Why Peptic ulceration and Gallstones are the cause of indigestion?
Indigestion implies pain or discomfort associated with eating. It is a very vague but common symptom. Throughout life, about one-third of people experience such problems, and in old age it rises to over a half. Most people become familiar with their own particular problems and they adapt their diet and lifestyle to minimize their distress, while maximizing their pleasures. Only if their symptoms change in nature or severity are they likely to seek medical help. The most common cause of indigestion in late life is a hiatus hernia.
Peptic ulceration and malignancy
Peptic ulceration of the stomach or duodenum is the next most frequent cause of indigestion. In both condition, the lining of the stomach or duodenum will have become eroded, either because of excess acid activity or because of reduced resistance of the lining to normal wear and tear. Elderly people are particularly vulnerable to complications such as bleeding and perforation.
Another increased risk in elderly patients is that the stomach lesion may be malignant. Confirmation of this possibility is clearly important but may be difficult. There are unlikely to be any clear indications from the patient’s symptoms-the barium meal X-ray may be inconclusive. The most reliable method of investigation is gastroscopy, where the stomach is inspected with a flexible fiber optic instrument. This can normally be performed in an out-patient clinic and a piece of the ulcer can be removed for detailed examination. It is only complicated ulcers which necessitate an operation. The majority respond well to treatment with medicines and tablets, especially cimetidine, ranitidine, and omeprazole. Aggravating factors such as smoking, drinking alcohol, or taking aspirin and similar drugs, should be avoided. Although these ulcers tend to run a fluctuating course, they should not seriously interfere with the pursuit of a full and enjoyable life.
Gallstones are another cause of indigestion, which increases in frequency on aging. The incidence reaches 30 per cent in women and 25 per cent in men, but in many cases they do not cause symptoms. Sharp pains on the right side of the abdomen below the ribs is the most common way in which gallstones can advertise their presence, and these pains may become very severe and require painkillers. The constant irritation by the stone may cause the gallbladder to become inflamed and tender. The stone may escape from the gallbladder but lodge in the duct on its way into the bowel. As well as being painful, this may also lead to jaundice as the main exit from the liver may become blocked. The patient’s skin becomes increasingly yellow if the blockage persists. The correct diagnosis may be made on X-ray examination (cholecystogram) or ultrasound techniques (using reflections of sound waves to reveal the stones). When symptoms are severe there is no alternative to surgical removal of the stones. The recent development of ‘keyhole’ surgery makes this a less formidable event. Painless jaundice may occur as a side-effect of some drugs (tranquillizers) and secondary to pancreatic cancer.