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Source of indigestion is as key as cure


My 17-year-old daughter has been complaining about indigestion a lot lately and she's not eating normally. I've seen those new heartburn remedies on the market and wondered if we should try them. What do you think?

Both of the medications you refer to have been available by prescription for quite some time and have a good safety profile. Hence, it may be quite reasonable for your daughter to try these medications according to package directions for relief of her symptoms. However, the fact that she is not eating normally worries us a bit, and if she does not respond promptly to use of these medications, a visit to her physician is warranted. She should also go if the symptoms return once she has stopped using these drugs.

Indigestion is rather a vague symptom. If your daughter is experiencing heartburn, it may be due to stress (is she worried about school, work or family problems?) or her diet (drinking too much coffee or other caffeine-containing beverages). Both factors can increase stomach acid production, as can smoking cigarettes or drinking alcohol. Obviously, controlling her stress level or eliminating these other offending agents will contribute more to her improvement than will the use of medications, although the latter may help speed up her healing. Skipping meals frequently because one is busy or in an attempt to lose weight can leave the stomach lining exposed to stomach acid for prolonged periods of time without the natural buffering properties of food.

Some teen-agers try to lose or control their weight by inducing vomiting after eating. This brings stomach acid up into the esophagus, which is also experienced by the individual as indigestion or heartburn.

You have probably already thought about ulcers as the cause of her symptoms; certainly teen-agers can suffer from the same kind of ulcer disease as adults. Other illnesses, such as inflammatory bowel disease, can also begin with symptoms that mimic ulcers. If your daughter is losing weight, has noticed blood in her stools, or has noted that her stools have become very dark or tarry looking, she should skip the over-the-counter medications and go right to the doctor.

A parasitic infection, called giardia, can be acquired by drinking contaminated water. This parasite, which lives in the upper part of the human intestinal tract, can cause indigestion, although we would expect that your daughter would also have experienced a lot of stomach bloating or belching or that she is passing a lot of gas. If she has gone backpacking this summer or has traveled abroad, this diagnosis should also be investigated.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center. Dr. Joffe is director of adolescent medicine.

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