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Dyspepsia (cont.)

Medical Author:
Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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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 for 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.

Promotility drugs similar to cisapride, as previously discussed, are being pursued actively.

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).

REFERENCE: MedscapeToday.com. Functional Dyspepsia.


Reviewed by William C. Shiel Jr., MD, FACP, FACR on 4/18/2012

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