Dyspepsia (cont.)
What is in the future for dyspepsia (indigestion)?
The future of dyspepsia will depend on our increasing knowledge of the
processes (mechanisms) that cause dyspepsia. Acquiring this knowledge, in turn,
depends on research funding. Because of the difficulties in conducting research
in dyspepsia, this knowledge will not come quickly. Until we have an
understanding of the mechanisms of dyspepsia, newer treatments will be based on
our developing a better understanding of the normal control of gastrointestinal
function, which is proceeding more rapidly. Specifically, there is intense
interest in intestinal neurotransmitters, which are chemicals that the nerves of
the intestine use to communicate with each other. The interactions of these
neurotransmitters are responsible for adjusting (modulating) the functions of
the intestines, such as contraction of muscles and secretion of fluid and mucus.
5-hydroxytriptamine (5-HT or serotonin) is a neurotransmitter that stimulates
several different receptors on nerves in the intestine. Examples of experimental
drugs that affect intestinal neurotransmission are sumatriptan (Imitrex) and
buspirone (Buspar). These drugs are believed to reduce the responsiveness (sensitivity)
of the sensory nerves to what's happening in the intestine by attaching to a
particular 5-HT receptor, the 5-HT1 receptor. The 5-HT1 receptor drugs, however,
have received only minimal study so far and their role in the treatment of
dyspepsia, if any, is unknown.
Dyspepsia (Indigestion) At A Glance
- Dyspepsia is a functional disease in which the
gastrointestinal organs, primarily the stomach and first part of the small
intestine, function abnormally. It is a chronic disease in which the symptoms
fluctuate in frequency and intensity.
- Theories of the cause of dyspepsia include abnormal
input from intestinal sensory nerves, abnormal processing of input from the
sensory nerves, and abnormal stimulation of the intestines by motor nerves.
- The primary symptoms of dyspepsia are upper abdominal
pain, belching, nausea, vomiting, abdominal bloating, early satiety, and
abdominal distention (swelling). The symptoms most often are provoked by
eating.
- Dyspepsia is diagnosed on the basis of typical
symptoms and the absence of other gastrointestinal diseases, particularly
acid-related diseases and non-gastrointestinal diseases that might give rise
to the symptoms.
- Testing in dyspepsia is directed primarily at
excluding the presence of other gastrointestinal diseases and
non-gastrointestinal diseases. Some patients may require specific testing of
certain gastrointestinal functions.
- Treatment in dyspepsia is primarily with education as
well as smooth muscle relaxant and promotility drugs. There also may be a role
for anti-depressant drugs and dietary changes.
- Future advances in the treatment of dyspepsia depend on a clearer
understanding of its cause(s).
Previous contributing editor: Leslie J. Schoenfield, M.D., Ph.D.
Last Editorial Review: 11/7/2008
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