Editing Indigestion (section)

==Cause==
Indigestion is a diagnosis related to a combination of symptoms that can be attributed to "organic" or "functional" causes.<ref name=":2">{{Cite journal|last1=Barberio|first1=Brigida|last2=Mahadeva|first2=Sanjiv|last3=Black|first3=Christopher J.|last4=Savarino|first4=Edoardo V.|last5=Ford|first5=Alexander C.|date=2020-07-28|title=Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria|url=http://dx.doi.org/10.1111/apt.16006|journal=Alimentary Pharmacology & Therapeutics|volume=52|issue=5|pages=762–773|doi=10.1111/apt.16006|pmid=32852839|s2cid=221344221|issn=0269-2813|hdl=11577/3363479|hdl-access=free}}</ref> Organic dyspepsia should have pathological findings upon endoscopy, like an ulcer in the stomach lining in [[peptic ulcer disease]].<ref name=":2" /> [[Functional dyspepsia]] is unlikely to be detected on endoscopy but can be broken down into two subtypes, epigastric pain syndrome (EPS) and post-prandial distress syndrome (PDS).<ref name=":3">{{Cite journal|last1=Sayuk|first1=Gregory S.|last2=Gyawali|first2=C. Prakash|date=2020-09-01|title=Functional Dyspepsia: Diagnostic and Therapeutic Approaches|url=https://doi.org/10.1007/s40265-020-01362-4|journal=Drugs|language=en|volume=80|issue=13|pages=1319–1336|doi=10.1007/s40265-020-01362-4|pmid=32691294|s2cid=220656815|issn=1179-1950|url-access=subscription}}</ref> In addition, indigestion could be caused by medications, food, or other disease processes.

Psychosomatic and cognitive factors are important in the evaluation of people with chronic dyspepsia. Studies have shown a high occurrence of mental disorders, notably anxiety and depression, amongst patients with dyspepsia; however, there is little evidence to prove causation.<ref>{{Cite journal|last1=Holtmann|first1=Gerald|last2=Shah|first2=Ayesha|last3=Morrison|first3=Mark|date=2017|title=Pathophysiology of Functional Gastrointestinal Disorders: A Holistic Overview|url=https://www.karger.com/Article/FullText/485409|journal=Digestive Diseases|language=english|volume=35|issue=S1|pages=5–13|doi=10.1159/000485409|issn=0257-2753|pmid=29421808|s2cid=3556796|doi-access=free}}</ref>

=== Organic dyspepsia ===

====Esophagitis====
[[Esophagitis]] is an inflammation of the esophagus, most commonly caused by gastroesophageal reflux disease ([[Gastroesophageal reflux disease|GERD]]).<ref name=":0" /> It is defined by the sensation of "[[heartburn]]" or a burning sensation in the chest as a result of inappropriate relaxation of the lower esophageal sphincter at the site where the esophagus connects to the stomach. It is often treated with proton pump inhibitors. If left untreated, the chronic damage to the esophageal tissues poses a risk of developing cancer.<ref name=":0" /> A meta-analysis showed risk factors for developing GERD included age equal to or greater than 50, smoking, the use of non-steroid anti-inflammatory medications, and obesity.<ref>{{Cite journal|last1=Eusebi|first1=Leonardo H.|last2=Ratnakumaran|first2=Raguprakash|last3=Yuan|first3=Yuhong|last4=Solaymani-Dodaran|first4=Masoud|last5=Bazzoli|first5=Franco|last6=Ford|first6=Alexander C.|date=March 2018|title=Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/28232473|journal=Gut|volume=67|issue=3|pages=430–440|doi=10.1136/gutjnl-2016-313589|issn=1468-3288|pmid=28232473|s2cid=3496003}}</ref>

====Gastritis====
Common causes of [[gastritis]] include peptic ulcer disease, infection, or medications.

=====Peptic ulcer disease=====
Gastric and duodenal ulcers are the defining feature of [[peptic ulcer disease]] (PUD). PUD is most commonly caused by an infection with ''H. pylori'' or [[Nonsteroidal anti-inflammatory drug|NSAID]] use.<ref>{{Cite journal|last1=Fashner|first1=Julia|last2=Gitu|first2=Alfred C.|date=2015-02-15|title=Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection|url=https://pubmed.ncbi.nlm.nih.gov/25955624|journal=American Family Physician|volume=91|issue=4|pages=236–242|issn=1532-0650|pmid=25955624}}</ref>

====== ''Helicobacter pylori'' (''H. pylori'') infection ======
The role of ''[[Helicobacter pylori|H. pylori]]'' in [[functional dyspepsia]] is controversial, and treatment for ''H. pylori'' may not lead to complete improvement of a patient's dyspepsia.<ref name=":0" /> However, a recent systemic review and meta-analysis of 29 studies published in 2022 suggests that successful treatment of ''H. pylori'' modestly improves indigestion symptoms.<ref>{{Cite journal|last1=Ford|first1=Alexander C.|last2=Tsipotis|first2=Evangelos|last3=Yuan|first3=Yuhong|last4=Leontiadis|first4=Grigorios I.|last5=Moayyedi|first5=Paul|date=2022-01-12|title=Efficacy of Helicobacter pylori eradication therapy for functional dyspepsia: updated systematic review and meta-analysis|url=https://pubmed.ncbi.nlm.nih.gov/35022266|journal=Gut|volume=71 |issue=10 |pages=gutjnl–2021–326583|doi=10.1136/gutjnl-2021-326583|issn=1468-3288|pmid=35022266|s2cid=245922275}}</ref>

====Pancreatobiliary disease====
These include [[cholelithiasis]], [[chronic pancreatitis]], and [[pancreatic cancer]].

====Duodenal micro-inflammation====
[[duodenum|Duodenal]] micro-inflammation caused by an altered duodenal [[gut flora|gut microbiota]], reactions to foods (mainly [[gluten]] proteins) or infections may induce dyspepsia symptoms in a subset of people.<ref name="JungTalley2018">{{cite journal|vauthors=Jung HK, Talley NJ|year=2018|title=Role of the Duodenum in the Pathogenesis of Functional Dyspepsia: A Paradigm Shift|journal=J Neurogastroenterol Motil|type=Review|volume=24|issue=3|pages=345–354|doi=10.5056/jnm18060|pmc=6034675|pmid=29791992}}</ref>

===Functional dyspepsia===
{{main|Functional dyspepsia}}
[[Functional dyspepsia]] is a common cause of [[Chronic condition|chronic]] heartburn. More than 70% of people have no obvious organic cause for their symptoms after evaluation.<ref name=":2" />  Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying ([[gastroparesis]]) or impaired accommodation to food. Diagnostic criteria for [[functional dyspepsia]] categorize it into two subtypes by symptom: epigastric pain syndrome and post-prandial distress syndrome.<ref name=":3" /> [[Anxiety]] is also associated with [[functional dyspepsia]]. In some people, it appears before the onset of gut symptoms; in other cases, anxiety develops after onset of the disorder, which suggests that a [[gut–brain axis|gut-driven brain]] disorder may be a possible cause.<ref name=":3" />  Although benign, these symptoms may be chronic and difficult to treat.<ref name="TalleyFord2015">{{cite journal|vauthors=Talley NJ, Ford AC|title=Functional Dyspepsia|journal=N Engl J Med|volume=373|issue=19|pages=1853–63|date=Nov 5, 2015|pmid=26535514|doi=10.1056/NEJMra1501505|type=Review|url=http://eprints.whiterose.ac.uk/97326/10/nejmra1501505.pdf}}</ref>

==== Epigastric pain syndrome (EPS) ====
Defined by stomach pain and/or burning that interferes with daily life, without any evidence of organic disease.<ref name=":5">{{Cite journal|last1=Stanghellini|first1=Vincenzo|last2=Chan|first2=Francis K. L.|last3=Hasler|first3=William L.|last4=Malagelada|first4=Juan R.|last5=Suzuki|first5=Hidekazu|last6=Tack|first6=Jan|last7=Talley|first7=Nicholas J.|date=May 2016|title=Gastroduodenal Disorders|url=https://pubmed.ncbi.nlm.nih.gov/27147122|journal=Gastroenterology|volume=150|issue=6|pages=1380–1392|doi=10.1053/j.gastro.2016.02.011|issn=1528-0012|pmid=27147122}}</ref>

==== Post-prandial distress syndrome (PDS) ====
Defined by post-prandial fullness or early satiation that interferes with daily life, without any evidence of organic disease.<ref name=":5" />

===Food, herb, or drug intolerance===
Acute, self-limited dyspepsia may be caused by [[overeating]], eating too quickly, eating high-fat foods, eating during stressful situations, or drinking too much alcohol or coffee. Many medications cause dyspepsia, including [[aspirin]], [[nonsteroidal anti-inflammatory drugs]] (NSAIDs), [[antibiotics]] ([[metronidazole]], [[macrolides]]), bronchodilators (theophylline), diabetes drugs ([[acarbose]], [[metformin]], [[Alpha-glucosidase inhibitor]], [[amylin family|amylin analogs]], [[GLP-1]] receptor antagonists), antihypertensive medications (angiotensin converting enzyme [ACE] inhibitors, [[Angiotensin II receptor antagonist]]), cholesterol-lowering agents ([[Niacin (substance)|niacin]], [[fibrates]]), neuropsychiatric medications (cholinesterase inhibitors [donepezil, rivastigmine]), [[SSRIs]] ([[fluoxetine]], [[sertraline]]), [[serotonin]]-norepinephrine-reuptake inhibitors ([[venlafaxine]], [[duloxetine]]), Parkinson drugs ([[Dopamine agonist]], [[monoamine oxidase]] [MAO]-B inhibitors), weight-loss medications (orlistat), [[corticosteroids]], [[estrogen]]s, [[digoxin]], [[iron]], and [[opioids]].<ref name="Mounsey 84–88">{{Cite journal|last1=Mounsey|first1=Anne|last2=Barzin|first2=Amir|last3=Rietz|first3=Ashley|date=2020-01-15|title=Functional Dyspepsia: Evaluation and Management|url=https://pubmed.ncbi.nlm.nih.gov/31939638|journal=American Family Physician|volume=101|issue=2|pages=84–88|issn=1532-0650|pmid=31939638}}</ref><ref>{{cite journal|vauthors=Ford AC, Moayyedi P|year=2013|title=Dysepsia|url=http://pylori.org/indigestion-symptoms-signs-treatment/|journal=BMJ|volume=347|page=f5059|doi=10.1136/bmj.f5059|pmid=23990632|s2cid=220190440|access-date=2014-12-21|archive-date=2014-12-21|archive-url=https://archive.today/20141221173257/http://pylori.org/indigestion-symptoms-signs-treatment/|url-status=dead|url-access=subscription}}</ref> Common herbs have also been shown to cause indigestion, like white willow berry, [[garlic]], [[ginkgo]], chaste tree berry, [[Serenoa|saw palmetto]], and [[Tanacetum parthenium|feverfew]].<ref name="Mounsey 84–88"/> Studies have shown that wheat and dietary fats can contribute to indigestion and suggest foods high in short-chain carbohydrates ([[FODMAP]]) may be associated with dyspepsia.<ref name=":4">{{Cite journal|last1=Duncanson|first1=K. R.|last2=Talley|first2=N. J.|last3=Walker|first3=M. M.|last4=Burrows|first4=T. L.|date=June 2018|title=Food and functional dyspepsia: a systematic review|url=https://pubmed.ncbi.nlm.nih.gov/28913843|journal=Journal of Human Nutrition and Dietetics|volume=31|issue=3|pages=390–407|doi=10.1111/jhn.12506|issn=1365-277X|pmid=28913843|s2cid=22800900}}</ref> This suggests reducing or consuming a [[Gluten-free diet|gluten-free]], low-fat, and/or [[FODMAP diet]] may improve symptoms.<ref name=":4" /><ref name="DuncansonTalley2017">{{cite journal|vauthors=Duncanson KR, Talley NJ, Walker MM, Burrows TL|year=2017|title=Food and functional dyspepsia: a systematic review.|journal=J Hum Nutr Diet|type=Systematic Review|volume=31|issue=3|pages=390–407|doi=10.1111/jhn.12506|pmid=28913843|s2cid=22800900}}</ref> Additionally, some people may experience dyspepsia when eating certain spices or spicy food as well as foods like peppers, chocolate, citrus, and fish.<ref name=":0" />

===Systemic diseases===
There are a number of [[systemic disease]]s that may involve dyspepsia, including [[coronary disease]], [[congestive heart failure]], [[diabetes mellitus]], [[hyperparathyroidism]], [[thyroid disease]], and [[chronic kidney disease]].

===Post-infectious causes of dyspepsia===
[[Gastroenteritis]] increases the risk of developing chronic dyspepsia. Post-infectious dyspepsia is the term given when dyspepsia occurs after an acute gastroenteritis infection. It is believed that the underlying causes of post-infectious [[irritable bowel syndrome|IBS]] and post-infectious dyspepsia may be similar and represent different aspects of the same pathophysiology.<ref name="pmid25348873">{{cite journal|vauthors=Futagami S, Itoh T, Sakamoto C|year=2015|title=Systematic review with meta-analysis: post-infectious functional dyspepsia|journal=Aliment. Pharmacol. Ther.|volume=41|issue=2|pages=177–88|doi=10.1111/apt.13006|pmid=25348873|doi-access=free}}</ref>