Dispepsia

 

dispepsia

Queremos abordar en este caso la dispepsia dado que es posiblemente uno de los motivos de consulta más repetidos y que más llegan a desesperaros. Intentaremos explicaros qué es la dispepsia, cuándo debéis darle más importancia y qué podéis hacer para mejorarla.

¿Qué es la dispepsia?

Es un dolor o malestar que se localiza en el hemiabdomen superior, es decir, por encima del ombligo. Cuando hablamos de malestar nos estamos refiriendo a hinchazón, ardor, sensación de saciedad precoz, digestiones pesadas, naúseas o eructos.

Este tipo de molestias las hemos padecido todo el mundo de manera puntual en algún momento de nuestra vida, asociadas en la mayoría de los casos a una transgresión dietética, ya sea por una comida abundante o el abuso del alcohol.

Cuando vemos que estas molestias de repiten con frecuencia o persisten  durante al menos 3 de los últimos 6 meses, es cuando hablamos de dispepsia.

¿Por qué se produce la dispepsia?

Hay muchas causas de la dispepsia. A groso modo, la clasificamos en dos grupos, la funcional y la orgánica.

La dispepsia orgánica es aquella en la que encontramos una causa clara que la produce. Las causas más frecuentes de dispepsia orgánica son la úlcera, la toma de determinados medicamentos, la enfermedad por reflujo gastroesofágico y las gastritis producidas por el abuso de alcohol.

La dispepsia funcional es aquella dispepsia que persiste durante al menos 3 de los últimos 6 meses, en la que hemos descartado dispepsia orgánica e infección por H.Pylori (poner enlace a post de helicobacter) y en la que los síntomas no mejoran exclusivamente con la defecación o se asocian a cambios en a frecuencia o consistencia de las deposiciones.

¿Qué me va a hacer mi médico si acudo a consulta porque los síntomas de dispepsia se me repiten?

Lo primero que hará tu médico es hacerte unas preguntas sobre tu estilo de vida y tus antecedentes para investigar si existe alguna causa que justifique los síntomas. Le  interesará saber si llevas una vida sedentaria o haces ejercicio, así como si fumas o bebes alcohol con frecuencia. También te preguntará a cerca del consumo de ciertos medicamentos como antiinflamatorios y revisará tus antecedentes personales de úlcera gástrica, cirugía abdominal o infección por H.Pylori.

Te va a preguntar a cerca de cómo es tu dolor. Dónde se localiza, cuánto te dura, de qué intensidad es, si se irradia hacia algún sitio, si notas que algo lo mejore o lo empeore, si has notado cambios en las deposiciones, si guarda relación con las comidas o si tienes algún otro síntoma que asocies con las molestias.

Después te explorará el abdomen. La exploración suele ser normal.  En cuanto a las pruebas, puede que te pida una analítica.

En función de tu edad, tus antecedentes o si tienes algún signo de alarma, puede ser necesario un test del H. Pylori o una endoscopia.

Si no hay una causa clara, no hay signos de alarma y no tienes más de 55 años, puede que te realicen un test del H. Pylori y si es positivo lo traten. Puede que previamente te pongan un tratamiento con inhibidores de la bomba de protones, como el omeprazol, durante unas semanas para ver si mejoras.

Si por el contrario tienes más de 55 años o algún signo de alarma, es posible que directamente hagan una endoscopia.

¿Cuándo debo acudir a mi médico?

Debes acudir cuando los síntomas se prolonguen durante un tiempo de manera repetida o si detectas alguno de los siguientes signos de alarma:

  • Pérdida de peso significativa no intencionada
  • Vómitos intensos y recurrentes
  • Molestias para tragar (disfagia)
  • Heces muy oscuras (negras)
  • Color de tono amarillento en los ojos con dentro de la boca

¿Qué tratamiento me van a poner?

En principio, te aconsejará medidas dietéticas. Dejar de fumar, no consumir alcohol y bajar de peso. Además, hacer una dieta baja en grasas.

Si tu médico encuentra una causa clara que explique la dispepsia, te aconsejará erradicarla. Por ejemplo, si se debe a la toma de antiinflamatorios, dejar de tomarlos.

Es frecuente que si no tienes más de 55 años y no hay signos de alarma, te pongan un tratamiento con inhibidores de la bomba de protones, como el omeprazol, durante 4 semanas. Según la respuesta obtenida, decidirán si retirarlo, mantenerlo un tiempo o duplicar la dosis unas semanas más.

Si te hacen el test del H. Pylori y sale positivo, habrá que ponerte un tratamiento que combina antibióticos con inhibidores de la bomba de protones que durará entre 7 y 14 días. Cuando pasen al menos 4 semanas de acabar el tratamiento, habrá que repetir el test para ver si el tratamiento ha sido efectivo.

¿Puedo hacer algo para mejorar o prevenir la dispepsia?

Claro que sí. Estos consejos te ayudarán con el reflujo y las digestiones pesadas.

  • Hay que evitar el estrés y el sobrepeso.
  • Después de comer no conviene ponerse a hacer ejercicio de forma inmediata. Reposa un rato la comida y sobretodo, evita agacharte.
  • Si tienes reflujo, intenta no acostarte hasta que pasen al menos 2 horas de haber comido o cenado. Puedes elevar la cabecera de la cama para dormir.
  • Debes Evitar la ropa ajustada o que comprima a nivel de la cintura.
  • Evita las comidas excesivas. Es mejor comer más veces y en pequeñas cantidades.
  • Durante la comida es preferible ingerir pocos líquidos. Bebe más entre comida y comida.
  • Come despacio y masticando bien la comida. No tomes los alimentos ni muy fríos, ni muy calientes.
  • Evitad los alimentos que puedan causar más acidez como alimentos grasos (mantequilla, queso, embutidos, salsas y pasteles), comidas fritas o muy condimentadas con especias, chocolate, tomate, cítricos (limones, naranjas y pomelos), alcohol, café, té y las bebidas gaseosas o con cafeína, menta o cola.
  • Evita el consumo de tabaco.

Marta Cano Pazos
Médico de Familia, médico de área en Segovia

REFERENCIAS

  • J. Talleg. American Gastroenterological Association Medical Position Statement: Evaluation of dyspepsia. Gastroenterology, 129 (2005), pp. 1753-1755 http://dx.doi.org/10.1053/j.gastro.2005.09.019 Medline
  • Tack,N.J. Talley,M. Camilleri,G. Holtmann,P. Hu,J.R. Malagelada. Functional gastroduodenal disorders: a working team report for the Rome III consensus on functional gastrointestinal disorders Gastroenterology, 130 (2006), pp. 1466-1479http://dx.doi.org/10.1053/j.gastro.2005.11.059 Medline
  • M. Tielemans,T. Eikendal,J.B. Jansen,M.G. van Oijen. Identification of NSAID users at risk for gastrointestinal complications: a systematic review of current guidelines and consensus agreements. Drug Saf, 33 (2010), pp. 443-453 http://dx.doi.org/10.2165/11534590-000000000-00000 Medline

 
Revisado: marzo de 2017

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