This is a vague term, and if the patient is put on the spot, he or she will usually describe the problem as heartburn, regurgitation of water brash, fullness in the stomach, or frequent belching following meals. Usually the patient’s appetite is not affected nor is there any weight loss. The causes are easy to arrive at by merely asking the question, “Why would food cause these symptoms?” Obviously, the food or drink ingested may be the source of irritation: spicy foods, coffee, alcohol, excessive fried food (which actually suppresses the secretion of gastric juice and slows gastric emptying), and insufficiently masticated food. The patient may sometimes be allergic to a particular food. The upper gastrointestinal (GI) tract may be already irritated with reflux esophagitis from a hiatal hernia, gastritis, or gastric or duodenal ulcer, or it may be partially obstructed by a carcinoma of the esophagus or stomach or by a pyloric ulcer. Chronic appendicitis and regional ileitis may cause partial obstruction or paralytic ileus. There may be diminished secretion of GI juices in pernicious anemia, cholecystitis, cholelithiasis, hepatitis, chronic pancreatitis, or pancreatic carcinoma or in patients with previous gastrectomies. There may be a systemic illness that is associated with GI irritation or paralytic ileus. In this category, one must consider congestive heart failure (CHF), electrolyte disturbances such as hypokalemia (diuretics) or hyperkalemia (Addison disease), abdominal angina, migraine, and epilepsy. Anemia and diabetic acidosis may produce similar symptoms. Is there another way of recalling these conditions that may be simpler? Yes, the application of the “target" method to the anatomy of the internal organs. In the “bullseye," one would think of the esophagus and stomach (esophagitis, esophageal carcinoma, gastritis, gastric ulcer, and gastric carcinoma); in the next circle one would consider gallbladder, pancreatic, liver, and heart diseases; and, in the final circle, kidney, central nervous system (CNS), and other systemic diseases and hormonal alterations. A third approach is simply to apply the mnemonic MINT to the organs of the upper abdomen. It is recommended that the reader apply this method as an exercise. Table 41 applies the mnemonic VINDICATE to the same organs.
INDIGESTION
V I N D Vascular Inflammatory Neoplasm Degenerative Varices Esophagitis Stomach Carcinoma Polyp Gallbladder Liver Cirrhosis Pancreas Pancreatitis Kidney Pyelonephritis
INDIGESTION
I C A T E Intoxication Congenital Autoimmune Trauma Endocrine Idiopathic Allergic Scleroderma Gastrectomy Diverticuli Scleroderma Calculus Uremia Calculus
The association of other symptoms and signs is important. If there is relief by antacids, esophagitis, gastritis, or an ulcer may be present. If there is blood in the stool, one should suspect an ulcer or carcinoma. Radiographic studies in the form of an upper GI series, esophagram, cholecystogram, and barium enema are usually indicated. A gastric analysis, esophagoscopy, and gastroscopy often need to be done. Awareness that a systemic disease such as an electrolyte disturbance or uremia may be the cause will suggest the need for other studies, especially if there are systemic symptoms, fever, or shortness of breath.
Read excerpts from these other book chapters related to Indigestion:
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8 
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