Chapter 58 Maldigestion
Introduction
Therapeutic Considerations
Indigestion
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.
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:
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).
Hypochlorhydria
In the patient with chronic indigestion, rather than focus on blocking the digestive process with antacids, the natural approach focuses on aiding digestion. Although much is said about hyperacidity conditions, a more common cause of indigestion is a lack of gastric acid secretion. Many symptoms and signs suggest impaired gastric acid secretion, and a number of specific diseases have been associated with insufficient gastric acid output.3–13 They are listed in Boxes 58-1 and 58-2.
BOX 58-1 Common Signs and Symptoms of Low Gastric Acidity
Bloating, belching, burning, and flatulence immediately after meals
A sense of “fullness” after eating
Indigestion, diarrhea, or constipation
Nausea after taking supplements
Weak, peeling, and cracked fingernails
Dilated blood vessels in the cheeks and nose
Chronic intestinal parasites or abnormal flora
