Indigestion, also termed dyspepsia or stomach upset, is the discomfort that is felt in the upper abdomen in accompaniment with difficulty in digesting food. It is mostly considered a symptom of certain diseases rather than a disease in itself.
Although this condition is quite frequent, the manifestations may vary with each occurrence of indigestion, depending upon the cause.
Indigestion may be caused either by common causes such as overeating, stress, intake of acidic food, and conditions such as gastroesophageal reflux disease, or due to some uncommon and rare causes. Pancreatic rest, lithobezoar, gastric lipoma, mesenteric panniculitis and diaphragmatic hernia are a few important but uncommon causes for indigestion.
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Pancreatic rests comprise an unusual congenital disorder, consisting of ectopic pancreatic tissue that originates outside the pancreas with no connection to it with respect to vascular supply or anatomical location. Usually, the pancreatic rest does not show any symptoms.
Pancreatic rests may be found in any part of the body. However, the most common site of occurrence is the upper gastrointestinal tract (stomach, duodenum, and jejunum). This condition is detected on endoscopic examination.
Based on the location and size of the pancreatic rest, the clinical symptoms that may occur include abdominal pain, gastrointestinal hemorrhage, dyspepsia, pancreatitis, and pancreatic carcinoma. The incidence of pancreatic rest in dyspepsia is typically rare. Four types of pancreatic rest are identified: “Type I” pancreatic rest is similar to normal pancreatic tissue histologically, whereas “Type IV” is identical to islets cells.
The presence of an undigested exogenous substance in the gastrointestinal tract is called a bezoar. A lithobezoar is composed of stones and rocks and it occurs rarely. Bezoars can be formed due to predisposing factors such as mental retardation, iron deficiency (anemia), gastrointestinal surgery, and psychological disorders.
They may be found in any part of the gastrointestinal system, generally in the stomach. Stones when ingested usually pass through the intestinal tract, but may accumulate in the stomach, resulting in dyspepsia. The condition is usually asymptomatic, but however, it sometimes manifests as abdominal pain and vomiting.
Lithobezoars are treated either by surgery or by endoscopy, because they do not react with chemical solvents, as the rock or stone is not subjected to dissolution. After the removal of the stones from the stomach, the patients are prescribed laxatives and domperidone tablets in order to clear the residual particles of intestinal stones through the feces. While examining patients with dyspepsia, gastrointestinal bezoars should be considered in the diagnosis because the condition may elude diagnosis otherwise.
Mesenteric panniculitis, which is a very rare disease, can be defined as a condition that affects the mesentery of the peritoneum which connects the intestine to the walls of the abdomen. In this disorder, inflammation and necrosis occur within the fatty tissues of the mesentery. If the condition progresses, it leads to chronic inflammation of the mesentery, which is also an uncommon cause for dyspepsia. Mesenteric panniculitis may be detected incidentally on a CT scan of the abdomen. Fever, loss in weight, and fatigue are among the commonly occurring symptoms of chronic inflammation of the mesentery.
Gastric lipoma is one of the rare gastric tumors, comprising about 2%–3% of all gastric growths. Most often, the gastric lipoma is submucosal in location. Sometimes they may manifest with symptoms such as stomach pain, dyspeptic disorders, GI obstruction, and bleeding into the gastrointestinal tract. Small lipomas are usually asymptomatic, whereas larger (greater than 4 cm in size) tumors may be accompanied by symptoms such as bleeding.
Gastric lipoma must be diagnosed correctly because it is a completely curable condition. The diagnosis is usually made by upper gastrointestinal endoscopy and CT scan.
Adult-onset diaphragmatic hernia is a very rare condition with a range of clinical symptoms. It results from blunt injury which is often hidden for several months and may come to light during evaluation for other symptoms such as dyspepsia, vomiting, and discomfort in the chest or epigastric region.
Immediate treatment is recommended, usually by laparotomy and thoracotomy singly or in combination.
Conditions like esophagitis, acute or chronic pancreatitis, food poisoning, allergy to some foods, irritable bowel syndrome (IBS), heart disease, angina, and heart attacks might also cause symptoms closely resembling those of indigestion.
Some rare conditions may be confused with indigestion, because they are also characterized by upper abdominal pain and discomfort, a few other rare conditions which shows the same signs are confused for indigestion. Such uncommon causes include:
- Metabolic diseases such as renal failure, diabetes, or hypercalcaemia
- Mesenteric vascular insufficiency
- Biliary colic
- Pancreatic or colon malignancy
Therefore, it is not easy to conclude the cause of indigestion, and proper diagnosis by a physician is vital.
Reviewed by Liji Thomas, MD