DYSPEPSIA, HEARTBURN AND ULCERS

DYSPEPSIA,
HEARTBURN
AND
ULCERS
What is Dyspepsia?
Dyspepsia can be translated as “bad digestion” and
is commonly called indigestion. It is a term that is often
used by doctors to describe a set of symptoms. These
symptoms are believed to have their cause somewhere
in the upper part of the gastrointestinal tract. The
upper gastrointestinal tract includes the tube from
the mouth to the stomach (the esophagus) as well as
the stomach and its outlet called the duodenum.
Dyspepsia affects about 30% of Albertans and is
responsible for many doctor visits.
WHAT YOU NEED
TO KNOW
The main symptom of dyspepsia is pain or discomfort
in the upper abdomen that comes and goes. Other
symptoms can include nausea, bloating (often
relieved by belching), feeling full quickly while eating,
inability to finish a normal meal and heartburn. These
symptoms are often changed by eating or having an
empty stomach.
If you have ongoing discomfort you should see your
doctor, especially if your symptoms are getting worse,
or if you have vomiting, weight loss or bleeding.
Administered by the Alberta
Medical Association
2
What is Heartburn?
Will Antacids Help With Heartburn?
Heartburn is an uncomfortable, burning feeling that
rises from the front of the lower chest up towards the
throat. It is often accompanied by a bitter or sour
taste of food in the throat or mouth. Don’t worry, it
does not affect your heart, but it is important to be
certain your discomfort is not coming from your heart.
Heartburn usually happens after eating a big meal or
when lying down and it can last from a few minutes to
a couple of hours.
Most people get fast relief from antacids. Take a dose
of antacid about an hour after meals and at bedtime.
You may want to discuss the timing and side-effects
of antacids with your pharmacist or doctor.
What Causes Heartburn?
When you eat, food passes from your mouth to
the stomach by way of a tube called the esophagus.
Between the stomach and the esophagus there is an
muscle that closes the opening from the esophagus to
the stomach as soon as the food has passed through.
This muscle is called the lower esophageal sphincter
(LES). If this opening doesn’t close, acid in the
stomach can move backward up into the esophagus
and cause a burning sensation. This is called
gastroesophageal reflux disease (GERD) or reflux,
for short.
What if Antacids orLifestyle Changes
Don’t Help?
If you have tried the suggestions in the Table 1 and
you are still experiencing regular heartburn, talk to
your doctor. Your doctor may put you on medications
for a few weeks or may order tests such as X-rays
of the esophagus or endoscopy which uses a flexible
tube to directly examine your esophagus and stomach.
Warning!
Table 1
See Your Doctor if
You Have Heartburn With
Other Symptoms Such as:
What Can I do to Prevent Heartburn?
♦ Raise the head of your bed by placing blocks
under the legs at the head of the bed blocks
should be about 10 to 15 cm or 4 to 6 inches
high)
♦ Try not eating within an hour or two of going
to bed
♦ If you like to nap after a meal, try to nap sitting
in a chair
♦ If you are overweight, talk to your doctor
about a weight loss program
♦ Try not to overeat
♦ Eat less fats
♦ Try to avoid foods that give you heartburn
♦ Try to avoid caffeine and alcohol
♦ Avoid clothes that are extremely tight around
your abdomen
♦ Avoid stress
♦ If you are a smoker, talk to you doctor about
quitting
3
♦
♦
♦
♦
Trouble swallowing or pain when swallowing
Vomiting
Black or bloody stools or vomit
Shortness of breath, dizziness, or
lightheadedness
♦ Pain going into your neck, jaw, shoulder
or arm
♦ Breaking out in a sweat when you have
the pain
♦ Heartburn often (more than 3 times per week)
for over 2 weeks
4
What is an Ulcer?
How is an Ulcer Diagnosed?
An ulcer is a sore or break in the lining of the
digestive tract. Most ulcers are found in the duodenum
(duodenal ulcer) but can also form in the stomach
(these are called gastric ulcers). Peptic ulcer means
that the damaging effects of the digestive juices
contributed to the ulcer. Most ulcers are caused by
infection with bacteria called Helicobacter pylori
(H. pylori). This infection weakens the lining and may
allow an ulcer to form. Ulcers not caused by this
bacteria are usually caused by ASA or non-steroidal
anti-inflammatory medications (NSAIDs).
Your doctor will take a history and possibly X-ray
of the esophagus or endoscopy which uses a flexible
tube to directly examine your esophagus and stomach.
What are the Symptoms of an Ulcer?
The most common symptom of an ulcer is a burning
pain in the upper abdomen (anywhere from your navel
to your breastbone) that often comes on between
meals or in the early hours of the morning. The pain
may last from a few minutes to a few hours. Food or
antacids often help to make the discomfort feel better.
If an ulcer is diagnosed, either a blood, breath, or
tissue test may be done to confirm if H. pylori is the
cause.
How is H. pylori Treated?
If H. pylori is diagnosed, the most effective treatment
is a combination of one or more antibiotics and drugs
that stop acid production. This is usually called Triple
Therapy. In most cases, this treatment (if taken
according to the directions) will completely heal the
ulcer and get rid of the bacteria. It is important to
note that some patients suffer side-effects from the
treatment (such as: vaginal yeast infections, diarrhea,
stomach upset, nausea, bad taste in mouth, and
dizziness). If side-effects occur, please talk to your
doctor.
Less common ulcer symptoms include:
♦ nausea or vomiting
♦ loss of appetite
Warning!
♦ weight loss
•
Antibiotic presciptions should be taken
until complete to discourage the growth
of more resistant bacteria (superbugs)
that may make it more difficult to treat
other infections later
•
Antibiotics should only be used by the
person for whom they are prescribed.
DO NOT share!
Warning!
See Your Doctor
IMMEDIATELY if:
♦ You vomit blood
♦ You have black or bloody stools
♦ You have severe abdominal pain
5
6
Should H. pylori be Treated Even if I
Don’t Have an Ulcer Yet?
There is no reason at the present time to consider
antibiotic treatment in people without ulcer symptoms.
Glossary
Gastroesphageal reflux disease (GERD): Acid in
the stomach moves backward up into the esophagus
and causes burning.
Heartburn: Burning sensation behind the breastbone,
caused by reflux.
Abdomen: The large cavity between the chest and
pelvis containing the stomach, small intestines, colon
(large bowel), liver, gall bladder, and spleen.
H2 blockers: These medications reduce the amount
of acid produced by the stomach and help to eliminate
ulcer pain. When treating H. pylori, these medications
are used in combination with antibiotics.
Acetylsalicylic acid (ASA): Medication that
provides relief from pain. The most common ASA
is Aspirin®.
H. pylori: A comnmon gastrointestinal infection
caused by a bacteria that can survive and multiply in
the stomach.
Acid indigestion: Dyspepsia symptoms are relieved
by antacid medications.
Indigestion: A term used to indicate any disruption
in the digestive process.
Antacids: Medications that neutralize stomch acid.
They can relieve the pain caused by ulcers but do not
keep an ulcer from coming back.
Lower esophageal sphincter (LES): Muscle that
closes the esophagus at the stomach opening to
prevent the return of food and juices from the stomach
into the esophagus.
Antibiotics: Medication that kill micro-organisms.
Antibiotics DO NOT harm viruses.
Biopsy: Tissue sample.
Blood test (serology): A quick and easy way to
check if your body has produced H. pylori antibodies
to try and fight the bacteria. This test is not as reliable
as other tests for H. pylori.
Duodenum: First part of the small intestine.
Duodenal ulcer: Ulcer located in the duodenum.
Dyspepsia: Indigestion.
Endoscopy: A thin flexible lighted tube attached to
a camera is eased down the throat to view and
photograph internal tissue (you may be slightly
sedated and your throat may be numbed with topical
anesthetic). This is a very safe procedure.
Esophagus: Tube connecting mouth and stomach.
Gastric ulcer: Ulcers located in the stomach.
Gastrointestinal (GI) tract: Digestive system.
Includes the mouth, esophagus (food pipe), stomach,
small bowel, large bowel, and anus.
7
Non-steroidal anti-inflammatory drugs (NSAIDs):
Medications that control inflammation other than that
caused by infection. Usually used to treat conditions
of the joints and muscles and pain such as menstrual
cramps or headache.
Non-ulcer dyspepsia: A term to describe the
common problem of upper abdominal pain or
discomfort when all tests are normal or negative.
Peptic ulcer: A sore or actual break in the lining of
the stomach or duodenum.
Proton pump inhibitors: Medication that stops the
pumping of acid into the stomach.
Prokinetic Drugs: Medications that increase the rate
at which the stomach empties; with less stomach
content there is less tendency for reflux.
Reflux: Regurgitation.
Regurgitation: The backward flow of gas, gastric
juice, or small amounts of food from the stomach to
the mouth.
8
Stomach: The large, “J” shaped sac that is found
between the esophagus and the small intestine.
Stomach ulcer: Gastric ulcer.
Tissue test: Performed on the tissue from the biopsy
to see if H. pylori is present.
Upper gastrointestinal (UGI) tract: Esophagus,
stomach and duodenum.
Upper gastrointestinal (GI) series: A series of
X-rays of the esophagus, stomach and duodenum.
Drinking a chalky liquid (barium) allows these tissues
to show up on an X-ray.
Urea breath test (UBT): The test measures carbon
monoxide in exhaled breath. The test involves:
a) fasting (not eating) for 4 hours; b) breathing into a
tube (supplied by the lab); c) drinking a solution; and
d) after 30 minutes a second breath sample is taken.
This is the most accurate and simple test to detect the
presence of H. pylori bacteria.
Where Can I Get More Information?
♦ See your doctor
♦ After reading this brochure, there may be other
questions you wish to ask. It may be helpful to
write down questions you have or points that you
would like to discuss with your doctor
This information guide was prepared by the
Dyspepsia Working Group of the TOP Program
to assist you with decisions about dyspepsia,
heartburn and ulcers.
The Alberta CPG Working Group for
Dyspepsia is a multidisciplinary team composed
of family physicians, general practitioners,
gastroenterologists, pediatric gastroenterologists,
a pathologist, radiologist, radiation oncologist, an
infectious disease specialist, and representatives
from the public and the Alberta Pharmaceutical
Association.
A version of this brochure is available on the
TOP web site:www.topalbertadoctors.org
2007
9