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Chapter 58 Maldigestion

image Therapeutic Considerations


The term indigestion is often used by patients to describe a feeling of gaseousness or fullness in the abdomen. It can also be used to describe “heartburn.” In a survey of over 20,000 adults in the United States, the overall prevalence of at least 1 upper gastrointestinal symptom was reported in 45% of those surveyed (based on the preceding 3-month period); symptoms included heartburn, early satiety, loss of appetite, and postprandial fullness (bloating).1 These symptoms of indigestion can be attributed to a great many causes, including not only increased secretion of acid but also decreased secretion of acid and other digestive factors and enzymes.

Indigestion is commonly treated with antacids or acid-blocking drugs, either chosen by patients over-the-counter or prescribed by medical practitioners. The use of these agents will typically raise the gastric pH above 3.5, effectively inhibiting the action of pepsin, the enzyme involved in protein digestion that can be irritating to the stomach. Although raising the pH can reduce symptoms, it also substantially impairs protein digestion and mineral disassociation. In addition, the change in pH can adversely affect gut microbial flora, including the promotion of an overgrowth of Helicobacter pylori. Finally, most nutrition-oriented physicians believe that lack of acid, not excess, is the true culprit in most patients with indigestion.

According to surveys, most people use antacids to relieve symptoms of reflux esophagitis.2 However, reflux esophagitis is most often caused by overeating, not excessive acid production. Other common causes are as follows:

These factors either increase intra-abdominal pressure or decrease the tone of the esophageal sphincter.

Chronic heartburn may also be a sign of a hiatal hernia. However, although 50% of people older than 50 years have hiatal hernias, only 5% of patients with hiatal hernias actually experience reflux esophagitis. Perhaps the most effective treatment of chronic reflux esophagitis and symptomatic hiatal hernias is to utilize gravity. The standard recommendation is to simply place 4-inch blocks under the bedposts at the head of the patient’s bed. This elevation of the head is very effective in many cases. Another recommendation to heal the esophagus is the use of deglycyrrhizinated licorice.

Enteric-coated peppermint oil has been shown to be very helpful in cases of nonulcer dyspepsia and reflux esophagitis. For more information, see Chapter 105, Mentha piperita (Peppermint).