During a consultation, your doctor will use various techniques in his assesment of the symptom: Meal symptoms. These may include a physical examination or other medical tests. Your doctor may ask several questions when assessing your condition. It is important to remember that your consultation is a two-way process and any extra information you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
Why: to determine if acute or chronic.
Why: e.g. abdominal pain after meals, frequent bowel movements after eating, stomach bloating after a meal, abdominal pain on an empty stomach.
Why: e.g. eating food may aggravate a gastric ulcer; eating fried or fatty foods will aggravate biliary disease, esophageal disorders and functional dyspepsia ( dyspepsia when no specific cause can be demonstrated); bending over will aggravate gastro-esophageal reflux; alcohol will aggravate gastro-esophageal reflux, oesophagitis, gastritis, peptic ulcer and pancreatitis.
Why: e.g. eating food may relieve a duodenal ulcer.
Why: if discomfort is relieved by food and antacids may suggest duodenal ulcer, hiatus hernia and oesophagitis. If discomfort is brought on by food may suggest cholecystitis, gastric ulcer or reactions to toxins in food such as MSG or sulfites.
Why: may suggest angina as cause of discomfort if brought on by exertion.
Why: may aggravate indigestion due to affecting motility.
Why: may aggravate indigestion.
Why: pregnancy increases the risk of indigestion and meal symptoms due to a relaxation of the lower esophageal sphincter.
Why: e.g. scleroderma (rare but important cause of oesophagitis), irritable bowel syndrome, gallstones, chronic pancreatitis, achalasia, hiatus hernia, pernicious anemia (may increase the risk of stomach cancer).
Why: e.g. non-steroidal anti-inflammatory medications (2-4 times the risk of gastric ulcers), anticholinergics, aspirin, calcium channel blockers, corticosteroids, digitalis, lipid lowering medications, narcotics, slow release potassium supplements, theophylline, tricyclic antidepressants and tetracycline - may all cause indigestion and meal symptoms.
Why: cigarette smoking is an important cause of indigestion.
Why: alcohol is an important cause of dyspepsia both in the occasional drinker, especially red wine, with a large evening meal and in the problem drinker with alcoholic gastritis.
Why: e.g. peptic ulcers.
Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include:
Why: can help with diagnosis e.g. discomfort between the shoulder blades may suggest esophageal spasm, gall bladder disease or a duodenal ulcer; discomfort behind the sternum (breastbone) may suggest esophageal disorders or angina; discomfort in epigastrium (midline just below ribs) may suggest disorders of the biliary system, stomach or duodenum.
Why: may suggest gastro-esophageal reflux, or oesophagitis.
Why: may suggest gastro-esophageal reflux, hiatus hernia or peptic ulcer.
Why: may suggest oesophagitis (especially if with hot and cold fluids) or stomach cancer.
Why: a common mistake is to attribute the discomfort of angina or a heart attack to a disorder of the gastro-intestinal tract. Recent weight loss? - may suggest stomach cancer, intestinal or mesenteric ischemia, pernicious anemia, chronic pancreatitis, chronic gastritis. Should also consider renal failure, cirrhosis of the liver and congestive heart failure.
Why: e.g. burning discomfort behind the sternum (breastbone) that radiates to the throat, associated with acid reflux, aggravated by heavy meals, swallowing hot and cold fluids, stooping, lying flat and lifting and straining, more likely to occur at rest than with exertion. Heartburn may be due to gastro-esophageal reflux, oesophagitis, hiatus hernia, peptic ulcer, scleroderma, pregnancy, obesity, smoking and alcohol, caffeine and some medications.
Why: e.g. intermittent symptoms of gnawing or burning-type pain in the epigastrium (midline, under the ribs) which can be located by finger point, pain is worse before meals and relieved by taking antacids or food. Pain may waken the person at night.
Why: e.g. deep boring upper abdominal pain, often radiating through to the back, fatty stools that float in toilet and are difficult to flush, possibly symptoms of diabetes.
Why: e.g. sudden onset of severe constant epigastric pain which may pass into the back. Symptoms are induced by a fatty meal.
Why: e.g. tiredness, dizziness, muscle weakness, headache, shortness of breath on exertion - may suggest chronic oesophagitis, chronic gastritis, peptic ulcer or stomach cancer.
Why: e.g. alternating diarrhea and constipation, pellet-like stools, abdominal bloating, flatulence, belching.
Why: may suggest mesenteric ischemia.
Why: e.g. early feeling of fullness after eating, indigestion, loss of appetite, weight loss, vomiting (if cancer causes stomach outlet obstruction), difficulty with swallowing ( if cancer occurs at opening to stomach).
Why: e.g. frequency of urination, excessive thirst, weight loss, fatigue, increased infections. May be complicated by gastroparesis which causes delayed emptying of the stomach and therefore feeling of fullness.
Why: e.g. symptoms at presentation are usually nonspecific and usually include abdominal pain, increasing abdominal girth and abnormal menstrual bleeding. May also have early feeling of fullness after eating due to pressure on the stomach.
Why: e.g. indigestion, vomiting, sometimes coffee ground vomit and melena (black tarry offensive stools) due to gastrointestinal bleeding. May also have an early feeling of fullness after eating.
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