A management protocol for a patient with dyspepsia/indigestion

Dyspepsia(upper abdominal burning sensation or heartburn or simple acidity problem) is a quite common problem among the general population. There is no one who hasn't encountered this problem in their lifetime. So some information on this issue won't be inappropriate I guess.

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There are many causes of dyspepsia. Painkillers, particularly NSAIDs, and other drugs notably steroids and bisphosphonate (for osteoporosis) are one of the main culprits of dyspepsia. Following a rich and spicy food, dyspepsia might create trouble. Some people might have a problem with a specific type of foods which doesn't cause problems in others.

Here are the things we should do to minimize dyspepsia:

• Stop all the offending medicines (if possible)
• Take anti-acid medicines. Mostly 3 types of anti-acid medicines are being used. PPI (proton pump inhibitors) are most commonly used one. Omeprazole, pantoprazole, esomeprazole, rabeprazole etc are included in PPI group. H2-receptor blockers are second most used medicine for acidity problem. Ranitidine, famotidine etc are in these group. There is also a plain antacid which can be used to treat dyspepsia.
• Sometimes, a PPI needs to be used daily for at least 1 month to treat the problem.
• After stopping the medicine, if the problem still persists, then you need to go for some investigations. The most common is to search for the presence of H. Pylori which is a bacteria responsible for ulceration in the stomach and first part of the intestine.
• If your age is over 55 years, symptoms not resolved with the long-term use of a good PPI, you have started losing weight, you feel difficulty in passing down food bolus through your oesophagus (dysphagia), you are experiencing recurrent vomiting then you need to go for one of the more invasive tests known as Upper GI Endoscopy.
• If H. Pylori is found, there is treatment protocols for removal of the bacteria. After the treatment, in most of the cases, patient get relief from their problem.