Differential Diagnosis of Indigestion

Many other diseases cause symptoms of indigestion and it is important to find out the actual disease that is causing indigestion. Sometimes it becomes difficult to find out the actual disease which is causing indigestion and health state of the patient can not be improved much.

The following are some of the diseases that has to be considered when there is a patient of indigestion:

Gastro-esophageal reflux disease (GERD): It is a very common medical problem in the Western countries. Approximately 40% of Americans report heartburn every month and 7%-10% Americans reports heartburn daily. Most of the heartburns are due to excess acid reflux and only about 10% of these patients with functional heartburn exhibit normal degrees of esophageal acid exposure.

Ulcer disease: Approximately 5% of GERD patients develop esophageal ulcers, and some form strictures. Symptoms do not reliably distinguish non-erosive from erosive or ulcerative esophagitis.

Functional dyspepsia: Nearly 25% of the population has symptoms of dyspepsia at least six times yearly, but only 10–20% of these individuals seek medical attention. Functional dyspepsia (the cause of symptoms in 60% of dyspeptic patients) can be defined as more than 3 months of bothersome postprandial fullness, early satiety, epigastric pain, or epigastric burning with symptom onset at least 6 months before diagnosis in the absence of organic cause.

Malignancy: Patients of dyspepsia often seek medical attention for the fear of cancer. But less than 2% of dyspepsia are due to gastro-esophageal malignancy. Individuals with history of tobacco or ethanol intake are at greater risk of gastro-esophageal cancer. Other risk factors of gastro-esophageal cancer include history  caustic ingestion, achalasia of stomach, and the hereditary disorder known as “tylosis”. Esophageal adenocarcinoma can complicate long-standing GERD. Between 8 and 20% of GERD patients exhibit intestinal metaplasia of the esophagus, known as Barrett’s metaplasia.

Other diseases: Esophagitis due to alkaline reflux can produces GERD-like symptoms, especially in patients who have had surgery for peptic ulcer disease. Opportunistic fungal or viral esophageal infections may produce heartburn. Other causes of dyspepsia are biliary colic, eosinophilic esophagitis and pill esophagitis, lactose intolerance, intolerance of other carbohydrates (fructose, sorbitol), small-intestinal bacterial overgrowth, Pancreatic disease (e.g. chronic pancreatitis and pancreatic cancer), carcinoma of liver, celiac disease, Ménétrier’s disease, infiltrative diseases (sarcoidosis and eosinophilic gastroenteritis), mesenteric ischemia, thyroid and parathyroid disease, and abdominal wall strain can cause dyspepsia. Congestive heart failure and tuberculosis can also cause dyspepsia.

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