Persistent Indigestion and Abdominal Discomfort - Gastroenterology and Hepatology

Q: Persistent Indigestion and Abdominal Discomfort

Hello： 1. <br>If you are experiencing anxiety and tension, you may consider trying medications prescribed by a physician. <br>2. <br>Pay attention to your eating habits; for example, irregular meal times or eating too quickly, and whether you are consuming irritating or hard-to-d

Dyspepsia and discomfort in the upper abdomen?

Hello, doctor.
I have been experiencing recurrent indigestion for over two years, which has led to weight loss.
I underwent an upper gastrointestinal endoscopy last year, and the results were normal; the doctor mentioned that my gastrointestinal tract is quite sensitive.
I also had an abdominal ultrasound, which came back normal.
My symptoms include feeling bloated after meals, taking about an hour to digest, discomfort in the upper abdomen, and feeling better after belching.
I often feel tightness in my gastrointestinal tract.
Recently, this has also led to increased anxiety and tension, and although the doctor prescribed anti-anxiety medication, I am hesitant to take it.
I have had an electrocardiogram and X-rays, both of which were normal.
Additionally, I noticed that the right upper abdomen feels more prominent than the left upper abdomen, and I'm unsure if this is muscle tissue.
I would like to know if a CT scan is necessary after the abdominal ultrasound to rule out issues with other organs.
Thank you.

Chen, 20~29 year old female. Ask Date: 2022/05/10

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If you are experiencing anxiety and tension, you may consider trying medications prescribed by a physician.
2.
Pay attention to your eating habits; for example, irregular meal times or eating too quickly, and whether you are consuming irritating or hard-to-digest foods.
3.
The right upper abdomen contains solid organs, such as the liver, while the left upper abdomen contains hollow organs, such as the stomach, so asymmetry between the two sides is not a concern.
4.
The value of a CT scan is that it can visualize the pancreas.
However, it may not necessarily reveal inflammation or polyps in the intestines unless there is a significantly large tumor present.
Ultrasound can detect most tumors in the liver, gallbladder, kidneys, and spleen.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2022/05/10

More Info

When dealing with persistent indigestion and abdominal discomfort, especially in the context of a two-year history of symptoms, it's essential to approach the situation systematically. Your symptoms of post-meal bloating, discomfort, and the sensation of tightness in the abdomen can be indicative of several underlying issues, even if previous tests like an endoscopy and ultrasound have returned normal results.

Firstly, it's important to understand that the gastrointestinal (GI) tract can be quite sensitive, and conditions such as functional dyspepsia or irritable bowel syndrome (IBS) could be at play. Functional dyspepsia is characterized by symptoms of discomfort or pain in the upper abdomen, often accompanied by bloating, early satiety, and nausea, without any identifiable organic cause. IBS, on the other hand, can present with a combination of abdominal pain, bloating, and changes in bowel habits (diarrhea or constipation).

Given that your symptoms have persisted for an extended period and have led to weight loss, it is crucial to continue investigating the underlying causes. While your previous tests have shown normal results, there are additional diagnostic steps that can be taken. A CT scan can provide a more detailed view of the abdominal organs and may help identify issues that an ultrasound might miss, such as small lesions, inflammation, or other abnormalities in the pancreas, liver, or intestines.

Moreover, the sensation of a bulge or asymmetry in your abdomen, particularly if you notice that the right upper quadrant feels different from the left, warrants further evaluation. This could be due to various factors, including muscle tension, organ enlargement, or even a hernia. A physical examination by a healthcare provider can help assess this further.

In addition to imaging studies, it may be beneficial to consider dietary modifications and stress management techniques. Since you mentioned that your symptoms have led to increased anxiety, addressing this aspect is vital. Anxiety can exacerbate gastrointestinal symptoms, creating a cycle of discomfort. Cognitive-behavioral therapy (CBT) or mindfulness practices can be effective in managing anxiety and may, in turn, alleviate some of your digestive symptoms.

If you are hesitant to take the anti-anxiety medication prescribed, discuss your concerns with your healthcare provider. They can provide alternative options or suggest non-pharmacological approaches to help manage your anxiety.

In summary, while your previous tests have returned normal results, it is essential to continue exploring the underlying causes of your persistent symptoms. A CT scan may be warranted to rule out any potential issues that were not visible on ultrasound. Additionally, addressing lifestyle factors, including diet and stress management, can significantly impact your overall well-being. Always communicate openly with your healthcare provider about your symptoms, concerns, and treatment preferences to ensure a comprehensive approach to your health.

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