Materiały źródłowe

• #1 Functional Dyspepsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554563/

  Functional dyspepsia is a common and benign gastrointestinal disorder that presents similarly to other conditions, making it difficult to diagnose. […] Although the exact mechanism of functional dyspepsia is poorly understood, its pathophysiology is complex. […] Although the exact mechanism is poorly understood, the pathophysiology of functional dyspepsia is complex, involving several different mechanisms thought to contribute to each subtype. Traditionally, disturbances in gastric physiologic factors, including both macroscopic and microscopic mechanisms, have been attributed to functional dyspepsia. […] Macroscopic physiological mechanisms include: Gastroesophageal reflux disease (GERD). Delayed gastric emptying, rapid gastric emptying, gastric dysrhythmias, and antral hypomotility. Visceral hypersensitivity alterations in the nervous system, including a lower threshold for pain in the presence of normal gastric compliance, abnormal processing of afferent input in the spinal cord or brain, and dysfunction of mechanoreceptors.

• #1 Functional Dyspepsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554563/

  Microscopic physiologic mechanisms include: Impaired barrier function due to altered sensitivity to duodenal acid or lipids that impair mucosal integrity. Gastroduodenal inflammation characterized by altered lymphocytes, including „gut-homing” lymphocytes, increased eosinophils, and mast cells. Altered gut microbiome and H pylori infection. […] Additional proof of the connection between intestinal inflammation and functional dyspepsia includes the discovery of increased small-bowel homing T lymphocytes in patients suffering from functional dyspepsia. […] Psychological factors such as anxiety and depression can lead to increased activation of the amygdala and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, indicating central processing of visceral stimuli from the gastrointestinal tract.

• #2 Pathophysiology of functional dyspepsia | Gut

  https://gut.bmj.com/content/51/suppl_1/i63

  Functional dyspepsia is a symptom complex characterised by postprandial upper abdominal discomfort or pain, early satiety, nausea, vomiting, abdominal distension, bloating, and anorexia in the absence of organic disease. […] Gastrointestinal motor abnormalities, altered visceral sensation, and psychosocial factors have all been identified as major pathophysiological mechanisms. […] This perspective has now replaced the earlier view that the condition was the result of a sole motor or sensory disorder of the stomach. […] Future therapeutic strategies should be aimed at reducing nociception as well as enhancing the accommodation response.

• #3 Functional dyspepsia – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/functional-dyspepsia.html

  Gastric and duodenal motility disturbances have been observed in functional dyspepsia. Gastric emptying is often normal but may be slow in 25% of patients or occasionally fast. However, symptoms have generally not correlated with slow gastric emptying in functional dyspepsia. Other abnormalities include failure of the gastric fundus to relax normally after eating. This occurs in up to 40% of patients and is linked to early satiety. […] People with postprandial distress have unique duodenal pathology, namely increased duodenal eosinophils that may degranulate. Duodenal eosinophils have been linked to increased mucosal permeability, submucosal neuronal structural and functional changes, and symptoms. They may reflect an infectious or allergenic trigger. In functional dyspepsia, the duodenal microbiome is also abnormal with increased oral streptococci.

• #3 Functional dyspepsia – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/functional-dyspepsia.html

  Functional dyspepsia is characterised by troublesome early satiety, fullness, or epigastric pain or burning. […] The pathophysiology of functional dyspepsia is not completely understood. It is thought to be associated with upper gastrointestinal inflammation and motility disturbances, which may be triggered by an infectious or allergenic agent, or a change in the intestinal microbiome. Slow gastric emptying occurs in 20% of cases. […] Functional dyspepsia has been considered an idiopathic disorder but this view is changing. In some cases, functional dyspepsia develops after acute infectious gastroenteritis, suggesting acute intestinal inflammation may play a role. […] Helicobacter pylori is a recognised cause of functional dyspepsia. Most patients with H. pylori do not develop functional dyspepsia so in many of these cases it is an incidental finding. However in a minority, eradicating the infection cures dyspepsia long term, especially in those with epigastric pain as the main problem.

• #3 Functional dyspepsia – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/functional-dyspepsia.html

  Recently a unifying disease model has been proposed for functional dyspepsia. Either an infection, microbiome alteration or a food allergen, such as wheat, induces increased duodenal permeability and duodenal eosinophilia with or without increased mast cells. This activates a mucosal immune response. Local duodeno-gastric reflex responses to low-grade inflammation alter gastroduodenal function, including impaired fundic relaxation in a subset of patients. Circulating cytokines such as tumour necrosis factor alpha may lead to systemic and central nervous system symptoms such as anxiety.

• #4 Indigestion and Heartburn – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK409/

  Indigestion is a term commonly used by patients and physicians to indicate some form of gastrointestinal tract upset. It includes a wide variety of symptoms, which in turn may be manifestations of a wide variety of gastrointestinal and nongastrointestinal diseases. […] The complaint of indigestion more likely is the consequence of aerophagia with gastric distention or of delayed gastric emptying, the latter secondary to mechanical or motor disturbance. […] The rate of gastric emptying may be inhibited by meals of high osmotic pressure or high fat content, with inhibitory receptors probably located in the duodenum and proximal jejunum. […] The most common causes of mechanical pyloric or gastric outlet obstruction are tumors (polyps, carcinoma), narrowing secondary to acute inflammation and edema or chronic scarring from peptic ulcer disease, and idiopathic pyloric hypertrophy.

• #4 Indigestion and Heartburn – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK409/

  Heartburn usually is the result of acid or alkaline gastroesophageal reflux esophagitis. Gastroesophageal reflux can be demonstrated by means of barium studies, by manometric placement of a pH probe, or by radioisotope study. […] A sense of fullness, bloating, or upper abdominal discomfort and distention after meals, or, in common parlance, indigestion, suggests aerophagia and/or impaired or delayed gastric emptying.

• #5 Functional Dyspepsia: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/digestive/functional-gastrointestinal-disorders/functional-dyspepsia

  The cause of functional dyspepsia is unclear. Still, there are risk factors and symptoms that you should be aware of. […] Individuals whose nervous systems react more strongly to stress and anxiety may have visceral hypersensitivity. In people with visceral hypersensitivity, nerves in the digestive tract may have increased sensitivity, making natural expansion and contraction of the digestive tract uncomfortable. […] Stomach muscles are supposed to relax and expand to accommodate food passed into the small intestine. But in some individuals, this mechanism is impaired, leading to a consistent feeling of being full. The signals telling the stomach to empty food into the small intestine could also be damaged. […] Affecting about 30% to 40% of people in the United States, Helicobacter pylori (H pylori) is a bacteria that infects the stomach. H pylori may cause chronic inflammation and erode the mucous lining in the stomach. Some people with functional dyspepsia improve after being treated for H. pylori.

• #6 Functional Dyspepsia: Advances in Diagnosis and Therapy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16055

  Gastric emptying is slow in 25% of patients with FD, but symptoms fail to correlate with delayed gastric emptying in this syndrome; in a very small number, rapid gastric emptying has also been documented. While gastric emptying is a biomarker of a subset with FD, it does not appear to explain the reduced quality of life documented in such patients. Gastric hypersensitivity and impaired gastric accommodation also occur in subsets of patients, and these abnormalities can overlap. Recent observations suggest patients with PDS and impaired gastric accommodation are more likely to have anxiety too. […] One of the most exciting observations in FD has been the consistent finding of duodenal eosinophilia in many cases with PDS around the world, following the first report in adults by Talley et al. The normal cutoff may vary geographically but more than 22 eosinophils in 5 high power fields is generally considered abnormal; otherwise biopsies look normal and the eosinophilia will not usually be detected unless counting is performed.

• #6 Functional Dyspepsia: Advances in Diagnosis and Therapy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16055

  FD is now established to develop after acute bacterial, protozoal or viral gastroenteritis, with a 2.5-fold increased risk. Alternatively, post-gastroenteritis IBS or an overlap syndrome comprising FD and IBS can develop, implying a similar pathogenesis for the postinfectious subset. Risk factors for postinfectious FD include smoking, and smoking is a risk factor for duodenal eosinophilia.

• #6 Functional Dyspepsia: Advances in Diagnosis and Therapy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16055

  Familial aggregation of abdominal pain has been reported in FD implying either genes or early life factors must be important in the pathogenesis. Genetic factors likely play a role in disease pathogenesis but data are limited. Evidence implicates disturbed signal transduction in FD with a number of studies linking the polymorphism GNB3 C825T to FD. Both the CC and TT variant have been associated with FD in different populations. The relevance of other genetic variants is less certain and contradictory in the literature, and large robust studies are needed. […] New evidence suggests anxiety often precedes the onset of FD. Among 703 community subjects who completed questionnaires and an upper endoscopy at entry, 10 years later the risk of FD developing was nearly 8-fold increased in those with higher anxiety levels; depression on the other hand was not a risk factor. Further, the risk of FD in those with anxiety was limited to PDS and not EPS. Other data suggest one-third of people who develop an FGID like FD have symptoms that begin in the gut then new onset psychological distress develops; half to two-thirds start with anxiety and then develop gut symptoms suggesting a central rather than peripheral pathogenesis.

• #7

  https://link.springer.com/article/10.1007/s00535-019-01550-4

  Over almost 30 years since functional dyspepsia (FD) was defined, researchers have endeavored to elucidate the pathophysiology of functional gastrointestinal disorders. […] Now a consensus is emerging that the gastric symptoms of FD are caused mainly by gastric motility abnormalities and gastric hypersensitivity. […] We believe that most of those factors cause FD symptoms by inducing gastric motility abnormalities and gastric hypersensitivity via the duodenum. […] We now believe that the duodenum is at the center of those interactions and is the key organ in the pathophysiology of FD, with various factors causing FD symptoms through their effects on it. […] In summary, we believe that in patients with FD, stimuli to the duodenum induces gastric malfunction, which then causes dyspeptic symptoms.

• #8 Novel concepts in the pathophysiology and treatment of functional dyspepsia | Gut

  https://gut.bmj.com/content/69/3/591

  Emerging data increasingly point towards the duodenum as a key region underlying the pathophysiology of functional dyspepsia (FD), one of the most prevalent functional GI disorders. […] Impaired duodenal mucosal integrity and low-grade inflammation have been associated with altered neuronal signalling and systemic immune activation, and these alterations may ultimately lead to dyspeptic symptoms. […] Likely luminal candidates inducing the duodenal barrier defect include acid, bile, the microbiota and food antigens although no causal association with symptoms has been convincingly demonstrated. […] Recognition of duodenal pathology in FD will hopefully lead to the discovery of new biomarkers and therapeutic targets, allowing biologically targeted rather than symptom-based therapy.

• #9 Functional dyspepsia in adults – UpToDate

  https://www.uptodate.com/contents/functional-dyspepsia-in-adults

  Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. […] Up to 80 percent of individuals with symptoms of dyspepsia have functional (idiopathic, nonulcer) dyspepsia. Many authorities regard it as a disorder of gut-brain interaction, similar to irritable bowel syndrome, globus, and other symptom-based gastrointestinal disorders. […] Several factors are modestly associated with an increased risk of dyspepsia, including female sex, smoking, Helicobacter pylori infection, use of nonsteroidal anti-inflammatory agents, elevated body mass index, acute gastroenteritis, and specific psychiatric comorbidities. […] The association between acute gastroenteritis and the subsequent development of functional dyspepsia is well established. The prevalence of postinfectious functional dyspepsia in adults is approximately 10 to 13 percent.

• #10 Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

  Acid reflux happens when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the esophagus. This can cause heartburn and other symptoms. Frequent or constant reflux can lead to GERD. […] GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. […] If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed.

• #11 Pathophysiology of gastroesophageal reflux disease : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo21.html

  Gastroesophageal reflux disease (GERD) includes all consequences of reflux of acid or other irritants from the stomach into the esophagus. The main cause of gastroesophageal reflux is incompetence of the antireflux barriers at the esophagogastric junction. […] Gastroesophageal reflux occurs when LES pressure is lower than the intragastric pressure such as in LES hypotension, increased frequency of transient lower esophageal sphincter relaxation (TLESR), when the intragastric pressure increases. […] The severity of GERD increases progressively with reflux that is mainly in the postprandial period to that in the upright posture, to that in the supine or that is bipositional reflux. Nighttime reflux leads to severe GERD. […] Hiatal hernia results from multiple mechanisms and is associated with a decreased LES pressure, decreased acid clearance, increased reflux, and more severe esophagitis.

• #11 Pathophysiology of gastroesophageal reflux disease : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo21.html

  Mucosal defense mechanisms may be overcome by prolonged exposure of the esophageal mucosa to a pH 4 that may lead to severe and complicated esophagitis. […] Esophageal mucosal inflammation may affect nerves and muscle that alter LES function and esophageal body motility. A vicious cycle of inflammation and impaired motility may cause progressive disease. […] An incompetent gastroesophageal reflux mechanism allows abnormal amounts of gastric acid to enter the esophagus, where the acid burden causes mucosal damage and/or symptoms. When mucosal damage occurs (esophagitis), a vicious cycle can ensue to accentuate and maintain the GERD. […] Gastroesophageal reflux occurs when LES pressure is lower than intragastric pressure. Under normal circumstances a small amount of reflux occurs when LES pressures are low with a swallow and during TLESR, and when increases in intraabdominal pressure or intragastric pressure overcome the resting LES pressure.

• #11 Pathophysiology of gastroesophageal reflux disease : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo21.html

  The increased acid load in GERD patients and its relationship to low LES pressure and the severity of the esophagitis is also reflected in the pattern of reflux. The severity of GERD increases progressively from postprandial to upright, to supine, to bipositional reflux. […] Low LES pressure and abnormal reflux can also occur in certain diseases, most commonly with the collagen vascular disorders such as scleroderma, where damage to the muscle and to the excitatory cholinergic innervation occur. […] The acid load to the esophagus is greater in GERD patients, in part because more TLESRs are associated with reflux even though the number of TLESRs is more or less similar. […] The physiologic reason for the increased frequency of TLESR-associated reflux in GERD patients is unknown. […] The presence of a hiatus hernia impacts unfavorably on both of these sphincter mechanisms.

• #11 Pathophysiology of gastroesophageal reflux disease : GI Motility online

  https://www.nature.com/gimo/contents/pt1/full/gimo21.html

  The presence and location of the sling muscle has also been linked to maintenance of the acute angle of His at the greater curve aspect of the gastroesophageal junction, and the formation of a flap valve function that could also serve as an antireflux mechanism. […] The diaphragm can function as an „external sphincter” by compressing the gastroesophageal junction; this compression increases LES pressure by 10 to 100 mmHg with each inspiration, depending on the intensity of the inspiration. […] In the presence of a hiatus hernia, the diaphragmatic sphincter is distanced from the gastroesophageal junction and therefore loses its ability to function as an antireflux mechanism. […] With gastroesophageal reflux, a greater duration of exposure of the esophagus to a pH 4 leads to increasing severity of esophagitis and its complications. […] Both the LES mechanisms that produce excess reflux of acid and the esophageal body motility disorders that result in prolonged acid exposure to the mucosa contribute to the duration of the exposure.

• #12 Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/176595-overview

  When discussing the mechanisms for GERD, the issue of hiatal hernia must be addressed. Hiatal hernias can be encountered frequently in patients with reflux disease; however, it has been well proven that not all patients with hiatal hernias have symptomatic reflux. […] Some studies have shown that GERD is highly prevalent in patients who are morbidly obese and that a high body mass index (BMI) is a risk factor for the development of this condition. The hypothesis that obesity increases esophageal acid exposure is supported by the documentation of a dose-response relationship between increased BMI and increased prevalence of GERD and its complications. Therefore, the pathophysiology of GERD in patients who are morbidly obese might differ from that of patients who are not obese. The therapeutic implication of such a premise is that the correction of reflux in patients who are morbidly obese might be better achieved with a procedure that first controls obesity.

• #12 Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/176595-overview

  The mechanism by which a high BMI increases esophageal acid exposure is not completely understood. Increased intragastric pressure and gastroesophageal pressure gradient, incompetence of the lower esophageal sphincter (LES), and increased frequency of transient LES relaxations may all play a role in the pathophysiology of GERD in patients who are morbidly obese.

• #13 Can Stress Trigger Heartburn or Acid Reflux? | PEPCID®

  https://www.pepcid.com/understanding-heartburn/heartburn-and-stress

  Stress may also be connected to the conditions that cause heartburn: acid reflux and gastroesophageal reflux disease (GERD). Acid reflux occurs when stomach contents flow backward into the esophagus (the muscular tube that carries food from the mouth to the stomach), and GERD is the name for a condition in which acid reflux occurs frequently. Acid reflux and GERD can both cause heartburn and may both be influenced by stress levels. […] Researchers are still learning about how stress and heartburn are connected. They know that the brain and the digestive system communicate with each other through a system called the brain-gut axis. When the brain is feeling stressed, the brain-gut microbiota are disrupted and release various substances that can affect the way the digestive organs work. This process may: Slow down digestion, causing food to sit in the stomach longer and leading to a higher chance that stomach juices flow into the esophagus.

• #13 Can Stress Trigger Heartburn or Acid Reflux? | PEPCID®

  https://www.pepcid.com/understanding-heartburn/heartburn-and-stress

  Stress may make people more aware of their heartburn pain, and for some, stress can make some more likely to engage in behaviors that may trigger heartburn, such as eating fattier foods or smoking cigarettes. […] There are multiple unhealthy lifestyle factors that can lead to heartburn. For example, drinking alcohol, smoking, or using tobacco products can also increase acid reflux.

• #14 High Stomach Acid Symptoms, Causes, and Treatment

  https://www.verywellhealth.com/high-stomach-acid-symptoms-5215536

  High stomach acid can be caused by bacterial infections, stress, and rebound effects from medication withdrawal. […] This can lead to complications like reflux disease and stomach ulcers. […] Certain conditions can cause your body to produce too much of this acid. These include the following: Helicobacter pylori (H. pylori) is a bacteria that damages tissues in your stomach and duodenum (the first part of your small intestine). Having an active acute H. pylori bacterial infection in your stomach may lead to an increase in stomach acid, while chronic infection has been shown to reduce gastric acid secretion. […] Stress has been linked to delayed gastric emptying of acid. Research shows that chronic stress may also deplete prostaglandins, which protect the lining of the stomach from acid, increasing your risk of developing ulcers.

• #15 Indigestion (Dyspepsia): Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/indigestion

  You may have indigestion after eating some foods, such as greasy or spicy foods, taking certain medications, or due to an underlying health condition. Treatment can depend on the cause. […] Indigestion is the name given to a collection of digestive symptoms, including a feeling of fullness or discomfort in your upper abdomen, heartburn, and nausea. The medical term for indigestion is dyspepsia. […] You experience indigestion when your body cannot digest food as normal. This may be the result of eating a lot or eating too fast. […] Spicy, greasy, and fatty foods also increase the risk of indigestion. Lying down too soon after eating can make it harder to digest food. This increases your risk of abdominal discomfort. […] Indigestion can be a side effect of taking specific medications.

• #15 Indigestion (Dyspepsia): Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/indigestion

  Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen, are one class of medications that can cause indigestion. […] Antibiotics, medications that treat or prevent bacterial infections, can also irritate the digestive system and cause indigestion as a side effect. […] Several medical conditions can also cause indigestion. These include: gastroesophageal reflux disease (GERD), gastric cancer, pancreatic or bile duct abnormalities, peptic ulcers, lactose, gluten, and other intolerances, irritable bowel syndrome (IBS), gastroparesis. […] Sometimes you may experience indigestion with no apparent cause. The medical term for this is functional dyspepsia. […] Indigestion often goes away on its own and will pass with time. For example, if you experience indigestion after a large meal, your abdominal discomfort may lessen as your body begins to digest the food you’ve eaten.

• #16 Heartburn: Burn becomes a burden – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/heartburn-burn-becomes-a-burden

  A burning sensation, or pain or discomfort behind your breastbone, is known as heartburn. When stomach acid backs up into the esophagus, the tube that carries food from your mouth to your stomach, heartburn occurs. […] If the muscles weaken or relax abnormally, stomach acid can flow back up into the esophagus, known as acid reflux, and cause heartburn. […] The lining of the esophagus is sensitive to acid because is not protected like the lining in the stomach. Typically, people who experience heartburn are affected when the acid from the stomach goes where it should not be or is not cleared from the food pipe in a timely manner. […] Symptoms also can develop if the protective mechanism of the lining of the gut is weakened, which may happen from use of over-the-counter medications such as nonsteroidal anti-inflammatory drugs like aspirin or ibuprofen.

• #17 Dyspepsia – Signs and Symptoms – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.I.1.13.

  Dyspepsia is a complex of symptoms that includes epigastric pain or burning, abdominal fullness after meals (an unpleasant sensation of food retention in the stomach), and early satiety (feeling full that is disproportionate to the amount of consumed food and prevents the patient from finishing the meal), as well as nausea and vomiting. […] Organic dyspepsia occurs in the presence of an established organic, systemic, or metabolic cause with symptom resolution or improvement after resolution of the underlying condition: Gastroesophageal reflux disease (GERD); drug-induced gastric, duodenal, or esophageal mucosal injury (acetylsalicylic acid and other nonsteroidal anti-inflammatory drugs [NSAIDs], certain oral antibiotics [mainly doxycycline, erythromycin, ampicillin], digitalis, theophylline, iron or potassium salts, calcium channel blockers, nitrates, glucocorticoids, bisphosphonates); peptic ulcer disease; diseases of the biliary system; hepatitis; pancreatitis; pancreatic pseudocysts; malignancy (gastric, pancreatic, colorectal); intestinal ischemia; and abdominal aortic aneurysm.

• #18 Indigestion (Dyspepsia): Symptoms, Causes, Diet, and Treatments

  https://www.webmd.com/heartburn-gerd/indigestion-overview

  Indigestion that lasts longer than one meal or that comes and goes may be caused by your lifestyle, a medical condition, or a medicine you take regularly. Sometimes, people have persistent indigestion that’s not related to any of these factors. This type of indigestion is called functional or non-ulcer dyspepsia. […] Indigestion is common during pregnancy. You’re more likely to get it during pregnancy because of hormonal changes, the growing baby pressing against your stomach, and the muscles between your stomach and esophagus relaxing, which allows stomach acid to come back up. […] Indigestion is usually caused by eating a large or fatty meal. The symptoms of indigestion come on because large and fatty meals make your digestive system work extra hard. Your stomach stretches and your gallbladder and pancreas contract, and they all make strong digestive juices. All together, this can irritate your stomach.

• #19 Causes of Heartburn and Indigestion in Pregnancy

  https://www.healthline.com/health/gerd/pregnancy

  During normal digestion, food travels down the esophagus (the tube between your mouth and stomach), through a muscular valve called the lower esophageal sphincter (LES), and into the stomach. […] When you have heartburn, or acid reflux, the LES relaxes enough to allow stomach acid to rise up into the esophagus. This can cause pain and burning in the chest area. […] During pregnancy, hormone changes can allow the muscles in the esophagus, including the LES, to relax more frequently. The result is that more acids may seep back up, particularly when you’re lying down or after you’ve eaten a large meal. […] In addition, as your fetus grows during the second and third trimesters and your uterus expands to accommodate that growth, your stomach is under more pressure. This can also result in food and acid being pushed back up into your esophagus.

• #19 Causes of Heartburn and Indigestion in Pregnancy

  https://www.healthline.com/health/gerd/pregnancy

  Pregnancy increases your risk of heartburn or acid reflux. During the first trimester, muscles in your esophagus push food more slowly into the stomach and your stomach takes longer to empty. […] During the third trimester, the growth of your baby can push your stomach out of its normal position, which can lead to heartburn. […] Your doctor may diagnose you with GERD. This means that your heartburn needs to be controlled to protect you from complications such as damage to the esophagus. […] Your doctor may prescribe certain acid-reducing medications to reduce your symptoms. Research indicates that medications called H2 blockers, which help block the production of acid, appear to be safe. […] Another type of medication, called proton pump inhibitors, is used for people with heartburn that doesn’t respond to other treatments.

• #20 When Is Heartburn a Sign of Esophageal Cancer? | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/news/when-heartburn-signals-cancer-risk

  When patients come to me after they find out they have esophageal cancer, most of them have had GERD for a long time, sometimes decades, says Daniela Molena, Director of MSK’s Esophageal Surgery Program. […] Gastroesophageal reflux disease (GERD) is a potentially serious condition that, untreated, can lead to esophageal cancer. […] Indigestion a broad term that includes heartburn, acid reflux, abdominal pain, and other gastrointestinal symptoms can be a first sign. […] GERD develops when acid that digests food in the stomach washes up into the esophagus. […] After someone has had GERD for many years, it can advance to a condition called Barretts esophagus. […] When the esophagus is bathed in acid all the time, it wants to protect itself, and so the cells in the lining begin to change. These changes can advance to become cancer.

• #20 When Is Heartburn a Sign of Esophageal Cancer? | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/news/when-heartburn-signals-cancer-risk

  If patients develop Barretts esophagus, their GERD symptoms often disappear. […] It’s typical for patients with esophageal cancer to tell me that they suffered from GERD for years, but then it went away and they stopped taking their GERD medications, which would have actually reduced their cancer risk, Dr. Molena says. […] While GERD is a risk factor for esophageal cancer and a symptom of a very rare subtype of pancreatic cancer, it is not associated with other types of cancer, like colon cancer, stomach cancer, or lung cancer.

• #21 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease

  Gastrointestinal reflux disease (GERD) is more than just heartburn. Untreated, GERD can develop into more serious conditions, including cancer for a small percentage of individuals. […] A one-way valve called the lower esophageal sphincter (LES) allows food to pass into your stomach and prevents stomach acid from flowing back up into the esophagus. When this valve is weakened and not functioning properly, gastric juice comes up from the stomach and back into the esophagus causing irritation and inflammation (esophagitis). Over time, this can damage to the lining of the esophagus. Nearly half of patients with GERD will develop esophagitis, and up to 15 percent of patients with GERD may develop a pre-cancerous condition called Barretts esophagus. A small percentage of people with Barretts esophagus will progress to esophageal adenocarcinoma a form of cancer in the esophagus.

• #21 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease

  GERD can lead to more serious conditions if not diagnosed and treated properly. If you have experienced GERD for a number of years, it is important to have your esophagus checked for changes. […] In most cases, GERD is a chronic condition that people live with for the rest of their lives. The only curative treatment is surgery, but medications and lifestyle changes are helpful for managing the symptoms of GERD. […] When lifestyle changes do not work, medications designed to suppress the production of excess acid are typically the next step. […] A number of patients with GERD may be appropriate candidates for surgical treatment with an anti-reflux procedure. This procedure tightens the valve located between the stomach and the esophagus, called the lower esophageal sphincter, which prevents the stomach contents and acid from refluxing back into the esophagus.

• #22

  https://www.ijbcp.com/index.php/ijbcp/article/view/1483

  Functional dyspepsia represents a heterogeneous group of gastrointestinal disorders marked by the presence of upper abdominal pain or discomfort. […] Basic Pathophysiology of functional dyspeptic symptoms is unclear and is considered to occur due to a combination of visceral hypersensitivity, gastric motor dysfunction and psychological factors. […] Transient deficiency in digestive enzymes is one of the contributors for functional dyspepsia. […] The primary digestive enzymes are proteases, amylases and lipases. […] A commonly used therapeutic approach in its treatment is the use of oral enzymes supplementation therapy. […] This review summarizes the pathophysiology of functional dyspepsia, different pharmacological approaches and focuses on the safety and efficacy of digestive enzymes in managing dyspepsia.

• #23 Gastroesophageal reflux disease and heartburn Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/gastroesophageal-reflux-disease-and-heartburn

  Problems in spontaneous muscle action (peristalsis) in the esophagus commonly occur in GERD, although it is not clear whether such problems cause the condition, or are the result of long-term GERD. […] A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity or smoking. […] About 30% to 40% of reflux is most likely hereditary, according to several twin and family studies. An inherited risk exists in many cases of GERD, possibly because of inherited muscular or structural problems in the stomach or esophagus. […] Genetic factors may play an especially strong role in susceptibility to Barrett esophagus, a precancerous condition caused by very severe GERD.

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