POOR DIGESTION: SYMPTOMS, CAUSES, CONSEQUENCES, REMEDIES, DRUGS - MEDICINE - 2025

The poor digestion or indigestion, is a medical condition including gastrointestinal symptoms annoying for the patient located on top of the abdomen, usually occurring after a mealtime.

The diagnosis is made from the interrogation and abdominal physical examination. If the patient reports pain in the pit of the stomach, heartburn, fullness after eating, or a feeling of filling up quickly starting to eat, the doctor may suspect indigestion.

Abdominal physical exam. Public Domain, commons.wikimedia.org

Patients with increased intra-abdominal pressure, such as obese and pregnant women, are prone to indigestion. Some of the most frequent causes are gastroesophageal reflux, prolonged administration of anti-inflammatories and gallstones, among others.

Children may have symptoms of indigestion, but it is not as common as in adults. It is difficult to diagnose this disease in pediatric patients since the symptoms they describe are very vague, and they may also present others that are not common, such as nausea and vomiting.

It is important for the doctor to know how to differentiate the symptoms of indigestion from those of other types of conditions that can give a similar clinical picture, such as heart or esophageal diseases.

There are a large number of natural remedies that alleviate the symptoms of indigestion, but the patient should consult a specialist, since poor digestion may be hiding a more serious disease.

Pathophysiology

Digestion is the process by which food is carried from the mouth to the stomach. It begins with chewing, where food meets saliva and swallowing.

Food travels through the esophagus and is broken down by a number of specialized enzymes.

The food bolus, which is chewed food, begins to be separated by the work of digestive enzymes. This process causes a liquid component to form that is emptied from the stomach into the small intestine.

Swallowing scheme. By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, commons.wikimedia.org

Once in the intestine, the digested food is absorbed in the different portions of it. In this way, the vitamins and minerals ingested reach the bloodstream to nourish the body.

When there is poor digestion, the normal process can be altered in any of its phases. Depending on the condition that is causing the indigestion, you can tell at what specific point in your digestion the problem is.

In indigestion, also called dyspepsia, two groups of patients can be differentiated. Those who have a clear cause that is causing the disorder and those who do not. Thus we separate organic dyspepsia from functional dyspepsia, respectively.

For a person to be diagnosed with functional dyspepsia, they have to have been studied for at least three months without clinical examinations and evaluations providing any cause for the disease.

Causes

- Organic dyspepsia

When studying the patient with dyspepsia or indigestion, five basic causes are found that explain why the person suffers from this disorder; These are: gastroesophageal reflux disease (GERD), prolonged administration of non-steroidal anti-inflammatory drugs (NSAIDs), chronic peptic ulcer disease, and gallstones or gallstones.

Other conditions such as malignant diseases, irritable bowel syndrome and autoimmune diseases, can also be triggers of indigestion, but they are rare.

Gastro-esophageal reflux disease (GERD)

Reflux is a disease in which there is an increase in the amount of acid in the stomach at all times. Patients with this condition feel heartburn and a feeling of regurgitation.

Gastroesophaphic reflux. By BruceBlaus - commons.wikimedia.org

Nighttime symptoms are more common. During the day there are episodes of gastric discomfort and fullness after meals.

Non-steroidal anti-inflammatory drugs (NSAIDs)

The use of pain relievers and anti-inflammatories is a cause of dyspepsia that is sometimes overlooked. Many people take these drugs routinely, as they are sold without any restrictions.

The use of non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen among others, is associated with damage to the gastric mucosa, stomach discomfort, abdominal pain, gas sensation and, in more advanced cases, ulcer.

Peptic ulcer disease

When studied, approximately 10% of patients with dyspepsia have a gastric or duodenal ulcer.

Most ulcer patients are infected with Helicobacter pylori, which is a bacterium that lodges in the lining of the stomach and duodenum and works by neutralizing normal acid secretion and damaging the mucosa of these organs.

Formation of an H. pylori ulcer. From Y_tambe - commons.wikimedia.org

Gallstones

Gallstones or gallstones is a disease in which stones form in the gallbladder. The gallbladder is the reservoir that stores bile and is essential for the digestion of fats.

When there are stones in the gallbladder, it does not work properly and affects the secretion of bile, therefore the fats are not absorbed properly causing symptoms such as abdominal pain, fullness after eating and a sensation of gas.

- Functional dyspepsia

Functional dyspepsia is one that is diagnosed in a patient once all the pathologies that can cause indigestion have been ruled out. The diagnostic criteria that have been established through the conventions of specialists worldwide are the following:

- Persistent indigestion for more than 3 months in the last 6 months.

- Absence of an organic cause of dyspepsia in special examinations, such as upper digestive endoscopy.

- Absence of signs of improvement with defecation.

This last criterion was added to differentiate functional-type indigestion from irritable bowel syndrome, which is a disorder in which there are intestinal and colonic symptoms that include changes in the evacuation pattern (diarrhea alternated with periods of constipation) and abdominal distention, among others..

Patients with this syndrome see improvement with evacuation, which is not the case with functional dyspepsia. The causes of this condition are not clear, but it is known that there is a strong psychological component that contributes to its development.

It has been shown that, in a high percentage, patients with functional dyspepsia suffer psychological conditions such as anxiety, depression and panic attacks. This leads them to maintain poor mental health and decrease their quality of life.

Consequences and complications

Indigestion or dyspepsia is a fairly common pathology and patients who suffer from it tend to self-medicate without going to a specialist. For this reason, there may be complications that go unnoticed and are confused with other symptoms of the same condition.

The consequences have to do directly with the cause of indigestion but, in general terms, it is a condition that progressively deteriorates the patient's quality of life.

Loss of appetite

Loss of appetite is a common consequence of all indigestion patients. Some do not feel hungry while others stop eating for fear of the discomfort that they present later.

Prolonged fasting not only makes dyspepsia worse, it can also lead to further damage to the stomach lining, malnutrition, and anemia.

Malnutrition

Malnutrition has to do with protein values ​​in the blood and not directly with physical appearance, despite the fact that there is always weight loss. So a patient may be malnourished and not look haggard.

Gastric mucosa damage

Those people in whom the cause of poor digestion is the prolonged administration of non-steroidal anti-inflammatory drugs, may present serious damage to the gastric mucosa that, eventually and depending on other factors, can cause a perforated peptic ulcer.

This is a serious and acute complication, quite frequent in patients who have been treated with anti-inflammatory drugs for more than 3 months without medical supervision and without stomach protection.

It occurs when an ulcer completely crosses the layers of the stomach, leaving it completely open towards the abdominal cavity. Treatment is surgical and when it is not operated in a timely manner, it is fatal.

GERD

In the case of patients with gastroesophageal reflux disease (GERD), esophageal complications may occur.

GERD causes the acid content of the stomach to reach the esophagus, the problem is that the esophageal mucosa does not resist these levels of acidity, so it begins to modify its cellular structure.

These changes that esophageal cells make to adapt to the acidic environment, can result in mutations that cause pre-malignant diseases, such as the lesion called Barrett's esophagus, or malignant.

When the patient is not evaluated by a specialist who performs the corresponding examinations and can establish an adequate treatment, all these complications may be happening, affecting the overall health status.

Poor digestion in children

Despite the fact that the term "poor digestion" or "dyspepsia" is used mainly to explain conditions in adult patients, since 1986 some authors have used it to describe symptoms of the same characteristics in children.

It is not common for children to present dyspepsia, however, this diagnosis must be taken into account when evaluating a pediatric patient with recurrent abdominal pain.

Abdominal physical examination in a child. TRAILER TOWN, Iraq (July 31, 2008) Navy Petty Officer 3rd Class LaSahon P. Washington, corpsman with 2nd Low Altitude Air Defense Battalion, 1st Marine Logistics Group, palpates the abdomen of an Iraqi child during a cooperative medical engagement, July 31. (Photo by Lance Cpl. Robert C. Medina)

Children diagnosed with indigestion are a small percentage, between 5 and 10%. Of these, the majority present functional disorders.

In these cases, the diagnostic approach should include an interrogation about the relationships and the child's performance in school or other social activities, since these may be generating a psychological disorder that is causing the symptoms.

In the case of those children in whom there is an organic component diagnosed by upper gastrointestinal endoscopy, the main cause is usually the prolonged administration of non-steroidal anti-inflammatory drugs.

Symptoms in pediatric patients differ somewhat from those in adults. They may have pain in the pit of the stomach (especially at night and after eating), recurrent vomiting, or anorexia.

Poor digestion in pregnant women

In pregnant women, poor digestion is a fairly common disorder that is usually very annoying and that progresses with pregnancy. It has two main causes: increased hormones and an enlarged uterus.

The increased amount of female hormones causes the smooth muscle, which is part of the stomach and esophagus, to relax. This slows the passage of food into the stomach and increases reflux into the esophagus, causing heartburn and pain.

For its part, as the uterus increases in size, there is an increase in intra-abdominal pressure. The intestine, colon and stomach are pushed back, so there is difficulty for their normal mobilization. There is a decrease in the emptying of food from the stomach to the intestine, and this can cause fullness and a sensation of gas.

Pregnant women are advised to eat small meals 5 times a day, chew food well, walk and be active as much as possible. Avoid talking while eating to reduce air intake, drink less fluids with food, and do not lie down immediately after eating.

Natural treatments

From hot lemon water and herbal teas to fruits like apples, there are a host of foods and beverages that are used as a treatment for indigestion.

Although most are empirical treatments, there is scientific evidence that some of them do help and improve poor digestion.

In a 2002 study among several clinical centers, using pepper and cumin as a treatment for patients with dyspepsia, these spices were shown to have anti-inflammatory properties.

There is also scientific evidence that a liquid herbal mixture developed in Germany called Iberogast® has beneficial properties in patients with dyspepsia. Even its relaxing effects are used as a treatment in the case of functional dyspepsia.

Pharmacological treatments

The primary treatment for indigestion, regardless of its cause, are drugs that control stomach acid secretion or proton pump inhibitors.

By decreasing the continuous output of acid from the stomach, there will be an increasing improvement of the gastric mucosa, so there is relief from symptoms.

Whenever a patient must take non-steroidal anti-inflammatory drugs for more than 10 days, the doctor should indicate a gastric protection treatment.

Drugs that increase muscle motility in the esophagus and stomach, called prokinetics, improve the movement of the food bolus through the esophagus and the emptying from the stomach to the intestine, thus eliminating the feeling of fullness.

In the case of patients with functional dyspepsia, psychiatric treatments such as antidepressants and anxiolytics are used.

References

1. Harmon, R. C; Peura, DA (2010). Evaluation and management of dyspepsia. Therapeutic advances in gastroenterology. Taken from: ncbi.nlm.nih.gov
2. Madisch, A; Andresen, V; Enck, P; Labenz, J; Frieling, T; Schemann, M. (2018). The Diagnosis and Treatment of Functional Dyspepsia. Deutsches Arzteblatt international. Taken from: ncbi.nlm.nih.gov
3. Lacy, B. E; Talley, N. J; Locke, G. R; 3rd, Bouras, E. P; DiBaise, J. K; El-Serag, H. B; Prather, C. (2012). Review article: current treatment options and management of functional dyspepsia. Alimentary pharmacology & therapeutics. Taken from: ncbi.nlm.nih.gov
4. Harris, P; Godoy, A; Guiraldes, E. (2001). Abdominal pain, dyspepsia and gastritis in pediatrics: Role of Helicobacter pylori. Chilean journal of pediatrics. Taken from: conicyt.cl
5. Pinto-Sanchez, M. I; Yuan, Y; Hassan, A; Bercik, P; Moayyedi, P. (2017). Proton pump inhibitors for functional dyspepsia. The Cochrane database of systematic reviews. Taken from: ncbi.nlm.nih.gov