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