Cholestasis

Cholestasis is reduction or stoppage of bile flow.

• Disorders of the liver, bile duct, or pancreas can cause cholestasis.
• The skin and whites of the eyes look yellow, the skin itches, urine is dark, and stools may become light-colored and smell foul.
• Laboratory and often imaging tests are needed to identify the cause.
• Treatment depends on the cause, but drugs can help relieve itching.

With cholestasis the flow of bile (the digestive fluid produced by the liver) is impaired at some point between the liver cells and the duodenum (the first segment of the small intestine). When bile flow is stopped, the pigment bilirubin (a waste product formed when old or damaged red blood cells are broken down) escapes into the bloodstream and accumulates.

Causes

The causes of cholestasis are divided into two groups: those originating within the liver and those originating outside the liver.

Within the Liver: Causes include acute hepatitis, alcoholic liver disease, primary biliary cirrhosis with inflammation and scarring of the bile ducts, cirrhosis due to viral hepatitis B or C (also with inflammation and scarring of the bile ducts), drugs, hormonal effects on bile flow during pregnancy (a condition called cholestasis of pregnancy (see ), and cancer that has spread to the liver.

Outside the Liver: Causes include a stone in a bile duct, narrowing (stricture) of a bile duct, cancer of a bile duct, cancer of the pancreas, and inflammation of the pancreas (pancreatitis).

Symptoms

Jaundice, dark urine, light-colored stools, and generalized itchiness are characteristic symptoms of cholestasis. Jaundice results from excess bilirubin deposited in the skin, and dark urine results from excess bilirubin excreted by the kidneys. Retention of bile products in the skin may cause itching, with subsequent scratching and skin damage. Stools may become light-colored because the passage of bilirubin into the intestine is blocked. Stools may contain too much fat (a condition called steatorrhea) because bile cannot enter the intestine to help digest fat in foods. Fatty stools may be foul-smelling. The lack of bile in the intestine also means that calcium and vitamin D are poorly absorbed. If cholestasis persists, a deficiency of these nutrients can cause loss of bone tissue. Vitamin K, which is needed for blood clotting, is also poorly absorbed from the intestine, causing a tendency to bleed easily.

Prolonged jaundice due to cholestasis produces a muddy skin color and fatty yellow deposits in the skin. Whether the person has other symptoms, such as abdominal pain, loss of appetite, vomiting, or fever, depends on the cause of cholestasis.

Diagnosis

A doctor tries to determine whether the cause is within or outside the liver on the basis of symptoms and the results of a physical examination.

Recent use of drugs that can cause cholestasis suggests a cause within the liver. Small, spiderlike blood vessels visible in the skin, an enlarged spleen, and fluid in the abdominal cavity (ascites), which are signs of chronic liver disease, also suggest a cause within the liver.

Findings that suggest a cause outside the liver include certain kinds of abdominal pain (such as intermittent pain in the upper right side of the abdomen and sometimes also in the right shoulder ) and an enlarged gallbladder (felt during the physical examination or detected by imaging studies).

Some findings do not indicate whether the cause is within or outside the liver. They include heavy alcohol intake, loss of appetite, nausea, and vomiting.

Typically, the blood levels of two enzymes, alkaline phosphatase and gamma-glutamyl transpeptidase, are very high in people with cholestasis. A blood test that measures the level of bilirubin indicates the severity of the cholestasis but not its cause. An imaging study, usually ultrasonography, is almost always done if blood test results are abnormal. Computed tomography (CT) or sometimes magnetic resonance imaging (MRI) may be done in addition to or instead of ultrasonography. If the cause appears to be within the liver, a liver biopsy may be done and usually establishes the diagnosis. If the cause appears to be blockage of the bile ducts, more precise images of these ducts are usually needed. Typically, either endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) is done. MRCP uses magnetic resonance imaging. In ERCP, a contrast agent is injected and x-rays are taken.

Treatment

A blockage of the bile ducts can usually be treated with surgery or endoscopy (using a flexible viewing tube with surgical instruments attached). A blockage within the liver may be treated in various ways depending on the cause. If a drug is the suspected cause, the doctor stops its use. If acute hepatitis is the cause, cholestasis and jaundice usually disappear when hepatitis has run its course. A person with cholestasis is advised to avoid or stop using any substance that is toxic to the liver, such as alcohol and certain drugs.

Cholestyramine, taken by mouth, can be used to treat itchiness. This drug binds with certain bile products in the intestine, so they cannot be reabsorbed to irritate the skin. Unless the liver is severely damaged, taking vitamin K can improve blood clotting. Supplements of calcium and vitamin D are often taken if the cholestasis persists, but they are not very effective in preventing loss of bone tissue.

Adapted from: Merck & Co., Inc.

Biliary Atresia (BA)

Biliary atresia is a disease of the bile ducts that affects only infants. Bile is a digestive liquid that is made in the liver. It travels through the bile ducts to the small intestine, where it helps digest fats.

In biliary atresia, the bile ducts become inflamed and blocked soon after birth. This causes bile to remain in the liver, where it starts to destroy liver cells rapidly and cause cirrhosis, or scarring of the liver.

What causes biliary atresia?

The cause of this disease is not known. In some infants, the condition is most likely congenital, meaning present from birth. About one in 10 babies with biliary atresia have other congenital defects. Some research indicates that an early viral infection may be linked to biliary atresia.

Scientists do know that biliary atresia is not hereditary; parents do not pass it on to their child. It is also not contagious, and it is not preventable. It is also not caused by anything an expectant mother did or did not do.

What are the symptoms of biliary atresia?

Symptoms of biliary atresia usually appear between two and six weeks after birth. The baby will appear jaundiced, with yellowing of the skin and whites of the eyes. The liver may harden and the abdomen may become swollen. Stools appear pale grey and the urine may appear dark. Some babies may develop intense itching.

How is biliary atresia diagnosed?

Since other conditions lead to symptoms similar to those of biliary atresia, doctors must perform many tests before a conclusive diagnosis can be made. These tests may include blood and liver tests, an ultrasound examination, X-rays and a liver biopsy, in which a small amount of liver tissue is removed with a needle for examination in a laboratory.

How is biliary atresia treated?

Unfortunately, there is no cure for biliary atresia. The only treatment is a surgical procedure in which the blocked bile ducts outside the liver are replaced with a length of the baby’s own intestine, which acts as a new duct. This surgery is called the Kasai procedure after Dr. Morio Kasai, the Japanese surgeon who developed it.

The aim of the Kasai procedure is to allow drainage of bile from the liver into the intestine through the new duct. The operation is completely or partially successful about 80 percent of the time if performed early (before 3 months of age). In babies who respond well, jaundice and other symptoms usually disappear after several weeks.

In cases where the Kasai procedure does not work, the problem often lies in the fact that blocked bile ducts are “intrahepatic,” or inside the liver, as well as extrahepatic, or outside the liver. No procedure, except for liver transplant, has been developed to replace blocked intrahepatic ducts.

The Kasai procedure is most successful in babies younger than 3-months-old, so early diagnosis is important.

If the Kasai procedure is not successful, the only other option is a liver transplant. However, a suitable donor organ must be found quickly, before damage to the liver from the backed-up bile becomes deadly.

What happens after surgery?

The aim of treatment after surgery is to encourage normal growth and development. If bile flow is good, the child is given a regular diet. If tests show that bile flow is reduced, a low-fat diet and vitamin supplements will be required, since the absorption of fats and vitamins is impaired.

What is the outlook for babies with biliary atresia?

Without successful treatment, few children with biliary atresia live beyond age two. In some cases, where the Kasai procedure is completely successful, the child may recover and live a normal life. However, in most cases, even when surgery is successful, patients will suffer gradual damage to the liver. These children will need specialized medical care throughout their lives, and many will ultimately need a liver transplant.

Is a liver transplant the solution?

In children with biliary atresia, a liver transplant is generally not attempted unless the Kasai procedure has been tried. In cases where that operation is unsuccessful, the child may become a candidate for a liver transplant. Success depends on the timely availability of a matching donor liver. Fortunately, survival rates for liver transplant recipients have increased dramatically with improved surgical techniques and the development of drugs that help overcome the problem of organ rejection.

What can the family do?

Watching a newborn suffer from biliary atresia is a heart-breaking experience. Parents are frustrated because so little is known about the disease and treatment options are so limited. Many parents find comfort in support groups because it allows them to talk to other parents in similar situations. Finding out that others feel the way they do, and learning how other parents are coping with a child’s disease, is often a great comfort.

Adapted from: American Liver Foundation

Ascites

Ascites is the accumulation of protein-containing (ascitic) fluid in the abdominal cavity.

• Many disorders can cause ascites, but cirrhosis is the most common.
• If large amounts of fluid accumulate, the abdomen becomes very large, sometimes making people lose their appetite and feel short of breath.
• Analysis of the fluid can help determine the cause.
• Usually, bed rest, a low-salt diet, and diuretics help eliminate excess fluid.

Ascites tends to occur in long-standing (chronic) rather than in short-lived (acute) disorders. It occurs most commonly in cirrhosis (severe scarring of the liver), especially in cirrhosis caused by alcoholism or viral hepatitis. It may occur in other liver disorders, such as severe alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction of the hepatic vein (Budd-Chiari syndrome). Ascites can also occur in disorders unrelated to the liver, such as cancer, heart failure, kidney failure, inflammation of the pancreas (pancreatitis), and tuberculosis affecting the lining of the abdominal cavity.

In people with a liver disorder, ascitic fluid leaks from the surface of the liver and intestine. A combination of factors is responsible. They include portal hypertension, decreased ability of the blood vessels to retain fluid, fluid retention by the kidneys, and alterations in various hormones and chemicals that regulate bodily fluids.

Symptoms and Diagnosis

Small amounts of fluid in the abdominal cavity usually produce no symptoms, but massive amounts may cause abdominal swelling (distention) and discomfort. Pressure on the stomach from the swollen abdomen may lead to loss of appetite, and pressure on the lungs may lead to shortness of breath. When a doctor taps (percusses) the abdomen, the fluid makes a dull sound. When the abdominal cavity contains large amounts of fluid, the abdomen is taut, and the navel is flat or even pushed out. In some people with ascites, the ankles swell with excess fluid (edema). However, a doctor may not be able to detect ascitic fluid unless the volume is about a quart or more.

If the presence of ascites or its cause is not clear, the doctor may use ultrasonography. In addition, a small sample of ascitic fluid can be withdrawn by inserting a needle through the abdominal wall—a procedure called diagnostic paracentesis. Laboratory analysis of the fluid can help determine the cause.

Treatment

The basic treatment for ascites is bed rest and a salt-restricted diet, usually combined with drugs called diuretics, which make the kidneys excrete more water into the urine. If ascites makes breathing or eating difficult, the fluid may be removed through a needle inserted into the abdomen—a procedure called therapeutic paracentesis. The fluid tends to reaccumulate unless the person also restricts salt consumption and takes a diuretic. Because a large amount of albumin (the major protein in plasma) is usually lost from the blood into the abdominal fluid, albumin may be administered intravenously.

An infection called spontaneous bacterial peritonitis occasionally develops in ascitic fluid for no apparent reason, especially in people with alcoholic cirrhosis. Untreated, this infection can be fatal. Survival depends on early vigorous treatment with antibiotics.

Adapted from: Merck & Co., Inc.

Alpha-1 Antitrypsin Deficiency

Alpha-1 antitrypsin deficiency (Alpha-1) is a hereditary genetic disorder which may lead to the development of lung and/or liver disease. It is the most common genetic cause of liver disease in children. Adults can also be affected by Alpha-1 and may develop lung conditions such as emphysema as well as liver problems. Fortunately, many persons diagnosed with Alpha-1 never develop any of the associated diseases.

What are the symptoms of Alpha-1 Antitrypsin Deficiency?

In newborns, the typical symptoms of Alpha-1 are jaundice, swelling of the abdomen, and poor feeding. Alpha-1 may also appear in late childhood or adulthood and be detected because of fatigue, poor appetite, swelling of the abdomen and legs or abnormal liver tests.

What causes Alpha-1 Antitrypsin Deficiency?

Alpha-1 antitrypsin is a protein made in the liver which plays an important role in preventing the breakdown of enzymes in various organs. Individuals with Alpha-1 have a genetic disorder that prevents their body from creating enough of this protein. This trait must be inherited from both parents (who are, by definition, carriers) in order to cause the disorder.

How is Alpha-1 Antitrypsin Deficiency diagnosed?

The diagnosis of Alpha-1 is made by blood tests showing the low levels of alpha-1 antitrypsin and abnormal liver tests. Other tests such as ultrasound imaging or tests using specialized X-ray techniques may be necessary. A liver biopsy may be performed to check for damage to the liver.

How is Alpha-1 Antitrypsin Deficiency treated?

Currently, there is no cure for Alpha-1. Treatment is designed to maintain normal nutrition, to provide the liver and the body with essential nutrients, and to identify complications early in order to treat them better. Multiple vitamins and vitamins E, D, and K are often given. Certain abnormalities can be treated or controlled. Jaundice, severe itching, and fluid retention can all be dealt with through medication.

If I or my child has been diagnosed with Alpha-1 Antitrypsin Deficiency, what should I ask my doctor?

Speak with your doctor about the particular symptoms you are experiencing and the best methods for treating them. Also discuss the best ways to check for future progression of the disease.

Who is at risk for Alpha-1 Antitrypsin Deficiency?

Worldwide, approximately 1 in 2,500 individuals has Alpha-1 Antitrypsin Deficiency. This disorder is found in all ethnic groups; however, it occurs most frequently in whites of European ancestry.

Adapted from: American Liver Foundation

Alagille Syndrome

Alagille syndrome is a rare, inherited disorder in which bile flow from the liver is decreased and the there are fewer than normal bile ducts.

Alagille syndrome is a disorder that often affects the liver and other organs, including the heart, eyes, spine and kidneys.

Often, patients with alagille syndrome have distinctive facial appearances. A small number of patients (about 15%) go on to develop severe liver disease and require liver transplantation.

This disorder is usually present at birth. Alagille syndrome is one of the most common inherited disorders that causes reduced bile flow within the liver. It occurs about once in every 100,000 births.

What are the causes of alagille syndrome?

Recent studies have discovered that defects of a specific gene cause alagille syndrome. The disease usually is inherited from one parent.

A single copy of the diseased gene (received from either the mother or father) "dominates" the other normal gene and results in this disease.

There is a 50% chance a parent with alagille syndrome will transmit this disorder to their child. Family members with Alagille syndrome may be affected very differently by the disorder.

Bile is produced in the liver and then travels through the many small bile ducts in the liver into one large bile duct, and eventually into the intestines. In patients with alagille syndrome, the lack of small bile ducts inside the liver slows down the flow of bile from the liver to the intestines.

Bile is composed of bilirubin, bile salts, cholesterol and metals such as copper. Bile acids are necessary to absorb fat and certain vitamins. When the bile flow is decreased, each of its components builds up in the body, and the body is not able to properly absorb fat and vitamins. This causes a wide range of symptoms.

What are the signs and symptoms of alagille syndrome?

Symptoms of alagille syndrome range from mild to severe. Symptoms within the first three months of life often include:

• Jaundice, usually present at birth (yellowing of the skin)
• Severe itching (caused by the buildup of bile salt in the body)
• Pale, loose or clay-colored stools (this happens because there is little or no bile reaching the intestine to color the bowel movements)
• Poor weight gain (due to a lack of bile needed to digest and absorb fat)
• Poor growth
• Deficiency of vitamins A, D, E and K which depends on bile acids for absorption; this may result in vision changes, rickets, difficulty with balance and poor clotting of the blood
• Heart murmurs, due to narrowing of the blood vessels in the lung (peripheral pulmonary artery stenosis)

Other symptoms that may develop later include:

• Jaundice that will not go away
• Continued growth and development problems in early childhood
• Enlarged liver (feels larger and harder than normal)
• Hard, whitish nodules (called xanthonmas) that develop in the skin due to cholesterol and fatty deposits; the nodules usually occur in spots of repeated trauma in young children, such as knees and elbows
• Urine appears very dark yellow or brown (due to high levels of bilirubin in the bloodstream which pass to the kidneys)
• Persistent itching

How is alagille syndrome diagnosed?

A diagnosis of alagille syndrome is made based on either tests or a physical examination. While there are specific findings that indicate alagille syndrome, all patients do not demonstrate all of them.

Reduced bile flow is one finding that indicates alagille symdrome. Symptoms of reduced bile flow include jaundice, itching and cholesterol deposits in the skin.

A liver biopsy may be done to show examine the bile ducts and degree of scarring in the liver. Liver function tests are blood tests used to assess the general state of the liver or biliary system.

A nuclear scan may be done to show how much bile is flowing from the liver. Genetic testing may be available through research laboratoraties but as of 2006, it is not routinely available.

Other findings that may indicate alagille syndrome include:

• Heart murmur (due to narrowing of the blood vessel connecting the heart to the lungs)
• Bone defects (shape of the bones in the spinal column may look like a butterfly's wings)
• Kidney problems or kidney failure
• Distinct physical features, such as a broad forehead, straight nose, deep set eyes, a small, pointed chin, and fingers that are shorter than normal
• Problems with the eye -- an extra thickening of a line, known as the Schwalbe's line on the surface of the eye

What is the treatment?

There is no cure for alagille syndrome. Management of the disorder is aimed at preventing complications, increasing the flow of bile from the liver, maintaining normal growth and development and reducing blood cholesterol levels.

Medications. Medicine may be used to increase bile flow and to relieve severe itching caused by buildup of bile in the blood and skin. These same medicines may be used to treat high cholesterol levels that cause the hard, whitish nodules that develop in the skin in alagille syndrome patients.

Vitamin supplements. Reduced bile flow can lead to difficulty digesting fat and vitamins from a child's diet. Fat-soluble vitamin supplements (A, D, E, and K) may be used.
Baby formula rich in triglyceride. Baby formula rich in a type of fat that can be digested despite reduced bile flow may be used to help with fat absorption in infants.

High-calorie diet. Alagille syndrome patients often have difficulty absorbing the calories they eat. To prevent malnutrition and growth failure, a high-calorie diet with a lot of protein may be recommended. A feeding tube that delivers large quantities of nutrients overnight may be used.

Liver transplantation. A small percentage of patients will develop cirrhosis (severe damage to the liver). Liver transplantation is the only option for these patients.

A liver transplant also may be the last resort for patients with severe itching, portal hypertension (high blood pressure) and severe growth failure that is not responding to medication. Liver transplantation has been used successfully in these cases.

What is the long-term prognosis for alagille syndrome patients?

Prognosis depends on the severity of the bile flow obstruction and scarring of the liver, and the severity of other problems that may develop -- such as heart or lung problems or problems related to poor nutrition.

A typical course of liver disease with alagille syndrome patients is worsening cholestasis (decreasing bile flow) for several years, and then some improvement after that time.
Children with alagille syndrome generally have a better outcome than children with other liver disorders at the same age. Many adults with alagille syndrome lead normal lives

Helicobacter Pylori

This unusual name identifies a specific bacteria that can cause infection of the stomach. This infection can contribute to the development of diseases, such as dyspepsia (heartburn, bloating and nausea), gastritis (inflammation of the stomach), and ulcers in the stomach and duodenum. It will be useful to know some things about the upper digestive tract to understand how and where Helicobacter pylori infection can occur. When food is swallowed, it passes through the esophagus (the tube that connects the throat to the stomach). It then enters the larger upper part of the stomach. A strong acid that helps to break down the food is secreted in the stomach. The narrower, lower part of the stomach is called the antrum. The antrum contracts frequently and vigorously, grinding up the food and squirting it into the small intestine.

The duodenum is the first part of the small intestine, just beyond the stomach. The stomach, including the antrum, is covered by a layer of mucous that protects it from the strong stomach acid. It is known that alcohol, aspirin, and arthritis drugs such as ibuprofen can disrupt the protective mucous layer. This allows the strong stomach acid to injure underlying stomach cells. In some people, corticosteroids, smoking, and stress appear to contribute in some way. Until the mid 1980s, it was felt that one or more of these factors working together led to the development of gastritis and ulcers. Since that time, evidence has been mounting that Helicobacter pylori (H. pylori) has a major role in causing these diseases.

The Infection

H. pylori is a fragile bacteria that has found an ideal home in the protective mucous layer of the stomach. These bacteria have long threads protruding from them that attach to the underlying stomach cells. The mucous layer that protects the stomach cells from acid also protects H. pylori. These bacteria do not actually invade the stomach cells as certain other bacteria can. The infection, however, is very real and it does cause the body to react. Infection-fighting white blood cells move into the area, and the body even develops H. pylori antibodies in the blood. H. pylori infection probably occurs when an individual swallows the bacteria in food, fluid, or perhaps from contaminated utensils. The infection is likely one of the most common worldwide. The rate of infection increases with age, so it occurs more often in older people. It also occurs frequently in young people in the developing countries of the world, since the infection tends to be more common where sanitation is poor or living quarters are cramped. In many cases it does not produce symptoms. In other words, the infection can occur without the person knowing it. The infection remains localized to the gastric area, and probably persists unless specific treatment is given.

How is H. pylori Infection Diagnosed?

There are currently three ways to diagnose H. pylori infection. During endoscopy (a visual exam of the stomach through a thin, lighted, flexible tube), the physician can remove small bits of tissue through the tube. The tissue is then tested for the bacteria. A breath test is now available. In this test, a substance called urea is given by mouth. A strong enzyme in the bacteria breaks down the urea into carbon dioxide, which is then exhaled and can be measured. Finally, there is a blood test that measures the protein antibodies against these bacteria that are present in the blood. This antibody can mean the infection is present, or that it was present in the past and is now cleared. In other words, a person can have a positive blood test but no infection.

Gastritis and Dyspepsia

The symptoms are discomfort, bloating, nausea and perhaps vomiting. The person may also have symptoms that suggest ulcers such as burning or pain in the upper abdomen, usually occurring about an hour or so after meals or even during the night. The symptoms are often relieved temporarily by antacids, milk, or medications that reduce stomach acidity. Yet, the physician does not find an ulcer when the patient is tested by x-ray or endoscopy. When H. pylori is found in the stomach, it is tempting to believe that it is the cause of the symptoms, although this connection is not yet clear cut. The physician will usually prescribe antibiotic therapy to see if clearing the infection relieves symptoms.

Ulcers Stomach Ulcers: With stomach ulcers, H. pylori infection is found in 60 to 80 percent of the cases. Again, it is still uncertain how the infection acts to cause the ulcer. It probably weakens the protective mucous layer of the stomach. This allows acid to seep in and injure the underlying stomach cells. However, there is still a great deal of research to be done to unravel this relationship.

Duodenal ulcers: In times past, physicians were taught "no acid, no ulcer." The medical profession felt the single most important factor causing duodenal ulcers to form was strong stomach acid. Research has now shown that over 90% of all patients who develop duodenal ulcers have H. pylori infection in the stomach as well. Medical studies are under way to determine the relationship between the two and how an infection in the stomach can be related to a duodenal ulcer. Acid is still an important factor; patients without acid in the stomach never get duodenal ulcers. However, physicians now accept the fact that the infection is directly related to the development of duodenal ulcers. It is now rather easy to clear duodenal ulcers with the strong acid-reducing medicines available, but the ulcers will usually recur unless the H. pylori infection is also cleared from the stomach.

Stomach Cancer and Lymphoma

These two types of cancer are now known to be related to H. pylori bacteria. This does not mean that all people with H. pylori infection will develop cancer; in fact, very few do. It is likely that if the infection is present for a long time, perhaps from childhood, these cancers may then develop. This is another reason why it is important to treat H. pylori infection.

When is Treatment Necessary?

Since the infection is so common, it is sometimes recommended that no treatment be given when there are no symptoms; however, these recommendations may change as more research develops. Increasingly, physicians are treating the acute ulcer with acid-reducing medicines and treating the infection with antibiotics. Interestingly, one of these antibiotics is a bismuth compound that is available over-the-counter as Pepto-Bismol. It is also available as a generic drug called bismuth subsalicylate. The bismuth part of the medicine actually kills the bacteria; however, do not go to the drugstore and purchase a bottle of Pepto-Bismol, expecting this alone to cure the infection. H. pylori is buried deep in the stomach mucous, so it is difficult to get rid of this infection. Several antibiotic drugs are always used together to prevent the bacteria from developing resistance to any one of them. Current medical studies are being done to develop easier treatment programs for this difficult infection.

Summary

H. pylori is a very common infection of the stomach. It may be the most common infection in the world. It is now clear that the infection is directly related to the development of stomach and duodenal ulcers, and it is likely that it may be related to cancers involving the stomach. There are several diagnostic tests available, and effective treatment can prevent the recurrence of ulcers and perhaps the development of cancer

Adapted:Jackson-Siegelbaum Gastroenterology

Dyspepsia

Dyspepsia, also called indigestion, is a problem that most adults experience at least once in their lifetime. Upper abdominal discomfort, nausea, vomiting, and belching are all symptoms of dyspepsia. Indigestion is often related to consumption of too much food, especially heavy or greasy foods, eating late at night, smoking, alcohol consumption, or life stress. For some individuals, dyspepsia occurs regularly and becomes a health and quality-of-life issue. The April 5, 2006, issue of JAMA includes an article about dyspepsia.

SYMPTOMS

· Upper abdominal discomfort

· Sensation of bloating

· Nausea with or without vomiting

· Belching

· Abdominal gas

· Feeling full after eating small amounts (called early satiety

WHEN TO SEE YOUR DOCTOR

Because symptoms similar to those of dyspepsia may indicate a serious medical condition, you should see your doctor if you have indigestion on a regular basis. If you have bloody stools or vomit blood you should see a doctor immediately. Medical problems that have similar symptoms include gastroesophageal reflux disease (known as GERD), peptic ulcer disease, stomach cancer, pancreatic cancer, pancreatitis, gallbladder disease, irritable bowel syndrome, and even heart disease (upper abdominal pain may be due to angina or heart attack).

TESTING

Because dyspepsia can be a symptom of an underlying medical problem, your doctor may prescribe tests to look for these other conditions. These tests may include a barium swallow (an x-ray test in which the patient swallows a barium-containing solution to outline the gastrointestinal tract), upper gastrointestinal endoscopy (a lighted tube is passed through the esophagus into the stomach to look for abnormalities), or computed tomography (CT scan).

TREATMENT AND PREVENTION

• Avoid foods that trigger your dyspepsia symptoms.
• Avoid factors that make indigestion worse, such as eating large meals, especially heavy or greasy foods, eating late at night, eating quickly, or eating before exercise.
• Do not smoke.
• Avoid alcohol, if it produces symptoms of dyspepsia.
• Maintain a healthy weight, which helps to reduce symptoms of dyspepsia.
• Exercise regularly (at least 30 minutes of moderate to vigorous physical activity on most days of the week) to reduce stress, control weight, and improve well-being, all of which may ease dyspepsia.
• Follow your doctor's recommendations regarding medications for treating dyspepsia. These may include antacids, proton pump inhibitors, histamine-2 receptor blockers, and motility drugs (to help the stomach empty). Other medications may be prescribed for individuals with other medical problems that influence the symptoms of indigestion.
  

Adapted from: JAMA Patient Page