Alberto J. Muniagurria

Indigestion is defined as a syndrome made up of a set of symptoms and signs, characterized by bloating, gastric fullness, belching, sometimes nauseous state, heartburn, and slight epigastric pain or pain in the peri-umbilical region.

Indigestion can occur as a consequence of a disease of the digestive system, or of other devices or systems.

It is frequent not to find an organic cause that explains this symptomatic set, being attributed in such circumstances to psychosomatic alterations, such as anxiety, fatigue, depression and emotional stress.

A frequent cause of indigestion is the excessive ingestion or intestinal production of gases by the action of bacteria on carbohydrates and proteins. 20 to 60% of digestive gases come from swallowing air (aerophagia).

Causes of indigestion

Divided into psychosomatic and organic, and these / in turn, digestive and systemic, they are listed in the following table.

Causes of indigestion

1. Psychosomatic
   Anxiety, depression, emotional stress
2. Organic
   1. Digestive system
      • Esophageal:
        • Hiatus hernia
        • Acalasia
      • Gastric and duodenal:
        • Gastritis
        • Ulcer
        • Carcinoma
      • Intestinals
        • Crohn's disease and ulcerative colitis
        • Linfornas
        • Poor absorption diseases (lactase deficiencies, sprue)
        • Carcinomas
        • Mesenteric arterial insufficiency
        • Intestinal allergies
        • Parasitosis
      • Hepatobiliares
        • Cholecystitis
        • Colelitiasis
        • Hepatitis
        • Cirrhosis
      • Pancreatic:
        • Pancreatitis
        • Carcinoma
   2. Systemic
      • Heart failure
      • Renal insufficiency
      • Tuberculosis
      • Diabetes
      • Coronary insufficiency
      • Addison's disease
      • Hypothyroidism
      • Hyperparathyroidism
      • Chronic obstructive pulmonary disease

Syndrome interrogation

Characteristics and location of pain. The pain is generally dull and diffuse, and is described as fullness, bloating, pressure, discomfort, etc.

When its location is substernal, it suggests pathologies of cardiac, esophageal or cardiac origin. If the discomfort is referred to the epigastrium, it can originate in cardiac, hepatobiliary, pancreatic or gastroduodenal processes. Hepatobiliary pains tend to be located in the right hypochondrium and its spread is to the right and the scapula. Those of pancreatic origin spread to the left and the back. When the pain is located in the periumbilical area, it corresponds to the small intestine. When infraumbilical, it originates from the appendix, the large intestine, or the pelvic organs.

Relationship of symptoms with different circumstances. The pain may be constant, as in gastric cancer, or intermittent, as in gastritis, nocturnal as in duodenal ulcer, decubitus as in hiatus hernia, or seasonal as in certain peptic ulcers, or it may be related to food ingestion. Symptoms may appear minutes after ingestion, suggesting esophagogastric diseases, or hours after the end of it, which suggests difficulty in gastric emptying (pyloric stenosis), duodenal ulcer, or pancreatic insufficiency. When the symptoms improve or disappear with the ingestion of food or antacids, they usually indicate gastritis or ulcers.

Postprandial abdominal distension: When the distention relieves with belching is characteristic of aerophagia. Pain from acute bloating of the stomach can be severe and lead to confusion with coronary pain. Aerophagia is generally a habit, even though it can be associated with organic disease. The pains or discomfort of the left hypochondrium that sometimes irradiate the ipsilateral shoulder and that are alleviated with the removal of flatus are characteristic of splenic angle syndrome (gas accumulation in the splenic angle of the colon). Diets rich in carbohydrates are characterized by producing flatulence.

Relation of the symptoms with the type of food. A thorough questioning should be done about the type of diet and its association with the appearance of symptoms (milk, gluten, etc.), as well as the ingestion of medications (acetylsalicylic acid, butazolidine, etc.).

Study methodology

Given the nonspecificity and the multiple causes capable of giving rise to this syndrome, which is frequently a reason for consultation of psychosomatic patients, a comprehensive evaluation of the individual is necessary, using common sense in the selection of research methods, in order not to carry out or repeat unnecessary> expensive studies. Simultaneously, it must be taken into account that psychosomatic patients may be carriers of an organic pathology.

1. Careful medical history.
2. Laboratory: examination of fecal matter (fats, fibers, leukocytes, eosinophils, occult blood, parasitosis, culture).
3. Abdominal and pelvic echography to evaluate the gastric bubble.
4. Contrasting studies of the esophagus, stomach, small and large intestine, and bile ducts.
5. Endoscopic examinations in selected cases.
6. In special situations, specialized studies will be carried out in search of sistemic malabsorption diseases.