symptoms of digestive disorders
digestive disorders
Indigestion
Not every episode of dyspepsia requires immediate evaluation by a doctor. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with dyspepsia, certain symptoms and characteristics are cause for concern. They include Shortness of breath, sweating, or fast heart rate accompanying an episode of dyspepsia Loss of appetite (anorexia) Nausea or vomiting Weight loss Blood in the stool Difficulty swallowing (dysphagia) or pain with swallowing (odynophagia) Dyspepsia that persists despite treatment with drugs such as proton pump inhibitors (PPIs) People who have a single, sudden episode of dyspepsia should see a doctor right away, especially if their symptoms are accompanied by shortness of breath, sweating, or a fast heart rate. Such people may have acute coronary ischemia. People with chronic dyspepsia that occurs when they exert themselves but that goes away when they rest may have Angina and should see a doctor within a few days. People with dyspepsia and one or more of the other warning signs should see a doctor within a few days to a week. Those with recurrent dyspepsia and no warning signs should see a doctor at some point, but a delay of a week or so is not harmful. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the dyspepsia and the tests that may need to be done ( see Table: Some Causes and Features of Indigestion ). The history is focused on obtaining a clear description of the symptoms, including whether they are sudden or chronic. Doctors need to know the timing and frequency of recurrence, any difficulty swallowing, and whether the symptoms occur only after eating, drinking alcohol, or taking certain drugs. Doctors also need to know what factors make the symptoms worse (particularly exertion, certain foods, or alcohol) or relieve them (particularly eating or taking antacids). Doctors also ask the person about gastrointestinal symptoms such as anorexia, nausea, vomiting, vomiting of blood (hematemesis), weight loss, and bloody or black stools. Other symptoms include shortness of breath and sweating. Doctors need to know whether the person has been diagnosed with a gastrointestinal and/or heart disorder, has any heart risk factors (such as high blood pressure [ High Blood Pressure ] or an excessive amount of cholesterol in the blood [ The physical examination usually does not give doctors clues to a specific diagnosis. However, doctors look for signs of chronic disease, such as very pale skin, wasting away of muscle or fat tissue (cachexia), or yellowing of the eyes and skin ( Jaundice in Adults ). They also do a rectal examination to detect any blood. Doctors are more likely to recommend testing for people with such abnormal findings. Possible tests include Upper endoscopy Blood tests Because of the risk of cancer, doctors typically look in the esophagus and stomach with a flexible tube ( Endoscopy ) in people who are over age 60 and in younger people with warning signs. Those who are younger and have no symptoms other than dyspepsia are often treated with acid-blocking drugs. If this treatment is unsuccessful, doctors usually do an endoscopy. People with symptoms of acute coronary ischemia, particularly those with risk factors, should go to the emergency department for an immediate evaluation, including electrocardiography (ECG) and blood tests for damage to heart muscle cells. People with chronic, nonspecific symptoms should undergo blood tests. If results of the blood tests are abnormal, doctors consider additional tests (such as imaging studies or endoscopy). Some doctors recommend screening forHelicobacter pyloriinfection with a breath test or a test of a stool sample. Doctors do Manometry and pH (acidity) studies for people who still have reflux symptoms after they have undergone an upper endoscopy and have been taking a proton pump inhibitor (PPI) for 4 to 8 weeks. Sometimes an abnormality found during testing (such as gastritis or gastroesophageal reflux) is not the cause of the person's dyspepsia. Doctors know this only when the disorder clears up but symptoms of dyspepsia do not. 