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Health Column


By Salvador Quiroz


Indigestion: Does it Always Indicate Infection?


Indigestion is a term frequently used by patients to describe a variety of symptoms that are, for the most part, very non-specific. To some patients, indigestion refers to actual abdominal pain, pressure, or heartburn. Others may use the term to describe a vague feeling that digestion has not proceeded naturally. Others describe intolerance to specific foods. Still others may use it to describe belching, a feeling of excessive gas, or flatulence with or without nausea and diarrhea. All these terms may be confusing, especially since they may not have the same meaning to physicians as they do to patients. Thus, thorough questioning on the part of the doctor is necessary.

In some patients, specific foods appear to be related to indigestion. Citrus fruit and spicy food often provoke symptoms in persons prone to peptic ulcer disease or gastritis. Other foods may be poorly tolerated because of impaired intestinal digestion, such as fatty foods in patients with pancreatic or biliary tract disorders.

Patients may have a deficiency, either congenital or acquired, of a specific enzyme required for the digestion and absorption of a certain nutrient. A typical example is lactase deficiency. Lactase is the enzyme needed to metabolize milk products. In lactase-deficient persons, the ingestion of milk results in abdominal cramps, distention, diarrhea, and flatulence. Sucrose may lead to similar symptoms in persons with hereditary sucrose-isomaltase deficiency. Adding yeast cells to your diet, in the form of acidophilus, is usually enough to ameliorate this deficiency syndrome.

We all know of allergic reactions, that are usually immediate, initiated by some foods and food additives. What few people know, however, is that hypersensitivity reactions can be delayed hours or even days after the ingestion of the responsible agent. This delayed reaction may be associated with, among other things, joint and muscle pain, as well as fatigue. For obvious reasons, discerning the association between the symptoms and the ingestion of specific foods is quite difficult.

Also, certain foods are known to cause direct toxic effects on the intestine. Such is the case with gluten in a disorder labeled celiac sprue. A gluten-free diet for these patients usually solves their problems.

In most instances, we do not understand the mechanism by which indigestion is associated with eating certain foods. What we do know is, as in most things, there are grades or levels of severity in the defective digestion of foods and food additives.

In our next column, we will continue our analysis of this interesting, complex, and certainly very frequent problem.

Dr. Salvador Quriroz, internal Medicine and Kidney Disease. Mayo Clinic, Tel: 152 2329.


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