections, giardiasis, and strongyloidiasis.
• Systemic disorders, including diabetes, thyroid disease, collagen vascular disease.
• Cancers of the digestive tract.
• Conditions associated with women's reproductive organs. These conditions include menstrual cramps, pregnancy, and pelvic inflammatory disease.

Psychologic and emotional causes

Indigestion often accompanies an emotional upset, because the part of the nervous system involved in the so-called "fight-or-flight" response also affects the digestive tract. People diagnosed with anxiety or somatoform disorders frequently have problems with indigestion. Many people in the general population, however, will also experience heartburn, "butterflies in the stomach," or stomach cramps when they are in upsetting situations--such as school examinations, arguments with family members, crises in their workplace, and so on. Some people's digestive systems appear to react more intensely to emotional stress due to hypersensitive nerve endings in their intestinal tract.

Specific gastrointestinal disorders

In some cases, the patient's description of the symptoms suggests a specific digestive disorder as the cause of the indigestion. Some doctors classify these cases into three groups:

ESOPHAGITIS TYPE

Esophagitis is an inflammation of the tube that carries food from the throat to the stomach (the esophagus). The tissues of the esophagus can become irritated by the flow (reflux) of stomach acid backward into the lower part of the esophagus. If the patient describes the indigestion in terms of frequent or intense heartburn, the doctor will consider gastroesophageal reflux disease (GERD) as a possible cause. GERD is a common disorder in the general population, affecting about 30% of adults.

PEPTIC ULCER TYPE

Patients who smoke and are over 45 are more likely to have indigestion of the peptic ulcer type. This group also includes people who find that their indigestion is relieved by taking antacids or eating a small amount of food. Patients in this category are often found to have Helicobacter pylori infections. H. pylori is a rod-shaped bacterium that lives in the tissues of the stomach and causes irritation of the mucous lining of the stomach walls. Most people with H. pylori infections do not develop chronic indigestion, but the organism appears to cause peptic ulcer disease (PUD) in a vulnerable segment of the population.

NONULCER TYPE

Most cases of chronic indigestion--as many as 65%--fall into this third category. Nonulcer dyspepsia is sometimes called functional dyspepsia because it appears to be related to abnormalities in the way that the stomach empties its contents into the intestine. In some people, the stomach empties either too slowly or too rapidly. In others, the stomach's muscular contractions are irregular and uncoordinated. These disorders of stomach movement (motility) may be caused by hypersensitive nerve endings in the stomach tissues. Patients in this group are likely to be younger than 45 and have a history of taking medications for anxiety or depression.