Indigestion

Dyspepsia (Dyspepsia)

1) Disease Description (Causes and Symptoms)

• Definition: A general term for digestive disorders that occur after eating, including various symptoms such as upper abdominal discomfort, abdominal pain, early satiety, postprandial discomfort, belching, heartburn (reflux symptoms), nausea, vomiting, and weight loss.
• Main causes
  • Organic diseases of the digestive system: Gastritis, peptic ulcer, gastric cancer, gastroesophageal reflux disease (reflux esophagitis), pancreatitis, gallbladder disease, etc.
  • Functional dyspepsia: Cases in which no structural abnormalities are found on endoscopy or other examinations (related to stress, eating habits, and gastrointestinal motility disorders)
  • Systemic diseases/non-digestive causes: Heart disease (symptoms similar to myocardial infarction), anemia, infection, etc.
  • Lifestyle factors: Irregular meals, overeating, eating quickly, smoking, excessive alcohol or caffeine intake, sensitivity to certain foods, and stress
• Pathophysiology summary: Delayed gastric emptying, gastrointestinal hypersensitivity, esophageal reflux, Helicobacter pylori infection, or symptom induction due to disease of another organ
• Common symptoms: Postprandial fullness, loss of appetite, upper abdominal discomfort or pain, belching, heartburn, nausea, vomiting, weight loss, etc.

2) Treatment Methods and Precautions

• Diagnostic approach
  • Warning signs (requiring emergency care/detailed examination): Unexplained weight loss, persistent vomiting, hemoptysis or black stools (gastrointestinal bleeding), progressive dysphagia (difficulty swallowing), anemia, persistent severe pain, and, as an initial consideration, recommendation for endoscopy according to age criteria and regional guidelines
  • Main examinations: Upper gastrointestinal endoscopy (most important), Helicobacter pylori testing, abdominal ultrasound (when liver, gallbladder, or pancreatic disease is suspected), CT, esophageal pH testing (when reflux is suspected), etc.
• Medication treatment (selected according to symptoms and cause)
  • Proton pump inhibitors (PPIs) — primarily considered for heartburn and acid-related symptoms
  • Antacids (short-term), prokinetic agents (useful for delayed gastric emptying, belching, and fullness)
  • Eradication therapy for Helicobacter pylori when the test is positive (combination antibiotic therapy according to guidelines)
  • In functional dyspepsia, antidepressants (at low doses) may help improve symptoms (at the physician’s discretion)
• Lifestyle management (important)
  • Avoid spicy, irritating, and fatty foods; alcohol, tobacco, excessive coffee, and carbonated beverages
  • Eat slowly and chew thoroughly; avoid overeating and late-night meals (fasting for 2–3 hours before bedtime is recommended)
  • Maintain a regular routine, engage in moderate exercise, manage stress, and maintain regular bowel habits
• Procedures and surgery: If an organic lesion (e.g., gastric cancer or gallbladder disease) is the cause, surgical or endoscopic treatment for that lesion
• Precautions
  • Consult a doctor regarding long-term medication use. Functional dyspepsia is strongly affected by stress and eating habits, so medication alone may not completely cure it.
  • Immediate emergency medical care is necessary if heart-related symptoms such as chest pain or shortness of breath occur (to differentiate conditions such as myocardial infarction).

3) Checkpoints Before an Outpatient Visit (Items to Bring and Records)

• Items to bring
  • List of medications and health supplements currently being taken (including dosage and time of administration)
  • Copies or records of previous test results (endoscopy, abdominal ultrasound, CT, etc.)
  • Recent records of weight changes (scale readings)
• Symptom records (preparing these before consulting a doctor can help with diagnosis)
  • When the symptoms began and the pattern of occurrence (relationship to meals and time of day)
  • Types and severity of symptoms (degree of pain, frequency of vomiting, presence of fullness after meals)
  • Presence or absence of warning symptoms (bloody stool, vomiting blood, persistent vomiting, marked weight loss, difficulty swallowing, etc.)
  • Changes in lifestyle habits (eating, alcohol consumption, smoking, medications, stress, etc.)
• Other
  • Allergy history, family history (gastrointestinal cancers such as gastric cancer), chronic diseases, and history of surgery

(See the following section for examples of questions to ask the doctor.)

4) General Examples of Questions to Ask the Doctor

• "What are the expected effects and side effects of this medication (or prescription)?"
• "How do you distinguish whether my symptoms are functional dyspepsia or an organic disease? What additional tests are needed?"
• "How long should I take the medication, and what precautions should I take when stopping it? When should I return if my symptoms do not improve?"

5) Examples of Disease-Specific Questions

• "Do I need to be tested for Helicobacter pylori? If the result is positive, which eradication therapy do you recommend (including side effects and success rate)?"
• "Based on my symptoms, should I undergo an upper gastrointestinal endoscopy immediately, or is it possible to improve my lifestyle and monitor my condition first? (In particular, what is recommended based on my age and symptom profile?)"

Additional guidance: If you have warning symptoms (marked weight loss, persistent vomiting, gastrointestinal bleeding, progressive dysphagia, etc.) or suspected cardiovascular symptoms such as chest pain or shortness of breath, immediately visit an emergency room or seek care from a specialist.