Indigestion, or DYSPEPSIA, properly includes only such derangements of the digestive process as do not depend on any recognisable structural change. But it is very common to apply the term loosely to any digestive disorder, whatever its cause may be. In this sense dyspepsia is a symptom of a multitude of diseases, in the description of which, when it is sufficiently important, it will be found noticed. Functional dyspepsia, the dyspepsia of otherwise healthy people, is what will be considered here. Of this there are two chief varieties, the atonic and the irritative or acid dyspepsia. The former is caused by deficient secretion of the gastric juice and diminished movement of the stomach walls, and it is often associated with a want of vitality in the system. The latter is frequently found in persons of vigorous and robust frame and of active habits; and in many cases it is to be looked upon as the result of an excess of digestive activity leading to the accumulation of an abnormal amount of acid products in the stomach, especially toward the end of digestion. This form is more common in men than in women, and is rarely met with before adult life.
The symptoms of dyspepsia differ considerably in different individuals. The appetite is often good, and sometimes voracious, but it may be deficient. For some time after eating there may be no discomfort; but sooner or later pain comes on in the region of the stomach, at first dull, afterwards more severe. A feeling of fullness and distension follows, accompanied by flatulent discharge and the eructation of a sour liquid. The discomfort may sometimes deepen into nausea and vomiting. The pain occasionally shoots up towards the shoulders, and may run down the left arm, like the pain of angina pectoris. From this, however, it may be distinguished by the fact that it comes on after food. The pain is due partly to over-sensitiveness of the stomach, and partly to the irritation of its acid contents, especially of butyric acid. When the pain is of a paroxysmal character it is called Gastralgia or Gastrodynia. Cardialgia or heartburn, and Pyrosis or water-brash, are common symptoms which have also been dignified with special names. The former is said to be caused by the irritation of the upper end of the stomach by the fumes of its acidic contents, while the latter is essentially an abortive act of vomiting accompanied by a gush of saliva (Roberts).
In the treatment of indigestion the diet should be strictly regulated. The experience of the patient is often a better guide as to details than all the dicta of the faculty. The food should be properly cooked and well masticated, and the interval between meals should neither be too long nor too short. Where the appetite is feeble food must be taken frequently, in small quantities at a time; and it is often advantageous to use substances which have been partially digested with pancreatic or peptic extract. A mixture of animal and vegetable food is in general more easily digested than either kind taken exclusively. Mutton, fowls, and game are the most digestible kinds of animal food; roast beef is to be preferred to boiled; but pork and all cured meats, such as salted beef, ham, tongue, and all greasily-cooked dishes should be avoided. Cheese, pastry, raw vegetables, such as salads, cucumbers, &c., must also be prohibited. As a rule, dyspeptic persons would probably do well to avoid all stimulating drinks; but in some cases a little cold, weak brandy and water, or a glass of old sherry, or a little bitter ale may be taken with advantage.
It is of great importance to attend to the bowels (see CONSTIPATION). Regular exercise in the open air should be enjoined. Riding exercise is of special service where the liver is out of order. In some cases change of scene and occupation is of more benefit than anything else. In the medicinal treatment of dyspepsia a host of remedies are in vogue. Acids (especially nitro-hydrochloric acid), either before or after meals, bitters (such as quinine, calumba, gentian, quassia, and hops), and nux vomica increase the appetite and aid digestion. Pepsin is a valuable adjuvant. Nausea and vomiting may be checked by hydrocyanic acid, chloroform, and creasote in very small doses, or by ice and alkalies. Hyposulphite of soda, sulphurous acid, and carbolic acid act well when the vomiting depends on fermentation. For flatulence, bismuth, cardanoms, charcoal, sulpho-carbolate of sodium, hot water, and many other remedies are in use. For the pain in the stomach the subnitrate of bismuth in drachm doses has a well-merited reputation. Spirits of chloroform, followed by hot water, may also be used. The subcutaneous injection of morphia gives effectual relief for the time, but it should not be employed without advice. In nervous dyspepsia, hydrochlorate of cocaine in doses of a quarter of a grain has lately been used with success.