By Steven Guptha

The most common causes of indigestion are gastro esophageal acid reflux and functional dyspepsia.

Gastroesophageal Acid Reflux:

Acid reflux can result from a variety of physiologic defects. Reduced lower esophageal sphincter (LES) tone is an important cause of reflux in scleroderma and pregnancy.

Many individuals exhibit frequent transient LES relaxations during which acid bathes the esophagus. Overeating and aerophagia can transiently override the barrier function of the LES, whereas impaired esophageal body motility and reduced salivary secretion prolong acid exposure.

Gastric Motor Dysfunction

Disturbed gastric motility is purported to cause acid reflux in some cases of indigestion. Delayed gastric emptying is also found in 25-50% of functional dyspeptics.

Impaired gastric fundus relaxation after eating may underlie selected dyspeptic symptoms like bloating, nausea, and early satiety.

Visceral Afferent Hypersensitivity

Disturbed gastric sensory function is proposed as a pathogenic factor in functional dyspepsia. dyspeptic patients experience discomfort with fundic distention to lower pressures than healthy controls.

Other Factors

Helicobacter pylori has a clear etiologic role in peptic ulcer disease, but ulcers cause a minority of cases of dyspepsia. Infection with H. pylori is considered to be a minor factor in the genesis of functional dyspepsia.

Analgesics cause dyspepsia, while nitrates, calcium channel blockers, theophylline, and progesterone promote acid reflux.

Other exogenous stimuli that induce acid reflux include ethanol, tobacco, and caffeine via LES relaxation. Genetic factors may contribute to development of acid reflux.

Differential Diagnosis

Gastroesophageal Reflux Disease

Functional Dyspepsia

Functional dyspepsia, the cause of symptoms in 60% of dyspeptic patients, is defined as 3 months of bothersome postprandial fullness, early satiety, epigastric pain, or epigastric burning with symptom onset at least 6 months before diagnosis in the absence of organic cause.

Ulcer Disease

The most common causes of ulcer disease are gastric infection with H. pylori and use of NSAIDs.

Other rare causes of gastroduodenal ulcer include Crohn’s disease and Zollinger-Ellison syndrome a condition resulting from gastrin overproduction by an endocrine tumor.

Malignancy

Dyspeptic patients often seek care because of fear of cancer. Esophagealsquamous cell carcinoma occurs most often in those with histories of tobacco or ethanol intake.

Other risk factors include prior caustic ingestion, achalasia, and the hereditary disorder tylosis. Esophageal adenocarcinoma usually complicates long-standing acid reflux.

Other Causes

Alkaline reflux esophagitis produces GERD-like symptoms in patients who have had surgery for peptic ulcer disease.

Opportunistic fungal or viral esophageal infections may produce heartburn or chest discomfort but more often cause odynophagia. Other causes of esophageal inflammation include eosinophilic esophagitis and pill esophagitis.

INVESTIGATIONS:

Complete blood picture

Gastric scintigraphy

Ultra sound of abdomen

Ct scan of abdomen

HOMOEOPATHIC APPROACH:

LYCOPODIUM:

It suits to the patients with vigorous appetite ,but after eating a small quantity of food he feels so bloated

There is easy satiety of the appetite

Digestion is slow and difficult

Patient feels very sleepy immediately after eating

There s great accumulation of flatus in the stomach and intestines and this presses upwards which causes difficulty in breathing

It has also sour taste ,sour belching, and vomiting which is sour

Belching of gas does not relieve the symptoms of discomfort

PULSATILLA:

Dryness of the mouth ,putrid taste in the morning on awakening and sensation as if food is lodged under the sternum

The tongue is coated white thick rough

There is acidity and great heart burn

Food tastes bitter ,sour or putrid ,there is water brash and erructations tasting food and absence of thirst

All the symptoms are worse in the evening

ANACARDIUM:

There is sinking feeling which comes after two hours after eating.

There is dull pain in the stomach extending to spine and there are often tasteless erructations.

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