How to Diagnose Indigestion?
Diagnosis of the cause of indigestion may pose a problem. Proper history (a thorough interview) with a thorough physical examination may be essential for diagnosis of indigestion. Most of the cases of indigestion are generally due to GERD and functional dyspepsia. Gastroesophageal reflux disease (GERD) produces heartburn, that is exacerbated by meals and may even awaken the patient in the night. Individuals with functional dyspepsia have epigastric pain as the main symptom.
As most of the cases of indigestion are due to gastroesophageal reflux disease and functional dyspepsia, the general principle of diagnostic testing are directed at diagnosing gastroesophageal reflux disease and functional dyspepsia. Typical GERD can be diagnosed clinically and generally investigation is not required if “alarming†symptoms of GERD like unexplained weight loss, severe and recurrent vomiting, GIT bleeding (fresh and occult blood), jaundice, palpable mass and family history of gastrointestinal cancer etc. which can cause complications are excluded. Endoscopy can be done to find out if there is any mucosal injury in absence of alarming symptoms and if there is no response to empirical therapy. Endoscopy should also be done in patients with long standing heartburn (more than 5 years) if patient is more than 50 years of age to exclude Barrett’s metaplasia of esophagus. But benefit and cost effectiveness of endoscopy is doubtful.
Bernstein test can differentiate the unexplained discomfort in chest, if it is due to acid or some other cause. Bernstein test is done by blind perfusion of saline and then acid into the esophagus.
Presence of H. pylori should be done by urea breath testing, stool antigen measurement, or blood serology test, especially in H. pylori endemic areas (prevalence of H. pylori more than 10% of population). First H. pylori presence is established and than treated accordingly in H. pylori endemic areas. But in low H. pylori prevalence (<10%) areas empirical treatment is done with a proton pump inhibitor, if it fails than only test for H. pylori is done.
Other lab tests are done according to the situation and requirement, e.g. if bleeding is present complete hemogram is advised. Thyroid tests, estimation of serum calcium etc. are done as per requirement of individual cases.
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