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Signs of bad indigestion: What Causes Indigestion (Dyspepsia)? – Symptoms


Indigestion – causes, treatment | Southern Cross NZ

Indigestion refers to symptoms of discomfort in the upper abdomen during and after a meal, including pain or burning and uncomfortable fullness. It is not a distinct condition but may be a sign of a digestive tract disease. Treatment for indigestion not caused by an underlying disease may involve lifestyle changes and medication.

General information

Indigestion – also known as dyspepsia – is a collective term for a set of digestive symptoms that are experienced during and after eating a meal or drinking. It is a common condition which may affect one in four people.

There are three different types of indigestion:

  • Occasional —occurring infrequently
  • Chronic—occurring daily for a few weeks or months
  • Functional—chronic symptoms without a definite cause.


There are many causes of indigestion, most of which are related to lifestyle. Common causes include:

  • Eating too quickly or too much during a meal
  • Spicy, fatty, or greasy foods
  • Acidic foods, such as tomatoes, tomato products, and oranges
  • Too much alcohol, coffee, and caffeinated or carbonated drinks
  • Stress and anxiety
  • Smoking
  • Some medications, including certain antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), and iron supplements.

Indigestion can be related to health problems and digestive tract conditions, including:

Indigestion for which no obvious cause can be identified is known as functional dyspepsia. It is thought to be associated with inflammation of the upper digestive (gastrointestinal) tract and bowel movement dysfunction, which may be triggered by an infection or allergic response, or a change in the composition of the bowel microbiome (microbial flora).

Signs and symptoms

The following are signs and symptoms of indigestion:

  • Feeling full without having eaten much of a meal and possibly being unable to finish a meal
  • A feeling of uncomfortable fullness after a meal, which may be long-lasting
  • Mild to severe pain in the upper abdomen (the area between the bottom of the breastbone and the navel)
  • Burning sensation in the upper abdomen
  • Bloating in the upper abdomen
  • Burping or belching, including bringing up food or bitter-tasting fluid
  • Feeling sick and wanting to vomit (i. e. nausea)

Indigestion can be confused with heartburn (acid reflux or GERD), which is another type of digestive condition, and some people with indigestion also experience heartburn. In contrast to indigestion, which is felt in the upper abdomen, heartburn is a pain or burning sensation that is felt in the centre of the chest and which may spread into the neck or back during or after eating.

You should consult your doctor if indigestion persists for more than two weeks. If indigestion is accompanied by any of the following symptoms, you may have a more serious condition and should contact your doctor right away:

  • Shortness of breath, sweating, or chest pain that spreads to the jaw, neck, or arm
  • Chest pain triggered by physical exertion or stress
  • Severe and constant abdominal pain
  • Repeated vomiting or vomiting with blood
  • Black, tar-like stools
  • Difficult or painful swallowing that gets progressively worse
  • Loss of appetite or unintended weight loss
  • Fatigue or tiredness, which suggests anaemia.


A diagnosis of indigestion can usually be made based on a review of a person’s symptoms and medical history, and a physical examination.

An upper gastrointestinal endoscopy and other tests may be recommended for people whose indigestion began suddenly and who have severe symptoms, people with indigestion who are older than 55 years, or people with indigestion of any age who also have:

  • A family history of cancer
  • Difficulty swallowing
  • Evidence of bleeding in the digestive tract
  • Frequent vomiting
  • Weight loss.

An upper gastrointestinal endoscopy checks for abnormalities in the upper digestive tract. A tissue sample (biopsy) may be taken for analysis to look for digestive tract diseases and conditions.

Other tests may include:

  • Laboratory tests, to check for metabolism disorders
  • Blood, breath, and stool tests, to check for presence of H. pylori.
  • Imaging tests (X-ray or CT scan), to check for intestinal obstruction and digestive tract abnormalities. 


Treatment for indigestion depends on the cause and may include lifestyle changes, over-the-counter and prescription medications, and psychological therapies.

Lifestyle remedies

Lifestyle changes that may help to relive the symptoms of indigestion include:

  • Avoiding foods that trigger indigestion
  • Eating smaller more-frequent meals instead of three large meals a day
  • Chewing food slowly and thoroughly
  • Reducing or eliminating the use of alcohol, caffeine, and carbonated beverages
  • Quit smoking
  • Avoiding, reducing, or finding alternatives for medications (e.g. NSAIDs) that trigger indigestion
  • Losing weight if overweight/maintaining a healthy weight
  • Exercising regularly
  • Reducing stress and anxiety.


Medications may help to relieve symptoms of persistent indigestion. Antacids you can buy at a pharmacy and some other retail outlets – e.g. calcium carbonate and sodium bicarbonate, which neutralise stomach acid, and simethicone, which reduces bloating – are generally the first options to consider.

Other pharmacy-only and prescription medications could also be beneficial, including:

  • Proton pump inhibitors (PPIs), such as omeprazole and pantoprazole, which act by reducing stomach acid
  • h3-blockers, e.g., cimetidine, famotidine, which can also reduce stomach acid
  • Prokinetics, such as metoclopramide, which help empty the stomach more quickly
  • Antibiotics, such as clarithromycin and metronidazole, if H. pylori is causing your indigestion
  • Antidepressants or anti-anxiety medications, e.g., tricyclic antidepressants, which may ease the discomfort from indigestion by decreasing your sensation of pain.

Psychological therapies

Psychotherapy (taking therapy) may be recommended to help treat anxiety and depression that may be causing your indigestion. Meditation, mindfulness and relaxation exercises, and counselling may also be beneficial in controlling stress and anxiety.


Mayo Clinic (2016). Indigestion (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/indigestion/symptoms-causes/syc-20352211 [Accessed: 10/05/18]

National Institute of Diabetes and Digestive and Kidney Diseases (2016). Indigestion (Dyspepsia) (Web Page). Bethesda, MD: National Institutes of Health (NIH). https://www.niddk.nih.gov/health-information/digestive-diseases/indigestion-dyspepsia [Accessed: 10/05/18]

NHS Choices (2016). Indigestion (Web Page). Redditch: National Health Service (NHS)

England. https://www.nhs.uk/conditions/indigestion/ [Accessed: 10/05/17]

O’Toole, M. T. (Ed.) (2013). Dyspepsia. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.

Talley, N.J., Goodsall, T., Potter, M. (2017). Functional dyspepsia. Aust Prescr. 2017; 40(6): 209-213.

Updated: May 2018



Heartburn | HealthLink BC

Topic Overview

Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis. It is not caused by problems with your heart, although sometimes heart problems can feel like heartburn. See a picture of heartburn.

Heartburn may cause problems with swallowing, burping, nausea, or bloating. These symptoms can sometimes last up to 2 hours or longer. In some people, heartburn symptoms may cause sleep problems, a chronic cough, asthma, wheezing, or choking episodes.

Heartburn usually is worse after eating or made worse by lying down or bending over. It gets better if you sit or stand up.

Almost everyone will have troubles with heartburn now and then.

Heartburn occurs more frequently in adults than in children. Many women have heartburn every day when they are pregnant. This is because the growing uterus puts increasing upward pressure on the stomach.

Symptoms of heartburn and symptoms of a heart attack may feel the same. Sometimes your heartburn symptoms may mean a more serious problem and need to be checked by your doctor.

Dyspepsia is a medical term that is used to describe a vague feeling of fullness, gnawing, or burning in the chest or upper belly, especially after eating. A person may describe this feeling as “gas.” Other symptoms may occur at the same time, such as belching, rumbling noises in the abdomen, increased flatus, poor appetite, and a change in bowel habits. Causes of dyspepsia can vary from minor to serious.

Causes of heartburn

Heartburn occurs when food and stomach juices back up (reflux) into the esophagus, which is the tube that leads from the throat to the stomach. This process is called gastroesophageal reflux. Common causes of reflux include:

  • Incomplete closing of the valve (the lower esophageal sphincter, or LES) between the esophagus and the stomach.
  • Foods and drinks, such as chocolate, peppermint, fried foods, fatty foods, sugars, coffee, carbonated drinks, and alcohol. After heartburn occurs, the backflow of stomach juices can cause the esophagus to become sensitive to other foods, such as citrus fruits, tomatoes, spicy foods, garlic, and onions. Eating these foods may cause more heartburn.
  • Pressure on the stomach caused by obesity, frequent bending over and lifting, tight clothes, straining with bowel movements, vigorous exercise, and pregnancy.
  • Smoking and use of other tobacco products.
  • Prescription and non-prescription medicines, such as aspirin, ibuprofen, prednisone, iron, potassium, antihistamines, and sleeping pills.
  • A hiatal hernia, which occurs when a small portion of the stomach pushes upward through the diaphragm, which is the muscle that separates the lungs from the abdomen.
  • Stress, which can increase the amount of acid your stomach makes and cause your stomach to empty more slowly.

Severity of heartburn

Mild heartburn occurs about once a month. Moderate heartburn occurs about once a week.

Severe heartburn occurs every day and can cause problems such as trouble swallowing, bleeding, or weight loss. Heartburn with other symptoms, such as hoarseness, a feeling that food is stuck in your throat, tightness in your throat, a hoarse voice, wheezing, asthma, dental problems, or bad breath, may be caused by a more serious problem, such as gastroesophageal reflux disease (GERD). A persistent inflammation of the lining of the esophagus occurs in GERD and can lead to other health problems. Heartburn may also be related to an infection with Helicobacter pylori (H. pylori) bacteria.

Persistent heartburn symptoms can be a sign of a more serious medical condition, such as severe inflammation of the esophagus or cancer of the stomach or esophagus.

Heartburn is more serious when it occurs with abdominal pain or bleeding.

  • Abdominal pain, especially pain located directly below the breastbone, may be a sign of more serious problems, such as heart disease, peptic ulcer disease, gallbladder disease, a tear in the esophagus, or inflammation of the stomach (gastritis). For more information, see the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
  • Vomiting of blood may mean bleeding in the digestive tract, often from the esophagus or stomach. If you have bleeding in the esophagus, stomach, or part of the small intestine attached to the stomach (duodenum), stools may be dark red or black and tarry. Large amounts of bleeding can lead to shock, a life-threatening condition. For more information, see the topic Nausea and Vomiting, Age 12 and Older.

Heartburn in children

Almost all babies spit up, especially newborns. Spitting up decreases when the muscles of the esophagus, which is the muscular tube that connects the throat to the stomach, become more coordinated. This process can take as little as 6 months or as long as 1 year. Spitting up is not the same thing as vomiting. Vomiting is forceful and repeated. Spitting up may seem forceful but usually occurs shortly after feeding, is effortless, and causes no discomfort.

Children who vomit frequently after eating during the first 2 years of life have increased chances of having heartburn and reflux problems, such as GERD, later in life. Children with reflux problems also have increased chances of other problems, such as sinusitis, laryngitis, asthma, pneumonia, and dental problems. For more information, see the topic Nausea and Vomiting, Age 11 and Younger.


The treatment of heartburn depends on how severe your heartburn is and what other symptoms you have. Home treatment measures and medicines that you can buy without a prescription usually will relieve mild to moderate heartburn. It is important to see your doctor if heartburn occurs frequently and home treatment does not relieve your symptoms.

Check Your Symptoms

Do you have heartburn?

This is a feeling of burning, warmth, heat, or pain just behind your breastbone. It is sometimes called indigestion, acid reflux, or sour stomach.

How old are you?

3 years or younger

3 years or younger

4 to 11 years

4 to 11 years

12 to 55 years

12 to 55 years

56 years or older

56 years or older

Are you male or female?

Why do we ask this question?

The medical assessment of symptoms is based on the body parts you have.

  • If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Are you pregnant?

Yes, you know that you’re pregnant.


No, you’re not pregnant, or you’re not sure if you’re pregnant.


Do you have moderate or severe belly pain?

This is not the cramping type of pain you have with diarrhea.

Are you nauseated or vomiting?

Nauseated means you feel sick to your stomach, like you are going to vomit.

Are you having trouble swallowing?

Can you swallow food or fluids at all?


Able to swallow food or fluids


Unable to swallow food or fluids

Do you have heartburn pain?

This may be a feeling of burning, warmth, heat, or pain that starts in the upper belly and spreads upward into your throat.

How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine?

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Have you tried home treatment or taken any medicines for the heartburn?

Has home treatment helped with the heartburn?


Heartburn has improved with home treatment


Heartburn has improved with home treatment

How long have you had heartburn?

Less than 1 week

Less than 1 week

1 week to less than 2 weeks

1 week to less than 2 weeks

2 weeks or longer

2 weeks or longer

Do you think that a medicine could be causing the heartburn?

Think about whether the heartburn started after you began taking a new medicine or a higher dose of a medicine.


Medicine may be causing heartburn


Medicine may be causing heartburn

In the past few weeks, have you been losing weight without trying?


Has been losing weight without trying


Has been losing weight without trying

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines and natural health products can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of a heart attack may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Light-headedness or sudden weakness.
  • A fast or irregular heartbeat.

The more of these symptoms you have, the more likely it is that you’re having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, or a strange feeling in your chest or other areas.

Many prescription and non-prescription medicines can cause heartburn. A few examples are:

  • Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
  • Antibiotics.
  • Steroids, such as prednisone.
  • Some heart medicines.

Caffeine and alcohol also can cause heartburn.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Nausea and Vomiting, Age 12 and Older

Abdominal Pain, Age 11 and Younger

Pregnancy-Related Problems

Nausea and Vomiting, Age 11 and Younger

Abdominal Pain, Age 12 and Older

Home Treatment

Home treatment, such as lifestyle changes and non-prescription medicines, may be all that is needed to treat mild to moderate heartburn. But if your symptoms do not get better with home treatment, or if your symptoms occur frequently, see your doctor to find out whether other medical conditions may be causing your symptoms.

Keep a record of your heartburn symptoms before and after making lifestyle changes or using non-prescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record .

Medicines to treat heartburn

If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant. For more information, see the topic Pregnancy-Related Problems.


Many people take non-prescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.

  • Antacids such as Tums neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
  • Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
  • Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can’t take aspirin. It may make your tongue or stools black. The black colour is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. Ask your doctor if your child younger than age 12 should take this medicine.

Antacids work faster than acid reducers (h3 blockers), but their effect does not last more than 1 to 2 hours. h3 blockers can provide relief for up to 12 hours.

Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your body absorbs other medicines.

Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.

If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.

Stomach acid reducers

h3 blockers

Histamine receptor (or h3) blockers, decrease the amount of acid that the stomach makes, which may reduce irritation to the stomach lining and decrease heartburn. Some examples of non-prescription acid reducers are Pepcid AC, Zantac 75, and Axid AR. Talk with your doctor if you take an h3 blocker for more than 2 weeks.

Proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole (for example, Losec), reduce stomach acid and effectively treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten better with other home treatment measures, antacids, or h3 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn. PPIs are not available without a prescription.

Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor before you take a non-prescription acid reducer.

Symptoms to watch for during home treatment

Call your doctor if any of the following occur during home treatment:

  • Heartburn is not relieved by home treatment and medicine.
  • Swallowing problems are not improving.
  • You continue to lose weight for no reason.
  • Your symptoms become more severe or frequent.


You can make changes to your habits and lifestyle to prevent your symptoms of heartburn. Here are some things to try:

  • Change how you eat.
    • It’s best to eat several small meals instead of two or three large meals.
    • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren’t a good idea.
    • Chocolate, mint, and alcohol can make heartburn worse. They relax the valve between the esophagus and the stomach.
    • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make heartburn symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
  • Do not smoke or chew tobacco.
  • If you get heartburn at night, raise the head of your bed 15 cm (6 in.) to 20 cm (8 in.) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
  • Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 2 to 5 kilograms can help. For more information, see the topic Weight Management.

Preparing For Your Appointment

To prepare for your appointment, see the topic
Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

  • What are your main symptoms? Report any symptoms, such as abdominal pain, a change in bowel habits, or vomiting.
  • How long have you had heartburn?
  • Have you had this problem before? If so, do you know what caused the problem at that time? How was it treated? How did you respond to that treatment?
  • Have you had any signs of bleeding from your digestive system?
  • Have you had any difficulty swallowing when you eat or drink?
  • How much tobacco do you use? How much alcohol do you drink? How much caffeine do you drink?
  • Has your weight increased or decreased more than 2 kg (5 lb) recently?
  • Have there been any changes in your diet? Are you eating certain foods more often?
  • Have there been changes in your daily schedule, such as when you eat and when you go to bed?
  • Are you taking any non-prescription or prescription medicines? Bring a list of all the medicines you are taking to your appointment.
  • What home treatment measures have you tried? Did they help? Be sure to include lifestyle changes you have made.
  • What non-prescription medicines have you taken or used to treat your heartburn? Did they help?
  • Do you have any health risks?

It will be easier to make lifestyle changes if your family understands the reasons for the changes. Take a friend or family member to the appointment with you, and discuss diet and sleeping habits with your doctor.

Remember to take your heartburn symptom record to your doctor visit. Be sure to note any lifestyle changes you have made or non-prescription medicines you use.


Current as of:
June 26, 2019

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
E. Gregory Thompson MD – Internal Medicine
H. Michael O’Connor MD – Emergency Medicine

Current as of: June 26, 2019

Author: Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & H. Michael O’Connor MD – Emergency Medicine

Everything you ever wanted to know about indigestion (but were too bloated to ask) | Health & wellbeing

Most of us, particularly at this time of year, recognise the symptoms of indigestion: feeling sick, pain at the top of the abdomen (dyspepsia) or behind the breastbone (heartburn) and lots of burping. You may also feel bloated and particularly full up, even after eating small meals. About a fifth of adults in the developed world get recurring bouts of indigestion that can be distressing and debilitating. There may be an obvious trigger – such as a vindaloo washed down by five pints – but, equally, there may not be anything obvious.

A specific cause is rarely found, even if you have a tube threaded down your throat and into your stomach (an endoscopy) to have a good look around. People often worry about having underlying cancers, but if there are no other worrying symptoms, such as weight loss, difficulty swallowing or repeated vomiting, the risk is extremely low. Drugs that switch off acid production in the stomach, block pain messages to the brain or eliminate the gastrointestinal bacteria Helicobacter pylori (HP) can work wonders. Exercise, relaxation therapies and acupuncture may also help, though the evidence is scarce. Cutting out obvious triggers (such as alcohol, spicy foods and painkillers) makes sense – but, then again, this may not be the easiest month to try.

It feels as if I’m having a heart attack

That’s because the brain finds it hard to distinguish whether pain is coming from the heart or from the stomach and oesophagus. It can be hard to know the difference and, if you are really worried, it’s best to seek urgent medical help. A heart attack may start when you’re exerting yourself – using a treadmill or having sex, for instance. It will usually be a pressure, ache or tight band of pain on the left side of your chest. It can then spread up to your neck and jaw and make you breathless, faint and sweaty. Indigestion (confusingly called “heartburn”) typically starts in the upper abdomen and moves up behind your breastbone. It gets worse when you lie down or bend over because that causes stomach acid to reflux up into the oesophagus. You get a sour taste in your mouth if the acid reaches that far. Antacids (such as Gaviscon or Rennie) that neutralise acid help the pain. If you’ve had it for years, it’s clearly more likely to be indigestion than a heart attack.

My GP says I need tests. Why?

Your GP might want to make sure you haven’t got a specific underlying problem causing inflammation of the lining of oesophagus, stomach or the duodenum, the first part of the intestine. This section of the gut is called the upper gastrointestinal tract or UGI. Inflammation there might be due to acid reflux (gastrooesophageal reflux disease, or Gord), ulcers, the effects of drugs (such as ibuprofen), bacterial infection (by HP, for example) or, rarely, a cancer. The tests will include a blood test for anaemia, stool test for HP and referral for endoscopy for a direct view. You’re more likely to have them if you’re over 50, or have developed persistent indigestion recently that is getting worse.

The tests are clear but I’m still in pain

Sixty percent of people with recurrent dyspepsia don’t have signs of inflammation of the oesophagus (oesophagitis) or stomach (gastritis). There are no ulcers or cancers to be seen. Experts call this functional dyspepsia (FD) and think it’s due to unusual sensitivity of the nerves of the oesophagus and stomach. Tests for the bacteria HP, which is associated with inflammation, are usually negative. Even if HP is found, getting rid of it may not cure the symptoms, though family physican Professor Nigel Flook, of the University of Alberta in Canada, says it’s worth a try. “Treatment of HP can bring lasting relief for a small portion of dyspepsia sufferers.”

So, my gut is highly strung. What can I do?

It may help to know that although functional dyspepsia’s a pain, it’s not dangerous. A one-month trial of acid-suppressing treatment (proton pump inhibitors or PPIs) is often prescribed. Dr Alex Ford, a gastroenterologist at the University of Leeds, says that low-dose amitriptyline (used in the past, in much higher doses, to treat depression) can work well as it reduces pain signals to the brain.

Should I change my lifestyle?

The National Institute for Health and Care Evidence (Nice) recommends lifestyle changes such as losing weight if you’re overweight, cutting down alcohol, eating regular meals and giving up smoking. But according to Flook, it’s hard to predict what, if anything, will help. “The measures that make a difference to dyspepsia are a very individual matter. Possible triggers include eating large and late meals, caffeine, alcohol, fatty meals, NSAIDs [non-steroidal anti-inflammatory drugs such as ibuprofen] and other medications.” Exercise, relaxation techniques, psychological therapies and acupuncture may help, but evidence is hard to come by because it hasn’t been a research priority, says Ford. Special diets, such as ones low in short-chain carbohydrate Fodmaps (fermentable, oligo-, di-, mono-saccharides and polyols) that can help people with irritable bowel syndrome, need further research to see whether they will help those with dyspepsia.

Is acupuncture worth a try?

Acupuncturist Rhiannon Griffiths naturally thinks so: “Using a combination of acupuncture points on the legs, feet, hands, arms or tummy to re-regulate the correct flow of energy in the body can settle down the stomach, help digestion and calm irritable bowel syndrome. In Chinese medicine we also see the stomach like a cauldron – warm and bubbling away, so it’s important, especially in winter, to avoid putting cold or raw foods into the stomach as this brings the temperature down too much. The stomach then has to work really hard and expend all its energy in bringing it back up to optimum temperature for best digestion. This can leave you feeling lethargic, with indigestion, or even loose bowels.” No robust evidence has been found for the use of acupuncture in treating functional dyspepsia, though it is unlikely to cause harm.

Why is my indigestion worse after fried foods?

It’s possible you may have gallstones. The symptoms are very similar to dyspepsia: bloating, burping and pain in the upper abdomen. Gallstone pain may be worse after a fatty meal, starts 30 minutes to two hours after eating and is worse on the right-hand side where the gallbladder and liver lie. Your GP can organise an ultrasound scan that will inform diagnosis. If you’ve got lots of stones, you can have your gallbladder removed.

I’m terrified of cancer. What should I look out for?

Most people with indigestion don’t have cancer. These are the warning signs that should make you get urgent medical help: unexplained vomiting, bleeding, anaemia, weight loss and difficulty swallowing. But, remember: if you take 100 people with these alarm symptoms, fewer than four will turn out to have cancer, and only 13 will have some serious problem such as a bleeding ulcer.

Confusing or Ambiguous Upper Gut Symptoms

By choosing the appropriate test, a doctor can make a precise diagnosis of a structural upper gut disorder, such as esophagitis or peptic ulcer, by recognizing the diseased area. The patient’s history provides the information that permits the doctor to choose the right test.

In the case of the disorders of gastrointestinal function, such as dyspepsia or non-cardiac chest pain, there is no structural abnormality and no diagnostic test. Hence, diagnosis of these disorders depends even more upon how the patient describes his or her symptoms.

Many people use words to describe their gut symptoms that are vague or misleading. Since these terms are unhelpful in identifying the problem they should be avoided or explained carefully. The following are some examples.


A medical dictionary defines indigestion as “incomplete or imperfect digestion, usually accompanied by one or more of the following symptoms: pain, nausea and vomiting, heartburn and acid regurgitation, accumulation of gas and belching.” I have even heard the term used to denote diarrhea and constipation. Apparently indigestion can include almost any gut symptom. Consequently the term is of little use to a doctor trying to analyze a patient’s history in order to make a diagnosis or plan appropriate tests. For this reason the term is best avoided.

Dictionaries state that dyspepsia is a synonym for indigestion, which again is unhelpful. Gastroenterologists have defined dyspepsia more narrowly as a “pain or discomfort centered in the upper abdomen.” Such a pain is found in peptic ulcer disease or non-ulcer dyspepsia and must be differentiated from pains of other upper abdominal complaints. Dyspepsia is a symptom complex or diagnosis recognized by doctors, but unhelpful when trying to describe symptoms.

Learn more about functional dyspepsia

Thus neither indigestion nor dyspepsia are of any diagnostic use, and a person should avoid these terms in a medical interview.

It is preferable to describe in a few words the characteristics of the actual pain, discomfort, or gastrointestinal upset in order to help doctors determine what part of the gut is dysfunctioning and what the diagnostic possibilities might be.


Every human gastrointestinal tract contains gas that occasionally escapes through the mouth or anus. However, gas has come to mean different things to different people.

Someone who belches or burps feels “full of gas.”

Another person suffering the release of gas from the other end may use the term gas euphemistically, too embarrassed to describe gas escaping from the anus – and too discreet to use a slang term.

Still another may feel bloated or distended and say they are “full of gas.” Worsening during the day, the connection of this symptom with intestinal gas is poorly understood.

Noises from the stomach, frequently described as growling or grumbling sounds, are known medically as borborygmi. These sounds are the result of air gurgling with liquids as it passes through the ever-moving intestines.

Fortunately these gas scenarios are seldom signs of serious disease. Nevertheless, they can be annoying and worrying, so it is important that the doctor know how the symptoms of gas manifest so he or she can interpret the complaint.

Learn tips about controlling intestinal gas


Nausea is “the unpleasant feeling of sickness that often precedes vomiting.” It’s not that nausea is imprecise – we all know what it feels like.

The problem is that nausea is associated with so many disorders and circumstances that by itself it has no diagnostic significance. Seasickness or the nausea of pregnancy are obvious only if the doctor knows the appropriate history. Nausea very often, but not always, precedes or accompanies vomiting.

The disorders causing nausea are as varied as motion sickness (middle ear), intestinal obstruction, diseases affecting the brain, drug side effects, hormonal changes, and fright or anxiety states. Sometimes the sight of a food can nauseate.

If a person’s main complaint is nausea, only the associated circumstances, symptoms, and medications can help the doctor search for the cause.


Vomiting seems an easy symptom to understand. It is the return of gastric contents including food and gastric acid from the stomach through the mouth.

However, there are some lesser-known symptoms sometimes confused with vomiting. Regurgitation of acid and food into the esophagus may occur due to a weakness in the lower esophageal sphincter. This is called gastroesophageal reflux – the fundamental abnormality underlying GERD. Unlike vomiting, the regurgitated material returns to the stomach without being ejected through the mouth. In both cases the person may experience heartburn as a result of the acid in the esophagus.

Learn more about gastroesophageal reflux disease

A rarer type of regurgitation is known as rumination. Here a person regurgitates the meal from the stomach into the mouth and then swallows it again with neither discomfort nor concern. The meal is returned promptly before it is mixed with acid, so the person suffers no heartburn.

Learn more about rumination syndrome in children and adolescents

Sometimes excess production of saliva by glands in the mouth may accompany upper abdominal symptoms such as nausea or heartburn. Unlike vomiting, the saliva does not burn and is usually swallowed. This is known as waterbrash.

Hiatal Hernia

In many people, the junction between the esophagus (food pipe) and stomach “herniates” up through the diaphragm into the chest cavity. This phenomenon may be temporary or permanent, and is often cited as one of the causes of gastroesophageal reflux disease (GERD). However, hiatal hernia [also referred to as hiatus hernia] is an anatomical abnormality, not a symptom, and its presence or absence does not equate with the symptoms of GERD.

Learn more about symptoms of GERD

Rather than describing “my hiatal hernia,” it is more precise to describe the sensation itself. The most common symptom is heartburn – a burning sensation behind the breastbone. A careful description of heartburn, and noticing what makes it worse (lying down, large meals, effort, etc) is very helpful to a physician who will diagnose it as GERD, not hiatal hernia.

Learn more about GERD, hiatal hernia, and surgery

Chest Pain

There are many causes of chest pain, some very serious, and few are connected to the gut.

The primary concern is that chest pain might be due to heart disease. That is why it is very important to be as precise as possible about the nature of the symptom. Is the pain worse after exercise? Does it occur when walking a certain distance, disappear with rest, and then recur when the certain distance is walked again?

Pain resulting from injury to the muscles or bones of the chest wall will worsen with certain movements of the trunk. Pleurisy, an inflammation of the lining of the lung, will be sharply worse with inhaling or exhaling.

If the pain is due to esophageal disease, then a relationship with swallowing, with meals, or an association with acid regurgitation is usually present. Characteristically, acid-related pain is relieved by antacids and most dramatically by the proton pump inhibitors.

The details surrounding upper gut symptoms are often very important in arriving at a correct and timely diagnosis. Therefore describe symptoms such as chest pain with care. None of these are specific, however, and further evaluation is always required – cardiac disease must be ruled out. Your life could depend upon it.

Adapted from IFFGD Publication #524 by W. Grant Thompson, MD, Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada

Unusual Symptoms and GERD – About GERD

Chronic heartburn is the most common symptom of GERD. Acid regurgitation (refluxed material into the mouth) is another common symptom. But numerous less common symptoms other than heartburn may be associated with GERD.

These less common symptoms may include:

  • Belching
  • Difficulty or pain when swallowing
  • Waterbrash (sudden excess of saliva)
  • Dysphagia (the sensation of food sticking in the esophagus)
  • Chronic sore throat
  • Laryngitis
  • Inflammation of the gums
  • Chronic irritation in the throat
  • Hoarseness in the morning
  • A sour taste
  • Bad breath

The good news is that these symptoms often are very responsive to medical therapy and minor changes in lifestyle, and they rarely become lifelong problems.

Some Less Common GERD Symptoms

Sore Throat, Cough

Nocturnal reflux, especially after late-night food or alcohol intake, may reach the throat without waking you up. The refluxed gastric contents irritate sensitive tissues causing a sore throat, a need to “clear the throat,” and cough.

If due to reflux, a sore throat and cough is usually easily prevented by avoiding late night eating and drinking, and employing other anti-reflux measures.

Acid Laryngitis

Occasionally, gastric juice may reflux through the esophagus and upper esophageal sphincter and spill into the larynx, or voice box. The ensuing inflammation causes laryngitis and hoarseness. Damage to the larynx is sometimes visible through a scope.

Diagnosis may be difficult. Sometimes there is no heartburn to warn the individual of a reflux episode.

In some people this symptom improves using a proton pump inhibitor (PPI). More importantly, the individual should undertake the lifestyle changes necessary to minimize reflux.

Nocturnal Choking

Some people awake an hour or so after going to be with attacks of choking and retching. Acid and sometimes food appear in the throat and there is severe burning.

Heartburn may or may not be present. These attacks are distressing and the burning throat may take hours to settle down.

Avoiding late night eating and drinking may again be helpful. People with sleep apnea are particularly prone to this type of attack.

Tooth Problems

There are several reports, mostly in children, which suggest that stomach acid can cause problems with tooth enamel. However, this appears to be extremely rare


There is controversy about whether GERD can contribute to chronic sinusitis, although most of the data suggests that there is no relationship. It is more likely that sinusitis and GERD are confused with each other, rather than that GERD causes the sinusitis. Both problems can be associated with sore throats, and chronic cough.

Aspiration Pneumonia

Debilitated or elderly persons may have reduced sensitivity in the throat. This may reduce the usual antireflux defenses and permit some individuals to breath in (aspirate) regurgitated material into their lungs. The result is a chemical pneumonia quickly followed by infection with opportunistic organisms.

People who are semi-conscious may be more prone to aspirate, but in healthy individuals this occurrence is rare.


There is a relationship between non-allergic (non-seasonal) asthma and GERD. Respiratory symptoms such as coughing or wheezing produce reflux by sudden, violent pressure changes in the chest and abdomen. Reflux also may occur during the deep inhalation taken before forceful exhalation by a person with asthma.

Conversely, acid reflux irritates the larynx and may cause a reflex constriction of the bronchi. In an individual, it is difficult to confirm that reflux causes asthma. The best proof is improvement of both reflux and asthma with anti-reflux therapy.

Adapted from IFFGD publication: Unusual Symptoms and GERD by J. Patrick Waring, M.D., Digestive Healthcare of Georgia, Atlanta, GA; and IFFGD publication: What Else Can We Attribute to GERD? by W. Grant Thompson, M.D., F.R.C.P.C., Emeritus Professor of Medicine, University of Ottawa, Ontario, Canada

Heartburn, Acid Reflux, GERD: When Should You Worry?

It happens to almost all of us at some point—we feel that burning sensation in the chest after a glass of wine, a dinner of spaghetti and meatballs, or that late-night bowl of potato chips. It’s heartburn, and you feel it when acid from the stomach spills into the esophagus, which is called acid reflux. It can be quite painful.

“Heartburn can be severe enough to be mistaken for chest pain or a heart attack,” said Emil Graf, MD, a general and bariatric surgery specialist at Banner Health in Arizona.

Heartburn and acid reflux are also both symptoms of gastrointestinal reflux disease (GERD). “It’s the same disease process,” Dr. Graf said.

According to the National Institutes of Health, certain foods often trigger symptoms:

  • High-acid foods like citrus fruits and tomatoes
  • Alcohol
  • Chocolate
  • Coffee/caffeine
  • Fatty foods
  • Spicy foods
  • Mint

Watch for these signs of GERD

If you have GERD, along with heartburn you may also notice regurgitation at night. “When you lay down after eating a heavier meal or drinking water before bed, you can wake up burping up acid, or feel acid in the back of your throat or mouth. These are classic symptoms of GERD,” Dr. Graf said.

Less often, you might notice a chronic cough, hoarseness, a feeling that your voice gets tired quickly, or difficulty swallowing.

Here’s how to control your symptoms

When your symptoms flare up, there are a few things you can try:

  • Avoid foods that trigger your heartburn, especially in the afternoon or evening
  • Elevate the head of your bed to enlist gravity to help fight regurgitation
  • Take over-the-counter antacids like Tums or Rolaids, or acid suppressors such as Prilosec, Nexium, or Pepcid

When to connect with health care provider

Dr. Graf said if these tips don’t get your symptoms under control, or if you’re experiencing regurgitation, you should talk to your primary care provider or a gastroenterologist. It’s important to get treatment because GERD symptoms aren’t just uncomfortable. Acid can damage the lining of your esophagus. And over time that damage can lead to a condition called Barrett’s esophagus, which makes it more likely that you could develop esophageal cancer.

To put together a treatment plan, your doctor may start with an upper endoscopy. That’s a procedure where you’re sedated, and a surgeon puts a scope through your mouth and into your esophagus and stomach to see if the acid has caused any damage. If there’s no damage, you can likely have follow-up endoscopies when you have your colonoscopies. You can try prescription medications to control your GERD symptoms.

If your esophagus is damaged or inflamed, or if medication doesn’t get your symptoms under control, your doctor may recommend surgery. “Surgical treatments for GERD are very effective. They can give you significant relief and halt the progression of GERD,” Dr. Graf said.

The bottom line

If heartburn strikes once in a while, you can control it with over-the-counter medications and try to figure out which foods trigger your flare-ups. But if medication isn’t working or you’re regurgitating acid, talk to your doctor. Prescription medications or surgery can keep GERD from getting more serious.

A doctor can help you troubleshoot your heartburn triggers and walk through your GERD treatment options. To find a gastroenterologist, visit bannerhealth.com.

For a deeper dive into GERD, check out:

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Functional Dyspepsia – Gastrointestinal Society

Click here to download a PDF of this information.

Functional dyspepsia is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract. Peristalsis is the normal downward pumping and squeezing of the esophagus, stomach, and small intestine, which begins after swallowing. We call this disorder functional because there are no observable or measurable structural abnormalities found to explain persistent symptoms. You might hear other terms used to describe this condition, such as non-ulcer dyspepsia, pseudo-ulcer syndrome, pyloro-duodenal irritability, nervous dyspepsia, or gastritis. Various estimates suggest that 20-45% of Canadians have this condition, but only a small number will consult a physician.

The cause of functional dyspepsia is unknown; however, several hypotheses could explain this condition even though none can be consistently associated with it. Excessive acid secretion, inflammation of the stomach or duodenum, food allergies, lifestyle and diet influences, psychological factors, medication side effects (e.g., from non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen), and Helicobacter pylori infection have all had their proponents.

Symptoms of Functional Dyspepsia

The disturbed motility present in functional dyspepsia leads to amplified sensation in the upper gut (visceral hyperalgesia). This is due to uncoordinated and even ineffectual emptying of the upper digestive tract, with resulting symptoms of pain, fullness and bloating, and an inability to finish meals. Other common symptoms include heartburn, a sour taste in the mouth, excessive burping, nausea, and sometimes vomiting. Characteristically, these complaints are sporadic, poorly localized, and without consistent aggravating or relieving factors. The vast majority of those with functional dyspepsia experience more than one symptom, which may come and go. Sometimes symptoms could present with increased severity for several weeks or months and then decrease or disappear entirely for some time.

Diagnosing Functional Dyspepsia

In the past, some physicians would have diagnosed peptic ulcer disease in an individual complaining of upper middle abdominal (epigastric) pain and nausea. Now, using such investigative tools as detailed barium X-rays or gastroscopy, physicians can quickly rule out an ulcer diagnosis. After testing individuals with these symptoms, twice as many people will not have an ulcer as will have one.

A physician arrives at a diagnosis of functional dyspepsia when there is no evidence of structural disease and there have been at least three months of one or more of the following (with onset at least six months earlier):

  • bothersome post-meal (postprandial) fullness
  • early satiation
  • epigastric pain
  • epigastric burning

The role of investigations and testing in functional dyspepsia is often misunderstood. Current technology cannot confirm dysmotility and there is no definitive diagnostic test for functional dyspepsia. All conventional testing produces normal results; however, a normal result on X-ray or gastroscopy does not mean there is nothing wrong. This testing shortfall can lead to anger or frustration for individuals who continue to experience symptoms.

Management of Functional Dyspepsia

Dietary and Lifestyle Modifications

Although no evidence directly links specific foods to functional dyspepsia, it does make sense to limit or avoid foods where a symptom effect is obvious on an individual basis. Some people have reported increased symptoms when consuming excessive amounts of milk, alcohol, caffeine, fatty or fried foods, mint, tomatoes, citrus fruits, and some spices. However, there is no hard and fast rule, as irritating foods vary among individuals. Avoiding large portions at mealtime and eating smaller, more frequent meals is important to normalize upper gut motility. Following meals, it may help to avoid lying down for at least two hours.

Overweight individuals might find relief when they lose weight, as the excess bulk might put pressure on the digestive tract, affecting its function. Elevating the head of the bed by about six inches might also help, but make sure to do this by propping up the mattress or bed frame, not by using pillows. Using pillows can lead to back or neck pain and the increased bending could compress the stomach and actually worsen functional dyspepsia symptoms.


There are two main approaches to treating functional dyspepsia with medications: neutralizing acid and blocking its production.

For neutralizing acid, over-the-counter medications such as Maalox®, Tums®, and Pepto-Bismol® may subdue symptoms. Another product, Gaviscon®, neutralizes stomach acid and forms a barrier to block acid rising into the esophagus. Some find that these non-prescription antacids provide quick, temporary, or partial relief but they do not prevent heartburn. Consult your physician if you are using antacids for more than three weeks.

Two classes of medication that suppress acid secretion are histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs).

  • H2RAs work by blocking the effect of histamine, which stimulates certain cells in the stomach to produce acid. These include cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®). H2RAs are all available by prescription and some are accessible in a lower dose non-prescription formulation.
  • PPIs work by blocking an enzyme necessary for acid secretion and have the best effect when taken on an empty stomach, a half-hour to one hour before the first meal of the day. PPIs include omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole sodium (Pantoloc®), esomeprazole (Nexium®), rabeprazole (Pariet®), and pantoprazole magnesium (Tecta®). Dual delayed release PPI capsules, in the form of dexlansoprazole (Dexilant®), deliver the medication at two intervals. PPIs have emerged as the most effective therapy for relieving symptoms and improving quality of life, as well as healing and preventing damage to the esophagus. In Canada, PPIs are available only by prescription. Longer-term and multiple daily dose PPI therapy may be associated with an increased risk for osteoporosis-related fractures of the hip, wrist, or spine.

Treatments that reduce reflux by increasing lower esophageal sphincter (LES) pressure and downward esophageal contractions are metoclopramide and domperidone maleate. A plant-based prokinetic agent, Iberogast®, helps regulate digestive motility and improve symptoms.

All of the medications discussed above have specific treatment regimens, which you must follow closely for maximum effect. Usually, a combination of these measures can successfully control the symptoms of acid reflux.

Functional Dyspepsia Outlook

Functional dyspepsia is a common, long-recognized condition with a number of upper abdominal symptoms. Although diagnosing this condition can sometimes be challenging, due to the variable nature of symptoms, the prognosis for functional dyspepsia is good. There is no evidence that it leads to cancer or other serious disease. Theories as to its cause are multiple but a minor muscle motility disturbance is most likely. Typically, successful therapy involves dietary discretion and short courses of medication.

Want to learn more about functional dyspepsia?

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90,000 Treatment of generalized anxiety disorders and panic disorders (with and without agarophobia) by family physicians

This patient guide is based on the Estonian guidelines “Treatment of generalized anxiety disorders and panic disorders (with and without agarophobia) by family doctors”, approved in 2014 by the Treatment Guidelines Council, and the topics covered there along with recommendations. The recommendations for the management have been drawn up on the basis of an analysis of the evidence-based medicine literature and taking into account the needs in Estonia and the possibilities of health care, especially at the primary health care level.With early diagnosis of anxiety disorders at the primary care level and with adequate treatment, the health of the patient with excessive anxiety can be improved as well as the ability to cope with daily activities can be improved. A patient guide helps to cope with the illness, to understand the nature of the anxiety disorder, the different risk factors, gives recommendations on lifestyle and self-care that can help alleviate the illness, stimulates seeking medical help from a family doctor, explains the treatment of anxiety disorders, the effect of different groups of drugs, and psychotherapy; and the importance of ongoing treatment.The aim is also to ensure that the patient is informed about their diseases and, if possible, productive cooperation with the family doctor. These guidelines are good to use as material for individual advice and as a written source of information for both the patient and those close to him. The Patient Guidelines are written by practicing nurses who advise and treat patients with anxiety disorders every day. The guide was reviewed by psychiatrists and family physicians who participated in the development of the guide for health care professionals, as well as by patient representatives who made recommendations to this guide.

  • If, for no reason, you have severe, long-term anxiety symptoms that are uncontrollable and interfere with daily activities, including communication with other people, you should contact your family doctor or nurse.
  • Read the advice on self-help for anxiety disorders or ask your family doctor or nurse to explain the nature of the anxiety disorders, the factors that slow down and alleviate them, treatment options, the course of the disease, the possibilities for recovery, signs of exacerbation and self-help techniques.
  • In case of tension or anxiety, use self-help exercises.
  • Use self-help techniques and if they don’t work, talk to your doctor and try psychotherapy and / or medications. Both of these treatments are equally effective for treatment.
  • Cognitive Behavioral Therapy is the most widely used effective evidence-based therapy, which lasts 12-20 sessions and has fewer side effects compared to drugs.
  • If your doctor recommends treatment with antidepressants, then their intake is necessary for six months or a year, regardless of whether your condition has improved.
  • If you are prescribed sleeping pills in addition to antidepressants, use it for a short time (more than one month) to avoid dependence.
  • If you are prescribed a sedative (benzodiazepine) in addition to antidepressants to relieve severe anxiety, use it for a short time to avoid dependence (no more than six weeks from the moment you feel significant relief from your condition).

What is anxiety?

Anxiety is an integral part of modern life. In everyday life, situations often arise when the feeling of anxiety is justified. It would be abnormal if the person did not feel anxious about any situation that could actually be dangerous or could fail (such as an exam).

From an evolutionary point of view, anxiety is given an important role – to force a person to gather in order to prepare for escape.This helped to stay alive, since all not the most ongoing processes stopped, and attention was concentrated around finding a way out of a dangerous situation. The body was activated to escape, freeze and prepare for the fight. All people can feel anxiety as a reaction to stress. In some periods of life, situations or places, anxiety is felt on a different scale. For example, a little anxiety before an exam, sports competition, a trip, or a birthday is more or less familiar to everyone.

Feelings of anxiety can be manifested by various sensations – for example, tingling in the abdomen, a feeling of tension in some parts of the body or head, nausea, increased heart rate, restless thoughts, fear of losing control, fear of death. Anxiety turns into anxiety disorder when it begins to disrupt everyday life. Anxiety disorder differs from normal, normal anxiety in that the accompanying feeling of anxiety is very strong or lasts longer than (several months, does not decrease after the stressful situation has passed) and can lead to phobias that disrupt a person’s life.For example, a person is unable to fall asleep normally due to disturbed thoughts or begins to completely avoid normal situations (going to school or work, eating) that make him feel anxious. A person begins to assess the situation as dangerous when it is not such (for example, for another person).

The main symptoms of anxiety disorder are:

  • Mental symptoms: strong, unreasonable fear of a situation or object.
  • Physical symptoms: rapid breathing or heartbeat, increased blood pressure, shivering or jerking, sweating, choking, nausea, abdominal discomfort, dizziness, numbness, hot flashes.
  • Fear of death, fear of losing control of a situation or loss of mind, disorder of the sense of reality or a sense of detachment.

Figure 1. Most common physical symptoms

What is panic disorder?

A panic attack is characterized by sudden attacks of fear, which are often accompanied by a rapid heartbeat, sweating, weakness, impotence, fainting, dizziness, and increased blood pressure.During a panic attack, a person may feel hot flashes or flushes, and they may feel itching, burning, or numbness in their hands. A person may also feel nausea, chest pain, and suffocation. One of the signs of panic disorder is fear of unexplained physical symptoms. A panic attack can often manifest as feelings of unreality, fear of death, or fear of losing control. Often times, people experiencing a panic attack believe that they may have a heart attack, loss of mind, or it will put them in a state between life and death.They are not able to predict where and when a panic attack may start, in between them they are very worried and are afraid of the onset of a new attack. A panic attack can occur at any time, even during sleep. The attack reaches its peak within 10 minutes, but some symptoms may last longer.

A panic attack can be an unpleasant experience, but it is not life threatening.

Panic attacks most often begin at the border of adolescence and early adulthood.Not all people experiencing panic attacks develop panic disorder. Many have a single seizure that never recurs. The tendency for the appearance / development of panic attacks is associated with heredity. Repeated panic attacks can make people incapacitated and need to find the right treatment before they start avoiding the place and situation where they once had a panic attack. For example, if the panic attack was in an elevator, some people with panic disorder may develop a fear of elevators.This can affect the choice of work or place of residence and limit his opportunities for entertainment. Fear of elevators can also limit how you can access health care if you need to use an elevator en route to where you can get help.

Some people may become so limited in their lives that they begin to avoid normal activities such as grocery shopping or driving. About a third of these people become domestic recluses or may only come into contact with unwanted frightening situations when they are accompanied by a spouse or other confidants.If the condition develops this far, then this condition is called agoraphobia or fear of public places.

Panic disorder is a disease that can be successfully treated.

What is agoraphobia?

The word agoraphobia comes from the Greek language and means fear of openness or squares. In psychology, the main character of agoraphobia is the fear of panic attacks (Bourne 2007: 26). A person with agoraphobia fears (and avoids) situations where exit may be difficult or in the event of a panic attack it is impossible to get help. Agoraphobia is the most common anxiety disorder (about 5% of the population). Agoraphobia affects people from all social strata and spheres of the population (mostly women). The most common places where agoraphobia occurs are:

  • Crowded places, e.g. grocery stores, shopping malls, restaurants
  • Enclosed or restricted areas, e.g. bridges, tunnels
  • Public transport (bus, train, plane) • Being at home alone
  • Leaving home alone

It is important to note that people are not afraid of these places because of their signs, but because they are places where, in the event of a panic attack, it is difficult to exit or it can create an embarrassing situation.A person with agoraphobia is not only afraid of having a panic attack, but may be afraid of what other people will think when they see their panic attack.

The most common sign of agoraphobia is fear that there is no quick way out of a situation that creates an attack, as well as fear of parting with home or a trusted trusted person (spouse, roommate, parent). In the most severe cases, a person cannot move further than a meter from the house by himself or cannot leave the house at all.A person with agoraphobia is in anxiety most of the time: he is afraid not only of possible dangerous situations, but the very knowledge that he may get into such a situation. Often agoraphobia in such people is accompanied by depression, since he feels that he does not control the situation and is not able to change it in any way.

What is generalized or generalized anxiety disorder?

Generalized anxiety disorder is characterized by persistent , chronic anxiety, restlessness and tension.It usually lasts six months, but it is not accompanied by panic attacks, phobias, or obsessive thoughts. Anxiety and anxiety usually focus on several circumstances (for example, financial situation, relationships, academic / work success, etc.). It is inherent in the disorder that a person has many reasons for anxiety, he spends most of his time in anxiety and cannot take control of the situation. The scale of the experience is usually greater than the real likelihood that the anticipated events might actually happen.After constant anxiety, other additional symptoms generally appear. For example, restlessness, easy fatigue, inability to concentrate, muscle tension, sleep disorders, irritability. Generalized anxiety disorder can occur at any age and the exact cause is unknown. Most likely, its occurrence is influenced by heredity and experiences transferred in childhood (too high expectations, rejection, rejection by the parents), contributing to the onset of anxiety disorder.

If you notice a change in your mental state to such an extent that it interferes with your daily life or your loved ones have noticed it, you should contact your family doctor or nurse. If you are uncomfortable walking alone, you can take a loved one with you. The family doctor has the knowledge and ability to initiate appropriate treatment for anxiety disorder. Contact your family doctor if:

  • Anxiety symptoms last too long, for example, they persist even when the stressful situation is already in the past.
  • the symptoms of anxiety are too strong for you to be controlled.
  • along with anxiety, physical symptoms (for example, complaints of heart problems) arise, and it is necessary to monitor the general state of health.
  • alarm occurs for no particular reason.
  • all of the above began to interfere with your daily life, work, hobbies and relationship problems.
  • You want to seek help from a psychologist or psychiatrist, but do not know where, how and who to contact.

Clinical interviews or questionnaires are used to diagnose anxiety disorders. Various questionnaires (for example, the “Emotional Well-Being Questionnaire”) can be used to help clarify the different degrees of disorders.

Anxiety Self-Assessment Questionnaire

The use of an anxiety self-assessment questionnaire in the diagnosis of anxiety disorders can be helpful for a family doctor for the initial detection of the disease.Most often, the questionnaire is completed by patients themselves. Such questionnaires are suitable for use in patients who have subjective complaints (mood disorders, anxiety disorders). In most cases, it is easy for the patients to fill them in and it does not take much time. In addition, the questionnaire is filled out several times, after certain periods of time (for example, once a week, or once every two weeks, once a month), this makes it possible to get an overview of the change in your condition. A simple example of using a questionnaire is the Emotional Wellness Questionnaire.An Anxiety Self-Assessment Questionnaire can be found in Appendix 1 of this Patient Guide.

Treatment for anxiety disorders begins with talking to your family doctor or nurse. During the conversation, the nature of anxiety disorders and the factors that exacerbate and alleviate the disease are clarified. Also, methods of self-help are recommended, information is given about the possibilities of treatment and recovery, the course of the disease and signs of exacerbation.

Treatment Opportunities for Anxiety Disorders

Self-help for patients Psychotherapy Medicines
In the case of self-help, you are introduced to written or electronic self-help materials.You can work on them both independently and under the guidance of a specialist (doctor, nurse, psychologist). Self-help resources provide information on anxiety disorders and self-help techniques from which you can choose the one that suits you best. Psychotherapy is a treatment that uses psychological therapies to help create the changes in your thoughts, feelings and behavior that are necessary for recovery. In the case of anxiety disorders, cognitive behavioral therapy is considered an effective form of psychotherapy. In the treatment of anxiety disorders, antidepressants are used and, if necessary, sedatives and / or hypnotics are added to the treatment regimen.

Treatment goals

In the case of panic disorder, the main goal of treatment is to reduce the incidence and severity of panic attacks. In the case of agoraphobia, it is important to reduce the tendency to avoid places and situations that stimulate the development of severe anxiety.For generalized anxiety disorders, treatment can help reduce anxiety and feelings of tension.

Choice of treatments

During a discussion with your doctor, you should find out the most suitable treatment for you. The choice is influenced by the severity of your condition, the appropriate treatment proposed, and your preferences and options. It is advisable to use self-help techniques immediately after starting treatment. If they don’t work and your anxiety symptoms persist, your doctor may advise you to use either psychotherapy or medications that are equally effective treatments.If each of the methods of treatment separately did not give results, they can be combined.

Portability of treatment

Good cooperation between doctor and patient is a prerequisite for successful treatment Trust is a foundation for this – Patient should not be afraid to tell the doctor about the symptoms of the disorder and, if necessary, about other problems in their life. In order to obtain good treatment results, it is important that you are motivated for treatment and agree to follow the treatment plan prescribed by your doctor .It will be easier to agree to treatment if you know about the nature of the disorder, the methods of treatment, the duration of the course of treatment, the healing effects and side effects of the drugs prescribed to you, and the possible risks of addiction. Awareness of the positive results that you will receive from treatment will help motivation. Because treatment for anxiety disorders can sometimes take a long time, patience and continuity of treatment are essential.

Treatment tolerance problems

Side effects of drugs. If you start to feel severe side effects while taking the medication, do not interrupt the treatment on your own, but be sure to inform your doctor about this, who will find ways to continue the treatment or change it. Continuity of medication. If the symptoms of the disorder begin to disappear quickly with the use of drugs, the patient may want to prematurely interrupt the course of treatment. But after that, the symptoms of the disorder return again. Problems can also arise when the prescribed drugs remain unbought, if you take more or less than it was prescribed, or if you take them irregularly.You need to inform your doctor about all this, and on the basis of this data, the doctor will be able to evaluate the results of treatment, your consent to treatment and the side effects of the medication during each visit.

Do not interrupt started treatment yourself, be sure to inform your doctor about the side effects.

Visits to the doctor

Your doctor will be able to schedule appointments for you with an interval of one week to four weeks until your condition improves.In most cases, initial improvement occurs four to eight weeks after starting treatment. Further visits to the doctor may be less frequent, depending on the severity of the condition.

Knowing the physical and mental symptoms of anxiety will help you better deal with it. In case of anxiety, unfortunately, they often underestimate their capabilities and overestimate the possible danger. Self-help techniques are techniques that can help you cope with physical and mental symptoms and effectively solve your problems.All the self-help exercises in this manual can always be used when tension and anxiety arise.

  • Eat regularly and balanced
  • Reduce your intake of excess caffeine. Caffeine is found in coffee, tea, and energy drinks. Caffeine primarily affects the physical symptoms of anxiety (such as increased heart rate), which can lead to increased anxiety and panic attacks.
  • Avoid excessive alcohol consumption.
  • Smoking is recommended to quit.
  • Be physically active. Physical activity can help relieve stress and tension. Find a suitable type of aerobic activity (for example, walking, swimming, cycling, hiking, soccer, aerobics, jogging in the forest). Moderate physical activity should take at least 2.5 hours per week.
  • Take time to do what you love and pause from time to time in your daily work.

Cognitive Behavioral Therapy is the most commonly used treatment for anxiety disorders and has been scientifically proven to be effective.Cognitive Behavioral Therapy is delivered by qualified clinical psychologists and psychiatrists.
The core of cognitive therapy is the idea that thoughts have an important influence on our feelings and behavior. The events themselves have little effect on well-being, more important is what you notice during the events, what you think about them and how important you think they are. The therapist will help you recognize and understand thoughts and ideas that can be analyzed to help you.These thoughts and ideas influence how you feel – for example, make you feel anxious. The goal of treatment is to shift your thoughts into a realistic and helpful area. You will also learn during your treatment to find and change persistent thought patterns or beliefs that bring you back to anxious thoughts over and over again. For example, in the case of a panic attack, cognitive therapy helps identify the thoughts that precede the onset of a panic attack, helps to change beliefs about the danger of physical symptoms, and how to respond to these symptoms.Behavioral therapy helps change the hitherto persistent patterns of behavior that support anxiety disorders. For example, if you are afraid to be in public places and avoid them, it starts to disrupt your daily life. With therapy, you will learn not to adhere to avoidance tactics in the face of fearful situations. Anxiety may build up at first during therapy, but the therapist will teach you how to control your anxiety using breathing and relaxation techniques.

Cognitive Behavioral Therapy is a combination of both cognitive and behavioral therapy.

What happens during the course of cognitive behavioral therapy and how long does it last?

In the first session, the therapist tries with you to find a common understanding of the problem. With the help of a therapist, you will learn to see how your thoughts, beliefs, feelings, attitudes and behavior affect your daily life. You are given information about the nature of the disorder and trained to recognize the symptoms and what kind of anxiety is normal.

After that, a treatment plan and goals that you want to achieve during treatment, as well as the number of sessions required, are discussed with you. Each session lasts 50-60 minutes. Usually, therapy is carried out once a week, especially at the beginning of treatment, and less often by the end of the course of treatment. Most often, therapy lasts 12-20 sessions.

Remember that you are expected to actively participate in therapy. This means that you will be given homework assignments between sessions. For example, the therapist may ask you to fill out a diary about your thoughts during situations in which you feel anxious so that they can be analyzed later.

During therapy, you will be taught practical skills to help you keep your anxiety under control. These techniques include breathing and relaxation exercises.

Cognitive behavioral therapy is used both individually and in a group. Group therapy is also conducted under the guidance of a suitably qualified person to identify the nature of the anxiety and teach how to deal with it.

Benefits of CBT

  • An advantage of using cognitive-behavioral therapy over drugs is that there is less risk of side effects.
  • Therapy is practical by its type, with it focusing on the current problems that exist today and on the factors that support them.
  • The therapy can have a long-term positive effect, as the skills learned can be used later in life. Therefore, it is important that you apply them after your well-being has improved – they will help you to cope with normal feelings of anxiety, control the symptoms of anxiety and prevent their excessive expansion.It will also help reduce the likelihood that anxiety will return to its original level in the future.
  • Questions about therapy you can ask your family doctor
More information on CBT can be found here: Estonian Association for Cognitive Behavioral Therapy (www.ekka.ee) Peaasjad MTÜ (http://peaasi.ee/en)

Antidepressants are mainly used in the treatment of anxiety disorders, and sedatives and / or hypnotics are also used when necessary.


In general, treatment begins with antidepressants. Antidepressants are medications used to treat depression, but they are also used successfully to treat anxiety disorders.

The brain consists of many nerve cells that exchange information. This exchange of information in the brain occurs with the help of chemicals, including special messenger substances. For anxiety disorders, antidepressants are used that affect serotonin and norepinephrine levels.It has been found that messenger substances are involved in anxiety, fear and stress.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs)

These antidepressants are usually prescribed by a doctor first, that is, they are the drugs of first choice. All antidepressants used were found to be more or less equally effective. Therefore, when choosing a medicine, the doctor first of all makes a choice, taking into account the number of side effects and its price.The drug does not appear immediately, in most cases within four to eight weeks after starting treatment. Side effects can occur after the first dose of the medication, so treatment is usually started with doses less than the usual amount of medication required for treatment. The doctor increases the dose of the medicine gradually according to how you tolerate the medicine.

The SSRI group includes citalopram, etsitalopram, paroxetine, sertalin. The SSRIs group includes duloxetine and venlafaxine.

Antidepressants are not addictive. The duration of the course of treatment depends on your condition and, in addition, the frequency of side effects and withdrawal symptoms is very individual.

Most common side effects Duration of treatment End of treatment, possible withdrawal symptoms
• Nausea
• Headache
If during the course of treatment you feel a significant improvement in your well-being, then the medication should be continued for a period from six months to a year.Treatment too short increases the risk that the disorder may return. Because anxiety disorders can recur throughout life, a new course of treatment may be needed. At the end of the course of treatment, the doctor gradually reduces the dose of the medication, as withdrawal symptoms (nausea, headache, dizziness, anxiety) may occur. In most cases, these side effects are mild and go away on their own. With a sudden interruption of medication, the incidence of side effects increases.

Tips for antidepressant treatment:

  • Take your medication every day, at the exact prescribed dose and at the same time.
  • If you forget to take your medication, do so as soon as possible, but do not take a double dose.
  • If you feel any side effects of the medication, do not interrupt the treatment yourself. Some side effects disappear within a few days. If the side effects become more severe, contact your doctor.
  • Alcohol should not be taken during antidepressant treatment. This can contribute to the appearance of side effects.

Sedatives or benzodiazepines

Anxiety drugs belong to a group of drugs that reduce feelings of fear and anxiety. Medicines used to treat anxiety disorders are called benzodiazepines. In the brain, they potentiate the action of gamma-aminobutyric acid (GABA). GABA has an inhibitory effect on brain cells and therefore has a sedative effect.The sedatives include diazepam, alprazolam, lorazepam, oxazepam, bromazepam. In addition to its calming effects, sedatives relax the muscles, thus helping to reduce physical stress.

Unlike antidepressants, sedatives act faster. The incidence of possible side effects, dependence and withdrawal symptoms can be very individual.

Most common side effects Duration of treatment End of treatment, possible withdrawal symptoms
• Clouding of consciousness
• Feeling of weakness
• Long-term use may lead to tolerance or dependence (see pages 20 – 21).
i • Feeling weak • Long term use may cause tolerance or dependence (see pages 20 – 21). During an exacerbation (severe anxiety and anxiety), sedatives should be used for a short time (no more than a period of four to six weeks), unless the doctor has prescribed otherwise. The doctor may prescribe you a sedative even when you start antidepressant treatment, but the feeling of anxiety still seems too strong and difficult for you to bear.In this case, taking sedatives should continue no longer than six weeks after you feel significant relief in your well-being. You should stop taking sedatives by gradually reducing the dose to reduce the likelihood and severity of withdrawal symptoms. The dose reduction scheme must be prescribed by a doctor. Possible withdrawal symptoms (headache, muscle pain, anxiety, feeling of tension) usually occur within 48 hours after the dose is reduced or the drug is stopped.They can be mild and go away on their own, but they can cause more severe conditions, depending on how much and how long the medication is taken.

Sleeping medicines

Anxiety disorders are often accompanied by insomnia. The treatment of insomnia must first of all be psychological. If this method does not help relieve the symptoms of insomnia, your doctor may prescribe sleeping pills for a short time. Zopiclone and zolpidem are used as sleeping pills.These drugs are similar to sedatives, which also affect the activity of the gamma-aminobutyric acid system in the brain. Sleeping drugs have sedative and hypnotic effects. They speed up falling asleep and prolong sleep. The effect usually appears within 15-20 minutes after taking the medication. It is advisable to take medications immediately before bedtime and you need to ensure yourself the opportunity for restful sleep for the next 7-8 hours. Possible side effects and withdrawal symptoms are individual.

Most common side effects Duration of treatment End of treatment, possible withdrawal symptoms
• Bitter feeling in the mouth • Blurred consciousness the day after ingestion • Long-term use results in tolerance or dependence (see pages 20-21).

Sleeping pills are not recommended for longer than four weeks.

With a sharp interruption in the course of treatment, withdrawal symptoms (insomnia, headache, muscle pain, anxiety, feeling of tension) may appear. For this reason, taking sleeping pills should be stopped gradually according to the schedule prescribed by the doctor.

Long-term use of sleeping pills can lead to problems with drug abuse and dependence, since such drugs very quickly relieve anxiety and insomnia and restore well-being.There is no dependence when using antidepressants (see pages 17 – 18).


Abuse refers to the use of drugs when it begins to harm health, but despite this, a person continues to take these drugs. The harm to health can be both physical (for example, liver damage) and mental (for example, mood disorders). This happens when the medicine has been taken for at least a month or there have been repeated courses for 12 months.


With repeated use, the drugs have less effect on the body than at the beginning of the course of treatment. Tolerance or a condition arises when the body gets used to and adapts to the drug. The body gets used to the use of sedatives and sleeping pills very quickly.

The joint use of sedatives with alcohol and other addictive substances contributes to the emergence of tolerance. If a person has previously abused alcohol, he may develop a tolerance for sedatives.An alcohol abuser needs large doses of sedatives to achieve the same effect as a person without alcohol problems.

The most important sign of addiction is a strong desire or urge to use the drug. Taking medicine becomes the most important thing in life, all other things remain secondary. Such a person can no longer control when he starts and stops taking the medicine and in what volumes he takes it. Tolerance to medication is also growing – in order to achieve the same effect, the dose must be constantly increased.Although the user of the medication may be aware of their addiction, they continue to take the medication regardless of health problems, communication and social problems.

Addiction affects both the body and the psyche

Psychological dependence means a state when the drug user becomes obligatory for the drug user, and he cannot imagine his life without it.

Physical dependence results in withdrawal symptoms (eg headache, muscle pain, anxiety, feeling of tension) when the drug is stopped.This means that the body is accustomed to taking the medicine, and in the absence of it must get used to the new conditions.

Therefore, it is important that you monitor your condition during the course of treatment, and be sure to adhere to the medication prescribed by your doctor.

Information on all prescriptions issued and purchased by you can be checked in the prescription center, the state portal www.eesti.ee → Services → For a citizen → Health and healthcare → Prescriptions.

Alcohol and anxiety disorders

Alcohol and anxiety disorders have different points of contact.Statistics show that anxiety disorders are most likely to occur in alcohol abusers and vice versa. Alcohol dependence is about 2–3 times more common in people with anxiety disorders than in the general population. Alcohol abuse is also higher than the average (Kushner, et al. 2011). Johnston et al (1999), based on various studies, state that people with anxiety disorders make up a significant proportion of the total number of people suffering from alcoholism.It is not known exactly which of these problems (anxiety disorders or alcoholism) appears first and why, but one thing is for sure that several types of disorders are present at the same time (that is, they are comorbid) or originate from each other. Comorbid anxiety disorder was present in 22–69% of alcoholic patients (Roberts 1999).

In stressful situations, people often turn to alcohol, although in fact alcohol is considered a poor aid in recuperation, as well as in getting rid of anxiety.About one fifth of patients with anxiety disorders report using alcohol to relieve anxiety. In addition, alcohol abuse impairs the ability to perform daily activities, including the ability to use other methods to correct the situation.

Does alcohol abuse cause anxiety?

  • Based on data from various studies (Johnston et al. 1991; Kushner et al. 2011), this question can be answered with confidence in the affirmative.In most cases, this is due to withdrawal symptoms. There are several reasons for this.
  • Alcohol withdrawal symptoms or fear of them already lead to anxiety in advance.
  • Physical stress: Feeling unwell leads to mental imbalance and associated anxiety.
  • The work of the nervous system: if the human brain is used to alcohol, then a sharp interruption of its intake changes the work of the brain (the balance of chemical compounds), the brain is under stress and this leads to increased anxiety.

What happens if you use alcohol to recuperate?

With regard to alcohol and anxiety, one thing is certain: using alcohol to reduce anxiety does not really solve your problem. Using alcohol to control anxiety is the best example of a solution to avoid. Typically, the cycle begins with the first glass and continues in a vicious circle: in the beginning, the use of alcohol reduces the manifestations of symptoms, but when alcohol disappears from the body, a person can find solutions how to deal with anxiety now.As a result, the person returns to alcohol again. Finding: People with anxiety disorders often have problems with alcohol or drug abuse and thus increase their risk of worsening the anxiety disorder.

Marijuana use and anxiety disorders

Although it is considered a sedative and anxiety-reducing drug among marijuana proponents, its use is associated with the risk of anxiety and panic attacks.The endogenous (human-derived) cannabinoids in the amygdala (the nucleus in the brain that governs emotions) do indeed control anxiety and escape responses, and controlled cannabinoid intake could theoretically help slow the development of anxiety. However, chronic and heavy use leads to overreacting of cannabinoid receptors and triggering the opposite response: increased anxiety and panic attack, and in some cases, addiction (Ramikie et al.2014). Although marijuana does not appear to be physically addictive, tolerance (need for dose escalation) can still develop and a stress response similar to that after alcohol withdrawal may occur upon discontinuation (Ahtee 2000). Patients with pre-existing anxiety disorder are particularly at risk of experiencing increased anxiety or panic attacks while using marijuana (Szuster et al. 1988).

After smoking marijuana, the first effect appears after seven to eight minutes, the sensations reach their peak in about 30 minutes and last from two to three hours.In the first stage, a person most often becomes talkative, active and cheerful. Physical symptoms include reddening of the whites of the eyes, dry mouth and when swallowing, dizziness, coughing, and increased sensitivity of the eyes to light. The individual response varies according to the volume of consumption. A person under the influence of marijuana after 1.5-3 hours may seem withdrawn, but there are many images and associations, different senses are exacerbated: colors seem brighter, smells more intense, pay more attention to details.

Long-term use of marijuana leads to mental changes and behavioral disorders: learning ability decreases, short-term memory is weakened, associations become impractical, and the ability to assess the situation is weakened. Disorders in the assessment of time, place and distance arise, reaction time increases and coordination deteriorates. Abundant use leads to personality changes, passivity, apathy. Reception in large doses can cause anxiety and hallucinations, in the worst cases, and panic attacks.One third of regular marijuana users develop irritability and feelings of fear and depression (Fabritius et al. 2000).

Due to the lack of evidence, it is difficult to argue that marijuana has a therapeutic effect for people suffering from anxiety, since the response to it is very individual. By no means is the use of marijuana a solution to health problems associated with profound mental problems that can be effectively treated with behavioral therapy (Bushak 2014).


Ahtee, L. (2000). Opioidid ja kannabinoidid. Kogumikus: Salaspuro, M., Kiianmaa, K.,

Seppä, K. (Toim) Narkoloogia. (lk 132-154). Tallinn: Medicina.
Alcocholrehab.com (2008–2015). Alcochol induced anxiety. Alcohol Withdrawal Causes Severe Anxiety Symptoms.
Barlow, D. H., Craske, M. G. (2007) Mastery of Your Anxiety and Panic. Workbook. Oxford University Press.
Bourne, E.J. (2011). The Anxiety & Phobia Workbook 5th ed.New Harbinger Publications.
Bushak, L. (2014). How Marijuana Relieves (Or Exacerbates) Anxiety. (2009–2014).
Craske, M. G., Barlow, D. H. (2007) Mastery of Your Anxiety and Panic. Therapist Guide. Oxford University Press.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (1994). Washington D.C .: American Psychiatric Association.
Fabritius, C., Salaspuro, M. (2000). Kanep mõnuainena. Kogumikus: Salaspuro, M.,
Kiianmaa, K., Seppä, K. (Toim) Narkoloogia.(lk 419-422). Tallinn: Medicina.
Generaliseerunud ärevushäire ja paanikahäire käsitlus perearstiabis, RJ-F / 2.1–2014. Ravijuhendite nõukoda. 2014.
Harro, J. (2006). Uimastite ajastu. Tartu: Tartu Ülikooli Kirjastus.
Hawton, K., Salkovskis, P. M., Kirk, J., Clark, O. M. (1993) Psühhiaatriliste probleemide kognitiivne käitumisravi. Praktiline käsiraamat. Fontes PMP.
Johnston, A.L., Thevos, A.K., Randall, C.L., Anton, R.F. (1991). Increased severity of alcohol withdrawal in in-patient alcoholics with a co-existing anxiety diagnosis.British journal of addiction 86.6: 719-725.
Kiianmaa, K. (2000). Alkohol. Kogumikus: Salaspuro, M., Kiianmaa, K., Seppä, K. (Toim) Narkoloogia. (lk 102-113). Tallinn: Medicina.
Kushner, M. G., Specker, S. M., Maurer, E. (2011). Substance Use Disorders in Patients With Anxiety Disorders.
Lönnqvist, J., Heikkinen, M., Henriksson, M., Marttunen, M., Partonen, T. (2006). Psühhiaatria. Kirjastus Medicina. Meditsiinisõnastik. (2004). 2., uuendatud trükk. Kirjastus Medicina.
National Institute of Mental Health (2014a).What is Generalized Anxiety Disorder?
National Institute of Mental Health (2014b). Introduction.
NHS (2014). Panic Disorder – Symptoms.
Pippo, S., Salo, U. (2007). Meelte ja tunnete taimed. Tallinn: Varrak.
Ramikie, T.S., Nyilas, R., Bluett, R.J., Gamble-George, J.C., Hartley, N.D., Mackie, K., Watanabe, M., Katona, I., Patel, S. (2014). Multiple Mechanistically Distinct Modes of Endocannabinoid Mobilization at Central Amygdala Glutamatergic Synapses. Neuron, 2014; 81 (5): 1111.
Psüühika- ja käitumishäirete klassifikatsioon RHK-10. Kliinilised kirjeldused ja diagnostilised juhised. (1995) Tartu Ülikool.
Salaspuro, M., Kiianmaa, K., Seppä, K. (2000). Narkoloogia. Kirjastus Medicina.
Stein, D.J. (2004). Clinical Manual of Anxiety Disorders. American Psychiatric Press.
Szuster, R.R., Pontius, E.B., Campos, P.E. (1988) Marijuana sensitivity and panic anxiety. Journal of Clinical Psyhiatry, 49 (11): 427-429.
Stahl, S. M. (2011) Stahl’s Essential Psychopharmacology.The Prescriber’s Guide. 4th ed. Cambridge University Press.
Stahl, S. M. (2013) Stahl’s Essential Psyhcopharmacology Online. 4th ed. (07.02.2016)
Williams, M., Penman, D. (2013). Ärksus. Tee rahuni pöörases maailmas. Tallinn: Pegasus.

Further reading

Selection of literature for self-help for patients

E. J. Bourne (2007) “Ärevushäirete ja foobiate käsiraamat”
M. Davis, E. Robbins Eshelman, M. McKay (2008) Lõõgastumise ja stressist
vabanemise käsiraamat “
A.Ellis (2000) “Kuidas saada jagu oma ärevusest”
D. Greenberger, C. A. Padesky (2007) “Mõistus juhib tundeid”
M. Williams, D. Penman (2013) Ärksus. Tee rahuni pöörases maailmas. “

Thematic web pages

Estonian Association for Cognitive and Behavioral Therapy

MTÜ Peaasjad

The patient can fill out this questionnaire on his own at home, at a visit to the family doctor or nurse, it can be completed again (for example, once a month, after two weeks, etc.).etc.). When filling out, you need to circle the option that best describes HOW THIS PROBLEM HAS BEEN CONCERNING YOU DURING THE LAST MONTHS. The sum of the received points in the test must be analyzed together with the family doctor or nurse, if in response you several times noted “sometimes”, “often” or “constantly”.

Never Rarely Sometimes Often Permanent
1. Sad Mood 1 2 3 4 5
2. Loss of Interest 1 2 3 4 5
3. Inferiority complex 1 2 3 4 5
4. Accusations of Self 1 2 3 4 5
5. Recurring thoughts of death and suicide 1 2 3 4 5
6. Feeling lonely 1 2 3 4 5
7. Feeling hopeless about the future 1 2 3 4 5
8. Inability to feel joy 1 2 3 4 5
9. Rapid irritation and anger 1 2 3 4 5
10. Feeling anxious or helpless 1 2 3 4 5
11. Feeling of tension and inability to relax 1 2 3 4 5
12. Excessive experiences for various reasons 1 2 3 4 5
13. Anxiety or impatience, but it is difficult to sit still 1 2 3 4 5
14. You get scared easily 1 2 3 4 5
15. Sudden panic attacks, which are accompanied by a rapid heartbeat, shortness of breath, a sense of loss of consciousness and other similar physical manifestations 1 2 3 4 5
16. Fear of being alone away from home 1 2 3 4 5
17. Feelings of fear in public and on the street 1 2 3 4 5
18. Fear of loss of consciousness in a crowd of people 1 2 3 4 5
19. Fear of traveling by bus, tram, train and car 1 2 3 4 5
20. Fear of being in the spotlight 1 2 3 4 5
21. Fear of communicating with strangers 1 2 3 4 5
22. Feeling sluggish and tired 1 2 3 4 5
23. Impaired attention and ability to concentrate 1 2 3 4 5
24. Rest does not help to restore strength 1 2 3 4 5
25. You get tired quickly 1 2 3 4 5
26. Problems falling asleep 1 2 3 4 5
27. Restless and intermittent sleep 1 2 3 4 5
28. Waking up from sleep too early 1 2 3 4 5

Breathing control

When inhaled, two types of muscles are used: the connective muscles (or diaphragm) and the external intercostal muscles. If inhalation uses more intercostal muscles, then this breathing is called chest breathing. At the same time, as air enters the lungs, the chest expands and the shoulders rise.Chest breathing is often shallow, irregular, and rapid, and accompanies feelings of anxiety and stress responses.

If a diaphragm is used for inhalation, then this is called diaphragm breathing or abdominal breathing, since the stomach is mainly involved in breathing. Abdominal breathing is deeper and slower than chest breathing and therefore more rhythmic and relaxing.

Abdominal breathing

Controlling your breathing and slowing it down soothes both your mind and body.For this, the use of abdominal breathing is recommended.

You need to lie on your back and put one hand on your stomach, the other on your chest. Watch your breathing.

Exercise using meditation

  1. Use abdominal breathing. Inhaling, say to yourself mentally “one” and exhaling – “relax.”
  2. During the next inhalation say to yourself mentally “two” and exhaling – “relax”.
  3. Repeat in this manner, inhaling to “ten” and then begin to return to “one”.
  4. Focus only on breath and words. It may not be easy and it is normal for you to start thinking about something else. Do not worry about this, but turn your attention back to breathing, numbers and words.

Exercise twice a day for about ten minutes (Barlow jt 2007).

About 10-14 cycles of inhalation-exhalation per minute will help you return to your natural rhythm of breathing. Exercise at first in a calm state so that later you can use this exercise in a situation that contributes to the occurrence of stress and anxiety.In the case of panic disorder, the purpose of the above exercise is to regulate your breathing, and in addition, you learn to accept and tolerate the symptoms of anxiety. This, in turn, will help you alleviate cases of increased anxiety (Craske jt 2007).

Gradual muscle relaxation

Gradual muscle relaxation relies on the body responding to anxiety-stimulating thoughts and events by increasing muscle tension. This, in turn, can worsen anxiety and other related symptoms.It is impossible to be both energized and physically relaxed at the same time. Muscle tension and relaxation will help you recognize two different states – tension and relaxation. Relaxation helps release both physical stress and relieve arousal.

  1. Find a quiet place and time for the exercise.
  2. Leave all your problems aside and feel comfortable. Relax your muscles.
  3. The exercises can be done while sitting, for example in a comfortable chair.
  4. Use abdominal breathing.

Tighten and relax the muscles described below. In each muscle group, tense the muscles for about 5 seconds and then relax them for about 10-15 seconds. Focus on reducing stress.

Hands. Make a fist with your right hand, feel the tension in the fist and in the forearm. Make a fist with your left hand, feel the tension in the fist and in the forearm.

Forearm. Bend your forearm at the elbow and contract the biceps muscle of the shoulder while keeping the hand relaxed.Straighten your forearms outward and contract the triceps muscle of the shoulder, resting your forearms on a chair, keeping your hands relaxed.

Face . Raise your eyebrows and furrow your forehead. Bring your eyebrows closer to each other (as if frowning). Squinting your eyes by contracting the muscles around your eyes. Clench your teeth and tighten your chin muscles. Without opening your lips, press your tongue firmly and firmly against the upper palate, pay attention to the tension in the abdomen. Press your lips together tightly, as if “pouting” when offended.

Neck. Tilt your head back as much as possible, and press with maximum force against the back of the chair. Place your chin against your chest.

Shoulders. Raise your shoulders to your ears, make circles with your shoulders.

Chest. Breathe with your abdominal muscles in a normal and regular rhythm. Inhale deeply so that the lungs fill completely, hold your breath for a couple of seconds and then exhale passively.

Belly. Tighten your abdominal muscles.Pull in your stomach.

Back. Fold the bottom out away from the chair.

Buttocks and legs. Place your heels on the floor, keep your legs straight and tighten your glutes and calves. Raise the soles of your feet and toes and contract the front calf muscles. Breathe with your abdominal muscles in a normal and regular rhythm (Hawton jt 1993).

It is recommended to train relaxation first in a normal calm state and every day. Exercise twice a day for about 15-20 minutes.If during the day you find that a muscle is tense, try to relax it (Hawton jt 1993).

Exercises are recommended even when during the day you feel tension or anxiety.

Alertness or Alertness

Mindfulness exercise can be used to deal with anxiety and tension. Mindfulness means being able to understand your thoughts, feelings, physical sensations, and your environment.At the same time, they put themselves in the position of an observer, without assessing what is happening in themselves and around, and without a desire to change the situation in any way.

Minute Meditation Exercise

  1. Sit in a straight-backed chair. If possible, leave some space between your back and the back of the chair so that your back does not rest on the back. Place the soles of your feet on the floor. Close your eyes and lower your head.
  2. Concentrate on inhaling and exhaling. Note the sensations that accompany each inhalation and exhalation.Track your breathing, but don’t expect anything special. Don’t change your breathing rhythm.
  3. After a while, thoughts may start to scatter. If you notice this, then again focus on breathing. Do not be annoyed with yourself – the goal of the exercise is to understand that thoughts can go their own way. It is important to return your attention to breathing and avoid self-criticism.
  4. You can feel relaxed and experience other sensations, but it is also important to feel that all feelings pass over time.Whatever happens, don’t interfere.
  5. After a minute, open your eyes and look around the room (Williams 2013).

How to deal with thoughts that create anxiety and fear

Our thoughts affect both feelings, physical reactions and behavior. If we learn to better feel our thoughts and see them in a more realistic light than when we feel bad, then we can change how we feel. Think of a situation that has happened lately when you felt intense anxiety.Try to analyze the situation using the questions below.

Recognizing thoughts that create anxiety and fear

When you feel anxious, think of the following:

  1. What thoughts were in your head? Was there any image in front of your eyes?
  2. What’s the worst thing that can happen to you?
  3. What does this really mean for you?

Weighted Reflection


  1. What is behind thoughts of fear?
  2. What other ways of interpreting the situation could be?
  3. Are you belittling your ability to solve a problem?
  4. Do you overestimate the seriousness of what is happening? Think carefully about how you have dealt with these situations in the past and practice how you might handle the challenges ahead (Hawton jt 1993).


If you have become more worried and feel that unresolved problems are beginning to accumulate in your life, and instead of resolving them you are pushing the work with them further and further, then help can be obtained with the help of problem-solving techniques. Instead of experiencing problems, start solving them, and thus your anxiety will decrease. First, consider what your problems are and how you can solve them. If you are anxious about problems that you cannot solve, or about still unclear problems that may happen in the future, then try to leave thoughts about them and direct your attention to something else.

Problem solving steps:

  1. What is the problem and what is the task that you want to achieve? Describe your problem as accurately as possible and think about what you want to achieve by solving it.
  2. Think of all the resolution options and write them down. It doesn’t matter if they are realistic or not.
  3. Review all possible solutions and weigh the pros and cons.
  4. Choose the most realistic solution options or those that get the most benefits.
  5. Plan implementation of solutions. Think about what is needed for this and what obstacles need to be overcome. Practice overcoming these obstacles. Consider what you can do right away and what you can save for the future.
  6. If you have solved the problem, think about what you have been able to achieve and what you have learned. Celebrate your progress and congratulate yourself (Hawton jt 1993).

Gradually moving away from avoidance tactics

If you feel too restless in certain situations or places and therefore try to avoid them, you will never be able to experience a successful solution to the problem.The next time in the same situation or place, you need to try to be calmer and you can cope with the problem. To move away from avoidance tactics, you need to get back in touch with the situation and get used to it. From the beginning, this approach can increase your anxiety and addiction requires persistence and courage from you.

  1. List situations and places of concern. Prioritize them according to the strength of anxiety, starting with the situations that cause the least anxiety.
  2. To begin with, try to spend some time in situations that cause the least anxiety. For example, if you are afraid to leave the house, take a short walk around the house with people close to you. Try to do this before you feel the anxiety begins to fade.
  3. Next, take a more difficult step, such as a walk alone, and repeat until the anxiety disappears.
  4. Continue these steps for more severe anxiety situations until you can handle the anxiety in those situations as well (Hawton jt 1993).

How to Deal with Panic Attack?

  • A panic attack can be unpleasant, but it is not life threatening.
  • If possible, stay in a situation where the feeling of panic has arisen. Keep yourself and others safe, such as when driving, park it in a safe place.
  • Remind yourself that fearful thoughts and physical sensations will pass. Focus on the things around you, such as the items on the shelves.See how big they are, what color and shape. This will help you to be distracted for a short time, in the case of long periods, the fear of panic symptoms may persist.
  • Focus on your breathing. Try to breathe slowly and deeply for a count of three as you inhale and exhale.
  • Try to resist your fearful thoughts. Try to find out what specifically triggers your fear and resist that cause. Repeat to yourself that what you are afraid of is actually unreal and will go away on its own after a few minutes.
  • Creative imagination or visualization. During a panic attack, thoughts of disaster or death may arise. Instead of focusing on negative thoughts and images, try focusing on the positive. Think of a place or situation where you feel calm and relaxed and try to focus on them. This should help you distract yourself and reduce the severity of the unpleasant symptoms. Visualization, of course, requires prior training.
  • Don’t fight a panic attack. Fighting it can make the attack more severe, as admitting that you are unable to do so can increase the feeling of anxiety. Instead, tell yourself again that the attack will go away, it does not threaten your life, and you are doing everything to cope with it.
  • Relax. To do this, first learn to relax your muscles.
  • Use cards with different ways out of the situation. Use slips of paper, but which you can write text to help you cope with fearful thoughts, such as “this won’t last long.”You can keep the cards in your wallet or notebook.

Find yourself the most appropriate, memorable ways to help you cope with anxiety, and try using in the event of a panic attack.

90,000 Symptoms and treatment of indigestion in dogs, what to do if a dog has a stomach ache, stomach ailments and allergies

January 27, 2020

Recently, the term “sensitive digestion in dogs” can be heard very often, but not all owners can explain exactly what it means.Digestive sensitivity refers to food intolerances, allergies, and regular indigestion in dogs. Not knowing what to do, many avoid treating dogs with problems, while they begin to urgently change the food, believing it to be the only cause of the painful condition.

However, to solve the problem and really help your pet, you need to figure it out, and not try to eliminate the symptoms of stomach disease in dogs, acting at random.

Upset stomach as a symptom

Common signs of indigestion in dogs are lack of appetite, vomiting, diarrhea, flatulence, and general weakness, but the causes of this condition can vary.About 20 years ago there was a very popular humoresque about a doctor who, regardless of the symptoms they described to him, said to all his patients: “You ate something!”


Some dog owners think in the same way, not suspecting that gastrointestinal disorders can be a sign of infectious diseases (intestinal plague, parvovirus enteritis, viral hepatitis, leptospirosis), as well as pathologies of the liver, kidneys, pancreas and even the heart.


Acute diarrhea and painful, non-stop vomiting are characterized by toxic infections, that is, poisoning. In this case, there is a risk not only for the health, but also for the life of the dog, therefore it is very important to immediately consult a doctor, not hoping that it will pass by itself. In the clinic, the animal will begin to remove intoxication with the help of droppers, and it is by no means worth abandoning this time-consuming and rather expensive procedure, as some owners do.

Prolonged intoxication is dangerous, as it disrupts the work of all organs and systems of the body. The miser pays twice, and you still have to pay for long-term treatment for liver, kidney and pancreas diseases.

So, if a digestive disorder is associated with infectious diseases or poisoning with poison, then the only way to cope with it is treatment as prescribed by a doctor, and there is no need to experiment with changing feed.

Food Intolerance

This condition is often confused with food allergy, which is of a completely different nature.Food intolerance is an undesirable reaction of the gastrointestinal tract to feed components associated with impaired digestion, assimilation of its ingredients and has nothing to do with immunity. For example, a dog is constantly weakened due to a lack of enzymes or due to the content of dyes, preservatives and other chemicals in food.

The problem is solved simply

Treatment of dogs with stomach problems of this kind is the least complicated. To cope with the problem, it is often enough to change the feed to a diet of a higher quality, which does not contain not only harmful, but also poorly digestible components.For example, cereals are very poorly digested by carnivores, because they have practically no necessary enzymes for this.

A dog eating food with a large amount of grain has a digestive upset. So look for foods that are meat-based and use rice as the carbohydrate source, which some veterinarians say is the best for dogs.

When choosing food for a dog with food intolerance, you should also pay attention to the lines with easily digestible proteins, such as turkey and lamb, as well as include probiotics in the diet that promote the digestion and absorption of food.Now there are feeds on the market that contain not only dietary types of protein, but also live probiotics – this is very convenient, because you do not need to buy the drug separately.

Take your time with a new diet

It so happens that digestive upset is due to the fact that the change of feed was carried out too abruptly. The owner sins on a new food and returns to the old one, thereby not only not solving, but aggravating the pet’s problem. Therefore, it is very important to switch the dog to a different diet gradually, mixing the new food with the old one for at least five days.

If, despite all efforts, your dog’s stomach upset continues, seek medical attention. He will understand the problem and prescribe special medications, for example, enzyme preparations.

Food allergy

Food allergy is an increased immune response to food components, more often to proteins (proteins) or glycoproteins. This state has its own very specific characteristics. Unlike food intolerance, which occurs with prolonged consumption or a high concentration of an undesirable component, an allergic reaction occurs very quickly and even from the smallest dose of the allergen.

The immune system, as a highly professional intelligence officer, instantly recognizes and begins to strike the “enemy”. The trouble is that any, even the highest quality food component can be an enemy in immune diseases.

What and how is allergy manifested in dogs

Studies have identified the ingredients that most often cause allergies in dogs: beef, chicken, dairy products, wheat, corn, fish, soy, etc. However, immune diseases are so individual that this list should be considered only as a guideline.

Another characteristic difference of food allergy is that its symptoms are usually not associated with indigestion, but with itching and redness of the skin. In dogs, itching occurs most often on the face, paws, ears, groin, and armpits. Continuous brushing leads to hair loss in these areas, as well as secondary yeast and bacterial infections.

The hardest part of treating a food allergy is identifying the allergen. Immunological tests now offered in veterinary laboratories are far from always effective, therefore the only correct and at the same time long way is to select an individual diet.

Observe not to heal

Finally, I would like to say that every responsible owner, no matter how delicate he may be, has a good habit of keeping an eye on the stool of his dog, because it is the “waste product”, in fact, that is the mirror of the animal’s gastrointestinal tract health. It is more pleasant to look into this “mirror” than to treat a dog’s stomach for a long time.

The chair should be well-shaped, firm, of an even dark brown color, without foreign inclusions and practically odorless.All deviations from this norm, with the exception of acute diarrhea, which, as we said, is a reason for immediate medical attention, should make the owner think about the diet of his pet. After all, the best food for your dog is the one that suits her.

90,000 Not in the head, but in the stomach: how to eat to avoid depression

  • David Robson
  • BBC Future

Photo author, Getty Images

A hundred years ago, several separate studies found a link between diet and mental health.Now scientists are confirming that bacteria in our gut can affect brain function and mental health.

The patient’s gut does not seem to be the place to look for the causes of depression. But it was he who drew attention to George Porter Phillips at the beginning of the 20th century.

While observing patients at the Bethlem Royal Hospital in London, Phillips noticed that depressed patients with melancholy often suffered from severe constipation, as well as other signs of “general metabolic disorders” – brittle nails, dull hair, and an earthy complexion.

One might assume that these physiological problems are the result of depression, but Phillips thought of an inverse causal relationship. He wondered if it was possible to alleviate the patient’s mental state by solving intestinal problems?

To find out, he put the patients on a special diet. It did not contain meat, only fish, and kefir, a fermented milk drink with lactobacilli, which is known to improve digestion.

Surprisingly, it worked.Of the 18 patients Phillips checked himself, 11 fully recovered, and the other two showed marked improvement. This experiment is one of the first pieces of evidence that bacteria in our gut can have a profound effect on our mental health.

There is a lot of talk about the microbiome and its role in human health today.

However, its connection with the psyche is more difficult to explain.

How can these microscopic scavengers feeding on our digestive waste affect the brain?

“I am in no way questioning the fact that microbes affect mental health,” says Jane Ellison Foster, laboratory director at McMaster University in Canada, whose research has led the way in this field.

This means that we will be able to heal our brain through the intestines. “This area has great potential for the development of both new therapeutic agents and personalized medicine.”

However, Foster stresses that an unhealthy gut is just one of many possible causes of mental illness. That is, only a fraction of the patients will respond well to the new “psychobiotic” treatment.

But for those suffering from an imbalance in the gut microflora, new methods can bring significant relief.

Author of the photo, Unsplash

Signs to the photo,

A study conducted at the beginning of the 20th century revealed that kefir has a positive effect on patients with depression

Despite the conclusions of the first studies, in particular the Phillips experiment, the idea of ​​the effect of intestinal state on mental health was unpopular for almost the entire twentieth century.

Serious evidence of this idea began to emerge only in the last two decades.

One of the most interesting modern experiments was carried out at Kyushu University in Japan in 2004.

A team of scientists demonstrated for the first time that in “sterile” mice raised without contact with microbes, fluctuations in the level of hormones corticosterone and ACTH, which are responsible for stress, were recorded.

Scientists have suggested that the gut bacteria of healthy mice somehow influence the hormonal profile.

The researchers then inoculated sterile mice with lactobacilli, which Phillips also used in his experiment.

Although the stress response in mice remained above normal, it was markedly reduced compared to animals that did not have bacteria in their bodies.

There are some indications that depressive behavior can be transmitted from species to species – from human to mouse – via microbes in the gut.

This was proved by Chinese researchers from the city of Chongqing, who transplanted part of the microbiota of patients with major depressive disorder into sterile mice.

Of course, these are only animal experiments, but their conclusions are confirmed by epidemiological studies involving a large number of people (the results of the latter were published on February 4, 2019).

All these studies systematically confirm that the intestinal microflora affects the human psyche, in particular, the development of depression and anxiety.

Author of the photo, Getty Images

Signs to the photo,

Only in two out of 10 patients antidepressants cause improvement

No single species of bacteria can lead to such an effect. The whole point, it seems, in the general ratio of different families of microbes.

The gut microbiome is less diverse in depressed and anxious people than in people with good mental health.

Moreover, in a recent publication on this topic, researchers found a link between schizophrenia and low gut diversity. When samples of the patients’ bacteria were transplanted into sterile mice, the brain shifts that are characteristic of this mental disorder.

Microbes and the brain

This connection can be formed in different ways.

Certain types of bacteria protect the intestinal wall by strengthening the lining of the intestine, which prevents contents from entering the bloodstream.

Without such a barrier, a person can suffer from the release of cytokines that cause inflammation. These proteins increase blood circulation around the source of infection and regulate the body’s immune response.

This reaction is important in fighting infection, but cytokines also contribute to fatigue. This is why we often feel tired and depressed when we are sick. But this condition can lead to depression for a long time.

The gut microflora affects how our body digests and metabolizes the precursors of the synthesis of important neurotransmitters such as serotonin and dopamine.

Intestinal bacteria directly affect the brain through the vagus nerve, which innervates the intestinal mucosa, allowing it to control digestion.

In this way, intestinal microbes can send signals that affect brain activity via the vagus nerve.

“Gut bacteria can communicate in different ways with different structures in the body, including the nervous system,” says Foster.“It’s a very dynamic, interactive, complex space.” A vicious circle

New treatments

As Foster notes, the industry is growing rapidly, with research being conducted by both university scientists and commercial companies.

Their goal is to find new treatments for depression.

Antidepressants alter the balance of chemicals in the brain, such as serotonin levels, but not everyone is helpful. In fact, only two out of 10 patients benefit from antidepressants.

Cognitive-behavioral therapy has a good effect, but it also does not help everyone.

As a result, many do not receive effective treatment. Therefore, the connection between the brain and gut bacteria may be one of the most promising areas of research.

Photo author, Getty Images

Pidpis to photo,

When sterile mice received beneficial lactobacilli, they tolerated stress much more easily

Unfortunately, many studies in this area are still very few, and their results are ambiguous. In some studies, dietary changes or the addition of probiotics reduced symptoms of depression, while in other studies, similar measures had an effect that was no different from the placebo effect.

Foster explains the negative result by the fact that the experiments were carried out on patients in whom depression had other causes.Gut bacteria can undoubtedly affect the mental state of some people, but in many cases the trigger may be completely different. Kefir is unlikely to help such patients.

To complicate matters further, everyone’s microbiome is unique, so any therapy that targets your gut flora must take these differences into account.

Therefore, the method of treatment must be complex and individual, the researcher believes.

“The theory of the connection between the intestine and the brain is primarily applicable in precision medicine (which takes into account the individual characteristics of the organism, and not general principles for all).”

The challenge, according to Foster, is “to identify the biotype or group of individuals with a similar microbiome that might be causing their symptoms.” Before starting treatment, check, for example, the patient’s propensity for inflammatory processes.

Since, unlike antidepressants, it is not about interfering with the brain, the possible side effects of such therapy will be less dangerous.

Eat Like Italians

The gut-brain connection theory provides further evidence that a healthy, balanced diet reduces the risk of many diseases, in particular depression.

Many of these studies focused on the so-called “Mediterranean diet” – the generic term for a diet rich in vegetables, fruits, nuts, seafood, unsaturated fats and vegetable oils, and low in refined sugar, red and processed meats.

(This is, of course, a rather crude generalization, since there are significant differences in the way people eat in southern Europe.)

However, one Spanish study showed that people who ate a traditional Mediterranean diet were at half the risk of developing depression.

Photo by Getty Images

Sign up to photo,

A Mediterranean diet rich in fruits, vegetables, healthy oils, low in processed foods is very beneficial to health

Scientists have shown that the Mediterranean diet increases the diversity of intestinal bacteria and reduces the possibility of others physiological changes, such as chronic inflammation, that also accompany depression.

More than a century after Phillips’ experiment at Bethlem Royal Hospital, no reliable treatment for depression has yet been found.

But for some people, a healthy gut can be an important first step towards a healthy psyche.

Read b original of this article in English you can visit the website BBC Future .

causes, symptoms and diagnosis, indications for seeking medical attention

Stock! Discount 20% on the first appointment for new patients of the clinic with the promo code “FIRST20”.

Small in size, but very important internal human organ – the thyroid gland. One of her common diseases is hyperthyroidism. Understanding the symptoms of thyroid hyperthyroidism in women and men, making an accurate diagnosis and prescribing effective treatment for this and other organs of the endocrine system is the task of an endocrinologist.

What is hyperthyroidism

Thyroid hormones – called thyroid hormones.These are thyroxine (T4) and triiodothyronine (T3). They enter the bloodstream and are distributed to many internal organs, affecting important functions. They regulate metabolism, brain activity, the work of the cardiovascular and nervous systems, the work of the gonads and the gastrointestinal tract.

With an increase in the production of thyroid hormones due to hyperfunction of the gland, they speak of hyperthyroidism.

There are three forms of pathology:

  • Subclinical – there are no noticeable changes in the state of health, the production of the hormones T4 and T3 remains unchanged, and the level of the hormone TSH is reduced.
  • Manifest – the T4 value is increased, the TSH decreases even more.
  • Complicated – a neglected form of the disease, in which complications have appeared on other organs and systems. Frequent manifestations – heart failure, tachycardia, unstable psychoemotional state.

Classify hyperthyroidism by the level of occurrence into:

  • Primary – the condition is caused by diseases of the thyroid gland.
  • Secondary – disorders of the thyroid gland are caused by pathologies of the pituitary gland, which is functionally interconnected with it.
  • Tertiary – the root cause of the disease – the pathology of the hypothalamus, which affected the work of other endocrine glands.

Hyperthyroidism of the thyroid gland – symptoms

Initial symptoms are rather uncharacteristic, they can be easily attributed to usual fatigue, stress, vitamin deficiency and other factors.

Later, as disorders grow due to hyperthyroidism of the thyroid gland, symptoms appear:

  • Weight loss without dieting and exercise – Appears due to the accelerated breakdown of nutrients and proteins that do not have time to be fully absorbed.
  • Rapid or irregular heartbeat with the same physical and emotional stress.
  • Frequent mood swings, causeless irritability, bad mood, discomfort from bright light, loud sounds.
  • Hair loss.
  • Weakness, loss of strength.
  • Insomnia.
  • Trembling of hands – hands and fingers.
  • Digestive disorders – nausea, indigestion.
  • Increased thirst and frequent urination due to water imbalance.
  • The appearance of a characteristic goiter on the front of the neck.
  • Protruding eyes.

Symptoms of thyroid hyperthyroidism in women: irregularities in menstruation, decreased ability to conceive, miscarriages. In the initial stages of hyperthyroidism, menopausal women have little or no symptoms. They appear later as the internal organs are disrupted.

Weakening of libido and problems with potency are typical symptoms of hyperthyroidism of the thyroid gland in men.

Symptoms of hyperthyroidism in old age may resemble senile dementia. Confusion, weakness, and heart failure appear. There is also a predominant lesion of one organ or system of the body.


Like other diseases without treatment or with improper self-treatment, hyperthyroidism can cause complications. The most severe of them are complications at:

  • Heart – arrhythmias, heart failure.Interruptions are exacerbated by physical exertion.
  • Musculoskeletal system – changes occur in the structure of bones, they become fragile. Metabolism is disturbed, the bone is insufficiently supplied with calcium and is depleted.
  • Eyes – a characteristic disease – Graves syndrome with ophthalmopathy. This leads to the growth and swelling of the tissue behind the eyeballs. Typical complaints of the patient are discomfort in the eyes, watery eyes, the eyelids do not close completely, there is increased sensitivity to light, double vision, decreased acuity.
  • Skin – Graves dermopathy. This is redness and swelling of the legs and feet.

In severe cases, a thyrotoxic crisis may occur. With it, all the symptoms of the disease, tachycardia and heart failure, there may be mental disorders. The patient needs emergency help.

Disruption of hormone production should not be ignored. Over time, this fact provokes a lot of additional pathologies. In addition, hyperthyroidism causes unpleasant symptoms.All this prevents a person from living normally. Mood swings and irritability can poison relationships with family and loved ones. The problem will not disappear on its own.

It is impossible and simply dangerous to treat hyperthyroidism without a thorough examination and an individually selected scheme by a doctor. Self-prescription of drugs negatively affects the state of health in general, can lead to the development of severe pathologies and even death.

It is not necessary to endure the symptoms of hyperthyroidism.In the Kutuzov Medical Center, you will be diagnosed with diseases that cause hyperthyroidism and will help you get rid of the pathology. Make an appointment with the specialists of the Kutuzov Medical and Diagnostic Center. We will help you find a healthy and fulfilling life.


Various causes can lead to hyperthyroidism. Hyperthyroidism can be primary, secondary, and tertiary.

Among the main factors that contribute to the onset of primary hyperthyroidism:

  • Congenital or acquired lesions of the thyroid gland – inflammation, lack of iodine or its excess.
  • Diseases of an autoimmune nature (due to malfunctioning of the immune system). With them, antibodies to thyroid cells appear in the body. Hashimoto’s autoimmune thyroiditis, Basedow’s disease occur, and the production of triiodothyronine increases.
  • Nodular goiter, adenoma – the appearance of seals and tumors in the tissues of the gland.
  • Inflammation of the thyroid gland – thyroiditis, in which its follicles are destroyed, and hormones from them enter the blood.

Secondary hyperthyroidism is a consequence of a decrease in the level of thyroid-stimulating hormone (TSH) due to disorders in the pituitary gland.TSH stimulates the activity of the thyroid gland, so an increase in the functionality of the healthy thyroid gland due to the pituitary gland may occur.

Tertiary hyperthyroidism is caused by malfunctions in the hypothalamus and a decrease in its work.

Hyperthyroidism is more common in people with a genetic predisposition to endocrine diseases. Women get sick more often than men. Risk factors include living in an endemic area (with iodine deficiency), polluted environmental conditions, and frequent stress.


If signs of hyperthyroidism appear, an endocrinologist’s consultation is required. At the appointment, the doctor will examine the patient and talk to him. You will need to answer questions:

  • Do close relatives have thyroid diseases?
  • How long ago there were signs.
  • The nature of the work.
  • Existing diseases and other questions.

With the help of palpation of the gland, its approximate size, structure, soreness, density are established.

To establish and clarify the diagnosis are assigned:

  • Hormonal research – determination of the level of TSH, hormones T3 and T4. By their values, you can determine the type of disease and the degree of violations. Such tests are especially important for older women, since symptoms of hyperthyroidism in menopause may be absent.
  • Blood test – which assesses the presence of antibodies to TSH (a sign of autoimmune diseases), the number of lymphocytes, monocytes and eosinophils, cholesterol levels and other indicators.
  • Ultrasound of the thyroid gland to assess its size, structure and other parameters.
  • Scintigraphy – a study of the rate of absorption of iodine to clarify the causes of hyperthyroidism.
  • Biopsy – taking a tissue sample from the gland (under ultrasound control) for cytological examination.
  • Chest X-ray to assess the degree of compression of the airways and blood vessels by the resulting goiter.

To take a blood test for hormones, it is recommended to come on an empty stomach (when more than 10 hours have passed since the last meal) and to avoid strenuous physical activity for two days.If you need to re-take tests (for example, to track the effectiveness of treatment), then it is important to come at about the same time of day as the previous time. This recommendation is due to the fact that the level of thyroid-stimulating hormone changes during the day.

How to treat hyperthyroidism

Methods and timing of therapy depend on the type of hyperthyroidism, its causes, other diseases in the patient, and his age.

Conservative treatment applied:

  • Preparations with iodine isotopes – they reduce the activity of the gland, accumulating in its tissues (compensation option).The organ returns to its normal size, its work is normalized. Treatment is carried out under the supervision of a physician and periodic monitoring of the patient’s health. With an uncontrolled process, the activity of the thyroid gland may be unnecessarily suppressed, which leads to hypothyroidism (low levels of hormones).
  • Medicines to suppress the production of thyroid hormones. Relief of the patient’s condition is observed after 2-3 weeks from the start of therapy, and the course as a whole lasts up to a year. Periodic examinations are necessary in this case – antithyroid medications can affect the liver and immune system.At the same time, she will react with allergies or a decrease in immunity – an increase in cases of ARVI and other colds.
  • Symptom Relief – Drugs are prescribed to normalize blood pressure, heart rate, and other symptoms.

In severe cases of advanced hyperthyroidism, when the thyroid gland is significantly enlarged or there are neoplasms in it, the doctor may recommend surgery. On it, the affected part of the gland or the entire organ is removed.After removal, you will have to take hormonal drugs for life to correct their deficiency.


In order to maintain a healthy thyroid gland, it is necessary to ensure that the diet contains foods rich in vitamins (especially A, groups B and C), selenium and copper. Give up bad habits, make sure you get enough rest, do not exhaust yourself with physical and emotional stress.

The thyroid gland is an important organ for humans. Pay attention to your health and periodically undergo examinations to notice diseases and prevent them in the early stages.

In the Kutuzov diagnostic and treatment center, you can get advice from qualified medical specialists. Our doctors have colossal experience behind them, they are constantly studying modern therapeutic techniques. We apply new developments to effectively treat thyroid diseases. We use promising therapy regimens with proven efficacy.

To examine the functioning of the thyroid gland, we carry out instrumental and laboratory studies that allow us to determine the source of the problem with high accuracy.The best equipment and highly qualified specialists are what makes the work of our center effective and useful for patients. Make an appointment with an endocrinologist at the Kutuzovsky Medical Center to receive quality medical care without queues and waiting.




Appointment (examination, consultation) of an endocrinologist, primary 2 200 ₽
Appointment (examination, consultation) of an endocrinologist repeated 1 900 ₽

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90,000 Dyspepsia (indigestion) – symptoms and treatment

Dyspepsia or indigestion

Dyspepsia (literally “bad digestion”), i.That is, in colloquial speech, indigestion is a feeling of discomfort in the solar plexus region, in the upper central region of the abdomen. In addition to discomfort, symptoms of indigestion can also be pain or a feeling of fullness in the stomach, heaviness in this area. Bloating, heartburn, nausea and vomiting are also symptoms reported by indigestion patients. It is estimated that up to 20-30% of the population suffers from dyspeptic disorders.

Indigestion symptoms

Possible dyspepsia symptoms:

  • feeling of fullness in the stomach after eating,
  • bloating – that is, a feeling of unpleasant enlargement of the abdomen,
  • heartburn – that is, a burning sensation in the esophagus caused by reflux of stomach acid,
  • nausea,
  • vomiting.

If these disorders last at least three months, then we can talk about the symptoms of dyspepsia. Of course, during this period, they can be of varying intensity and do not necessarily appear on a daily basis.

Indigestion is divided, first of all, into that which is a symptom of various diseases, as well as indigestion, which occurs due to factors that are very difficult to define in the definition of non-painful factors – then it is classified as a functional indigestion.Organic indigestion, that is, caused by diseases, can occur due to:

Functional dyspepsia can be caused by:

  • certain medicines (antirheumatic agents, salicylates, antibiotics, dietary supplements containing iron and potassium),
  • one-time consumption of too much food,
  • consumption of stale food in food,
  • hypersensitivity of internal organs,
  • greater sensitivity of the stomach than others,
  • tobacco smoke irritation,
  • excessive stress.

Organic indigestion occurs primarily in adults over the age of 45, very rarely in children. Functional dyspepsia, in turn, is more common in children.

Indigestion: What to Do?

If indigestion continues for 3 months, people over the age of 45, as well as anyone with associated symptoms, are advised to undergo tests to detect diseases that cause organic dyspepsia:

  • prolonged vomiting,
  • blood in feces,
  • anemia,
  • difficulty swallowing,
  • weight loss.

Complete diagnostics to determine the causes of organic dyspepsia includes:

  • history,
  • endoscopic examination (duodenum, stomach and esophagus),
  • Abdominal ultrasound,
  • radiological research.

Dyspepsia in children: examinations for indigestion in a child

Surveys for the detection of diseases causing dyspepsia in children are carried out only if they develop accompanying symptoms:

  • severe pain,
  • retardation of maturation, growth,
  • problems with swallowing,
  • chronic diarrhea.

Food and diet for indigestion

To avoid indigestion, you should follow several principles of healthy eating, for example, eat 3-4 meals a day, instead of 1-2 times. Food should be chewed well and taken slowly in a relaxed environment. Dinner should be eaten no later than 3 hours before bedtime. Individuals who complain of frequent indigestion are advised to avoid fried and fatty foods that can irritate the stomach.

In reality, bloating is not related to the amount of gas in the digestive tract, but primarily to their subjective feeling.Regardless, reducing their number tends to help. To avoid bloating, it is necessary to limit the amount of carbonated drinks in the diet, foods that cause gas (beans, peas, onions, apples) and try to eat slowly.

Heartburn requires monitoring the body’s response to certain foods, since symptoms may appear differently in different patients. Drinking milk, for example, can help relieve heartburn. After eating, it is advisable not to bend over, since this is what can cause the reflux of stomach acid into the esophagus.If indigestion already develops, you must follow a digestible diet for several days.

Dyspepsia: Indigestion Treatment

Treatment of indigestion caused by a disease is limited to treating the disease. In the case of functional indigestion, treatment may vary – however, it always remains symptomatic. Etiological treatment in this case is not possible because the immediate cause of indigestion is unknown.

If indigestion occurs infrequently, but only periodically, you can fight it yourself – with the help of diet and herbs.Herbs for indigestion are primarily St. John’s wort and flax seeds. Peppermint also helps in most cases of indigestion, with the exception of heartburn and gastroesophageal reflux disease. Half a glass of the herbal infusion should be taken before meals.

However, sometimes folk remedies for indigestion do not help. Several groups of drugs are used to treat indigestion:

  • medicines that reduce the release of hydrochloric acid,
  • histamine receptor blockers,
  • neutralizing drugs,
  • antidepressants,
  • neurohormonal drugs that stimulate the motility of the gastrointestinal tract (prokinetics).

Medicines that reduce the release of hydrochloric acid are agents that can be used for a long time, even for many years, but antidepressants and prokinetics should not be taken regularly for a long time.

Indigestion – provided that it is not caused by any other health problem – is not hazardous to health. Dyspepsia in some patients goes away on its own, even without treatment, in others, drugs are effective, and there is a group of patients who do not have any prescribed drugs or methods of treatment.

Eating disorder – compulsive overeating, treatment of psychogenic nervous overeating in Moscow

Everyone at least once got up from the table with a feeling of a full stomach. If this happens infrequently, then there is no cause for concern. If the episodes are repeated or in this way you are trying to get rid of stress, bad mood, you should suspect the development of a nervous ERP. Compulsive overeating, namely eating in an uncontrolled amount, recurring episodically.The disease often occurs against the background of mental disorders, sometimes contributes to gaining excess weight, obesity. Therapy is carried out by a psychiatrist, interacting with a nutritionist, psychologist.

Contents of the article

Nutritional Disorder – Description of the Disease

According to the Diagnostic and Statistical Manual of Mental Illness, psychogenic overeating (hyperphagic reaction to stress) is an independent disease that has a separate coding 307.51. A patient with RPP is used to dealing with negative emotional stress, bouts of binge eating. The disease manifests itself in a brutal appetite, which requires an abnormal amount of food with a high calorie content to satisfy. Serious factors (loss of a family member, injury) and minor reasons – a conversation in a raised voice, a missed bus, etc., can provoke a nervous attack. Eating disorder is psychologically based, and there is no physiology in causation.Food in this case is a tonic that allows you to forget about the problem for a while, to relax. A patient who has experienced a nervous shock is not trying to feed the stomach, but to drown out the feelings.

It is important to distinguish between the physiological feeling of hunger and appetite of a nervous nature. This is an important step on the path to recovery, the selection of the right treatment:

Nervous hunger Physical hunger
It can occur against the background of satiety, it occurs unexpectedly and abruptly. Develops gradually, the body does not require urgent saturation.
During seizures, the body requires unhealthy food – the priority is fast food, fatty foods, sweets, starchy foods, etc. You can quench your appetite with any food, homemade and healthy food.
The portion size is much larger than the usual volume, there is no control over the amount eaten. A person eats exactly as much as is necessary to satisfy hunger.
The portion size is much larger than the usual volume, there is no control over the amount eaten. The physical need for food arises from the feeling of “sucking in the stomach”, weakness.
After eating, feelings of guilt and shame arise. After eating, a feeling of satisfaction comes, strength appears.

The causes of a mental disorder can be genetic.

Compulsive eating disorder – symptoms

The basis of nervous overeating is meeting emotional needs, solving life problems, the ability to forget about loneliness for a while, etc.However, food is a temporary salvation, after a short satisfaction comes a feeling of shame for the weak willpower, guilt for the amount eaten. Manifestations of an eating disorder are often confused with other EDDs. Symptoms of bulimia have much in common with the clinical picture of binge eating disorder.

An eating disorder or binge eating disorder is accompanied by the following symptoms:

  • food becomes the only acceptable way to get rid of melancholy, sadness and other negative emotions;
  • the patient with RPP prefers to eat alone, hiding bouts of binge eating;
  • lack of a feeling of fullness after a sufficient amount of consumed food;
  • stressful load makes you regularly experience overeating even in the absence of a physical need for food;
  • the patient with RPE eats abnormally large portions in a short interval;
  • gluttony is exacerbated during stress, emotional distress.

The main manifestation of compulsive eating disorder is loss of appetite control. Even with a deliberate overfeeding, a person is unable to stop. People with an unstable psyche are more likely to suffer from psychogenic disorder, who take the events to heart. At risk are adolescents and women. Men also suffer from RIP, but much less often and, unlike women, do not seek to part with negative eating habits, taking them for granted.

Diagnosis and treatment of psychogenic overeating

If you suspect nervous overeating, you should urgently seek help. You can make an appointment with a psychiatrist.

The Diagnostic and Statistical Manual of Mental Illness contains a list of criteria, if 3 of them are met, the diagnosis of Eating Disorder – Binge Eating is confirmed:

  • you prefer to eat alone;
  • you are uncomfortable with the amount of food eaten;
  • you often sit down at the table without feeling hungry;
  • after eating there is a feeling of guilt, self-disgust;
  • Regardless of the size of the portion, you eat quickly, the food is not chewed thoroughly.

The doctor conducts a control weighing, finds out what the patient’s weight was in the recent past, how quickly the figure on the scale has changed. Further, he selects the tactics of treatment in accordance with the anamnesis.

Treatment of psychogenic overeating

Therapy of patients suffering from nervous overeating should be comprehensive. Eating disorders are treated by a psychiatrist, psychotherapist, psychologist, nutritionist. The family doctor is not competent in this situation due to the lack of the necessary knowledge and experience in the treatment of RPD.”TsIRPP” specializes in the study, therapy of RPP and adheres to complex tactics:

  • drug therapy;
  • psychotherapy effective for eating disorders;
  • power recovery.

In the course of psychotherapy, individual and group techniques are used, the main purpose of which is setting the right goals, teaching self-control, developing incentives, healthy beliefs.

Much attention in the treatment of eating disorders is paid to the organization of nutrition, in some cases hospitalization is recommended.The clinic has created comfortable conditions for treating patients, if necessary, emergency medical care is provided, an intensive care unit is provided. Binge eating disorder is usually treated on an outpatient basis. At first, support and control of loved ones in a familiar home environment are recommended. You can make an appointment at the Eating Disorders Research Center in Moscow by calling +7 (499) 703-20-51 or using the online form.

Complications and advanced forms

Eating disorder (overeating) is fraught with the development of severe consequences – obesity and atherosclerosis.The patient experiences chronic emotional dissatisfaction, which leads to prolonged depression and suicidal thoughts. If destructive overeating therapy is not carried out on time, the risk of complications is high:

  • Moving away from loved ones and family as the condition worsens, refusal from family dinners and friendly meetings, accompanied by a feast. A person with RPP prefers a secluded lifestyle to hide existing deviations from habitual behavior.
  • Often, a depressive state becomes the cause of addiction to alcohol and drugs.Thus, the patient with RPP tries to compensate for the dissatisfaction with his own life.
  • Binge eating disorder affects human health. Among the most common complications are obesity, arthritis, high cholesterol, hypertension, heart and kidney failure. The liver, gastrointestinal tract suffer from excessive uncontrolled nutrition, the character changes for the worse – irritation and anger prevail.

Given the severity of the complications, you should not postpone the visit to the doctor and self-medicate.Provided timely treatment, the prognosis for the treatment of compulsive disorder is favorable.

Make an appointment in Moscow by phone +7 (499) 703-20-51 or fill out the online form.

Author: Sineutskaya Ekaterina Olegovna


How it goes, what disorders and problems can be, prevention of diseases

The body of a baby is very different from the body of an adult.In particular, the digestive organs have their own characteristics. In the first weeks and even months of a baby’s life, his digestive system adapts to a new type of nutrition, a non-sterile environment unlike the mother’s womb. And while the baby’s body adjusts to the rapidly changing conditions, it is almost impossible to avoid digestive disorders in the baby.

Let’s talk about digestion in children: what disorders can occur, is there a prevention of digestive disorders, what should a child give to improve digestion?

Peculiarities of the digestive organs and the process of digestion in children

Often gastrointestinal disorders in newborns are caused by the peculiarities of the digestive system.In children, for example, the esophagus is arranged differently than in adults: its length is only 10 centimeters, and its width is from 5 to 8 millimeters. In addition, the esophagus in infants is not “equipped” with physiological constrictions (they appear at an older age), and the muscle and elastic tissue is undeveloped.

The stomach of the baby is characterized by weak contractions of the sphincter, which lead to frequent regurgitation. Moreover, in babies under one year old, the stomach is located horizontally and takes an upright position only when the child begins to walk.The volume of the stomach, by the way, is quite small: in the first days of life it is 35 milliliters, at three months – 100 milliliters, and in a year – already 500. The digestion of the crumbs well “takes” only milk and mixtures, for the digestion of other foods the activity is too low gastric juice.

All mucous membranes of the digestive organs in babies are very thin and delicate, and therefore they are a weak barrier for harmful microorganisms. This feature is one of the main causes of indigestion in children.

Causes of indigestion in infants

Disruptions in the gastrointestinal tract can be divided into two categories: temporary disorders and diseases.Let’s take a closer look at the types of digestive problems in newborns.

Temporary disorders:

The most common problem in newborns is an imbalance in the intestinal microflora, or transient dysbiosis , which occurs in 90% of babies. When a baby is in the womb, his body is sterile. The intestinal microflora begins to form ten hours after birth: at this time, various bacteria begin to populate the body.Among them there are both useful lacto- and bifidobacteria, and harmful: E. coli, lactic acid streptococci, and so on. Due to the weak barrier function, the baby’s body on its own cannot resist the “invaders”, which leads to dysbiosis.

The reason for dysbiosis can also be artificial feeding, because even the best formulas do not contain a sufficient supply of nutrients, which are rich in breast milk. Often, an imbalance of microflora occurs when complementary foods are introduced.The fact is that the enzyme pepsin, which is present in gastric juice, is responsible for the breakdown of food in the stomach. Babies have little pepsin, so it can be difficult for him to cope with any food other than milk.

Babies taking antibiotics are also at risk. Effectively fighting the underlying disease, such drugs often negatively affect the intestinal microflora. Dysbiosis can also be caused by various infections to which the child’s body is very susceptible. And, of course, we must not forget about hygiene: after all, the more microbes around, the higher the likelihood that they will “break through” the protective function of the child’s body.

Diseases of the digestive system in infants:

  • Congenital malformations . These can be arteries and stenoses of the digestive tract, which form during the period from the fourth to the eighth week of intrauterine development. In some infants, a doubling of the intestine also occurs – when the large intestine is in the form of a cyst, as well as a hernia of the umbilical cord and various abnormalities in the biliary tract. Depending on the type of disease, they can be eliminated surgically or partially stopped by non-invasive methods.
  • Thrush . Most people associate this term with “female” diseases, but it is also often referred to as candidiasis in the stomach of an infant, caused by an overgrowth of the fungus Candida albicans. It can be caused by both banal lack of hygiene and weak immunity of the child.
  • Gastroesophageal reflux . This is the throwing of the contents of the stomach and intestines into the lumen of the esophagus. It is usually caused by defects in the lower esophageal sphincter.
  • Functional dyspepsia .This is the name of the pathology of the gastrointestinal tract, which is characterized by many symptoms. Among them are burning pains in the abdominal region, intestinal distention, nausea, heartburn and belching. In infants, functional dyspepsia is usually associated with impaired secretion of gastric acid and enzymes.
  • Celiac disease . An inherited disorder associated with intolerance to gluten, a protein found in wheat, rye and barley.

Prevention of digestive disorders

Of course, in the case of congenital diseases of the digestive system in children, prevention is powerless.But it is quite possible to save the baby from various disorders. How can a child’s digestion be improved? First of all, a nursing mother should observe personal hygiene while breastfeeding and carefully monitor the feeding technique. The fact is that the cause of digestive problems in a newborn can be a banal swallowing of air. As for the mother’s diet, during the feeding period, she should give up citrus fruits, baked goods, cabbage, legumes, smoked and fried. Such products can cause heartburn, bloating, colic, and allergies in a baby.The frequency of feeding should be monitored no less carefully: underfeeding and overfeeding can also lead to indigestion in an infant.

Antibiotic therapy should be treated carefully. Such drugs can be used only for serious illnesses, when there is no choice: antibiotics carry a great load on the digestive system of a newborn child and on the entire body as a whole.

The intake of probiotics helps prevent or eliminate the already formed digestive upset in infants.These are products with live beneficial microorganisms – bifidobacteria and lactobacilli. Our famous compatriot Ilya Mechnikov proved their beneficial effect on the work of the gastrointestinal tract back in the 19th century, and many of his colleagues have confirmed this over the decades. Therefore, today we can say with confidence that probiotics are well studied, they are non-toxic and non-pathogenic, and their action has been proven by many clinical studies. It is worth noting that probiotics can contain only one type of bacteria or both at once.It is not very correct to compare the functionality of these microorganisms, because both types live in the gastrointestinal tract and are equally important for the intestinal microflora. In addition, lactobacilli have a beneficial effect on the development of bifidobacteria, which speaks in favor of complex probiotics. In addition, a number of parameters affect the quantitative proportion of these bacteria in the child’s body: the type of delivery, the factor of prematurity, the nature of the diet, the presence of various diseases in the child, the characteristics of his metabolism, and much more.So it is impossible to determine which type of bacteria is needed more without special research.

Do not miss scheduled medical examinations, because most of the diseases of the digestive system in infants are easily treatable, the main thing is to recognize the disease in time.

The causes of poor digestion in a child can be very different. Sometimes, to improve the well-being of the baby, it is enough just to adjust the feeding technique or revise the diet.But sometimes unpleasant symptoms indicate serious health problems. Therefore, the most important advice to parents of babies is to contact a pediatrician at the slightest alarm bells.