Dr Puneet Kumar Misra
The study on the carbo veg shows that this medicine having the main action on the upper gastrointestinal tract (GIT) indisposition .the indisposition of upper GIT are the effect by various factor of meals and life style. The various nonspecific complains of the GIT are the indicator of the indisposition of it and control by this medicine completely or partial.
Keywords- Upper gastrointestinal tract (GIT), Indigestion, Dyspepsia,
Introduction – Initially gastrointestinal disorders are not very distressing and person unable to explain it in the form of disorder or indisposition .most of the person feels this is normal when occur occasionally, but when the recurrence in the shorts duration and person daily routine are disturbs then he consider it as disorder.
Indigestion (dyspepsia) – Dyspepsia is the medical term for indigestion, a symptom which may include epigastric pain, heartburn, distension, nausea or ‘an acid feeling’ occurring after eating or drinking. The symptom is subjective and frequent. In many patients there is no demonstrable cause but it may be associated with Helicobacter infection, peptic ulceration, and acid reflux. Upper GI malignancy should be excluded in older patients who present with new onset dyspepsia. 1
Heartburn and Regurgitation – Heartburn describes retrosternal, burning discomfort, often rising up into the chest and sometimes accompanied by regurgitation of acidic or bitter fluid into the throat. These symptoms often occur after meals, on lying down or with bending, straining or heavy lifting. They are classical symptoms of gastro-oesophageal reflux but up to 50% of patients present with other symptoms, such as chest pain, belching, halitosis, chronic cough or sore throats. In young patients with typical symptoms and a good response to dietary changes, antacids or acid suppression investigation is not required, but in patients over 55 years of age and those with alarm symptoms or atypical features urgent endoscopy is necessary
Causes of dyspepsia – Upper gastrointestinal disorders • Peptic ulcer disease • Acute gastritis • Gallstones • Oesophageal spasm • Non-ulcer dyspepsia • Irritable bowel syndrome
Other gastrointestinal disorders • Pancreatic disease (cancer, chronic pancreatitis) • Colonic carcinoma • Hepatic disease (hepatitis, metastases)
Systemic disease • Renal failure • Hypercalcaemia
Drugs• Non-steroidal anti-inflammatory drugs (NSAIDs)• Glucocorticoids• Iron and potassium supplements • Digoxin
Others•Psychological (anxiety, depression)• Alcohol. 2
INDIGESTION ■ MECHANISMS The most common causes of indigestion are gastroesophageal reflux and functional dyspepsia. Other cases are a consequence of organic illness. Gastroesophageal Reflux – Gastroesophageal reflux results from many physiologic defects. Reduced lower esophageal sphincter (LES) tone contributes to reflux in scleroderma and pregnancy and may be a factor in some patients without systemic illness. Others exhibit frequent transient LES relaxations (TLESRs) that permit bathing of the esophagus by acid or nonacidic fluid. Reductions in esophageal body motility or salivary secretion prolong fluid exposure. Increased intragastric pressure promotes gastroesophageal reflux in obese patients. The role of hiatal hernias is controversial—most reflux patients have hiatal hernias, but most with hiatal hernias do not report excess heartburn.
Gastric Motor Dysfunction Disturbed gastric motility may contribute to gastroesophageal reflux in up to one-third of cases. Delayed gastric emptying is also found in ~30% of functional dyspeptics, while rapid gastric emptying affects 5%. The relation of these defects to symptom induction is uncertain; studies show poor correlation between symptom severity and degrees of motor dysfunction. Impaired gastric fundus relaxation after eating (i.e., accommodation) may underlie selected dyspeptic symptoms like bloating, nausea, and early satiety in ~40% of patients and may predispose to TLESRs and acid reflux.
Visceral Afferent Hypersensitivity Disturbed gastric sensation is another pathogenic factor in functional dyspepsia. Approximately 35% of dyspeptic patients note discomfort with fundic distention to lower pressures than in healthy controls. Others with dyspepsia exhibit hypersensitivity to chemical stimulation with capsaicin or with acid or lipid perfusion of the duodenum. Some individuals with functional heartburn without increased acid or nonacid reflux may have heightened perception of normal esophageal acidity.
Other Factors Helicobacter pylori has a clear etiologic role in peptic ulcer disease, but ulcers cause a minority of dyspepsia cases. H. pylori is a minor factor in the genesis of functional dyspepsia. Anxiety and depression may play contributing roles in some functional dyspepsia cases. Functional MRI studies show increased activation of several brain regions, emphasizing contributions from central nervous system pathways. Inflammatory factors like duodenal eosinophilia (and possibly increased duodenal mast cells) may contribute to early satiety and pain in functional dyspepsia. Up to 20% of functional dyspepsia patients report symptom onset after a viral illness, suggestive of an infectious cause. Analgesics cause dyspepsia, whereas nitrates, calcium channel blockers, theophylline, and progesterone promote gastroesophageal reflux. Other stimuli that induce reflux include etha- 257 nol, tobacco, and caffeine via LES relaxation. Genetic factors predispose to development of reflux and dyspepsia.
GENERAL PRINCIPLES For treatment – mild indigestion, reassurance that a careful evaluation revealed no serious organic disease may be the only intervention needed. Drugs that cause gastroesophageal reflux or dyspepsia should be stopped, if possible. Patients with GERD should limit ethanol, caffeine, chocolate, and tobacco use due to their effects on the LES. Other measures in GERD include ingesting a low-fat diet, avoiding snacks before bedtime, and elevating the head of the bed. Patients with functional dyspepsia also may be advised to reduce intake of fat, spicy foods, caffeine, and alcohol. Specific therapies for organic disease should be offered when possible. Surgery is appropriate for biliary colic. Diet changes are indicated for lactase deficiency or celiac disease. Peptic ulcers may be cured by specific medical regimens. However, because most indigestion is caused by GERD or functional dyspepsia, medications that reduce gastric acid, modulate motility, or blunt gastric sensitivity are used. 3
Scheme from various Materia Medica
- Weak digestion; simplest food disagrees; excessive accumulation of gas in stomach and intestines < lying down; after eating or drinking, sensation as if stomach would burst; effects of a debauch, late suppers, rich food. Eructations give temporary relief. 4
- The most marked and valuable place for this remedy is in its power to relieve complaints from excessive flatulence in the stomach. “Great accumulations of flatulence in the stomach.” “Stomach feels full and tense from flatulence.” 5
- —Eructations, heaviness, fullness, and sleepiness; tense from flatulence, with pain; worse lying down. Eructations after eating and drinking. Temporary relief from belching. Rancid, sour, or putrid eructations. Waterbrash, asthmatic breathing from flatulence. Nausea in the morning. 6
- Ø Abdomen Burning pain and great anguish in the abdomen. Pinching in the abdomen, coming from the left side and tending towards the right side, with sensation of paralytic weakness in the thigh. Much flatulency, especially after a meal, and sometimes with sensation of torpor in the abdomen. Flatulent, cramp-like colic, even at night. Borborygmi and movements in the abdomen. Excessive discharge of flatus, of a putrid smell. Aggravation of the abdominal sufferings after eating the smallest portion of food. The pains in the abdomen are often accompanied by anxiety and tears. He cannot bear any tight clothing around his waist and abdomen. 7
Ø #Eating and drinking After eating: headache; acidity in mouth; plainest food disagrees; heaviness, fulness (more after supper), sleepiness; nausea, vomiting; feels as if abdomen would burst; < after debauch from rich living. Dreads to eat because of pains; burning in epigastrium and deep in abdomen.Everything that he eats causes eructations of wind. Intermittent fever.After milk, sour eructations. Gastric symptoms: from wine; coffee; too much milk; excessive use of butter, or from rancid butter, from fats in general; fish, especially if tainted; from wine drinking; from mixed beverages in hot weather; from ice water or different waters; from flatulent vegetables; abuse of salt or salt meats.Affections after fat and fat foods, pastry, etc., which are not cured by Pulsar. 8
Ø The Carbo veg. patient experiences a decided relief from eructation. This is a particular symptom, but it becomes almost general, and sometimes quite general. Headaches are relieved by belching; rheumatic pains are relieved by belching; sufferings and distensions of various kinds are relieved by eructations.This abdominal fulness aggravates all the complaints of the body. 9
Ø 385. After dinner, the abdomen very much inflated (ninth days). – When he eats or drinks, he feels as if his abdomen would burst. After eating but little, inflation of the abdomen and rumbling in it. (Gff) After a moderate breakfast, at once full and satiated. (C) After a moderate breakfast, fullness, eructation, general heaviness; writings proceeds slowly and with difficulty. (C) 390. During and after eating, pinching in the belly. (Gff) After enjoying breakfast, weakness. After every dinner, great heaviness in the feet, for 8 days. After a moderate breakfast, a general sweat. After and during a meal, anxiety. 395. After eating, headache. Eructation (after 1 1/2 hour). (C) Severe, almost constant eructation. Very frequent eructation, as well before, as after a meal, chiefly in the afternoon, for 8 days (after 4 days). (C) Frequent empty eructation, the whole day, chiefly in the afternoon. (Gff) 400. Frequent empty eructation, and preceded by transient pinching in the belly. (Gff) Empty eructation after soup, and every time he drinks. Eructation, after eating and drinking. Eructation is always empty, and connected, especially in the afternoon with accumulation of flatus in the abdomen. (C) By eructation, a mouth full of mucus is belched up, always a few hours after dinner. 10
- Ø *#Abdomen ***EXCESSIVE FLATULENCE; greatly distending the abdomen, esp. *upper part worse lying down. Obstructed flatulence, with complaints arising from. The simplest or smallest portion of food worse the sufferings in abdomen. Colic forcing the patient to bend double. Epigastric region very tender. Pain in the liver.11
|Adult and child
|Male and female
|1.0year to 80year
|117 adult 13 child
|85 male 45 female
The Nonspecific digestive tract disorder, occasional or recurrent distension of abdomen after anything eating or drinking and amelioration after eructation. the study are focused on the disorder mentioned above , the Continues observation of drug action in four years on the 130 case .
Observations found and discussion
- Firstly I discuss the case of 1year age male kid , he unable to explain own problem but their mother give the information that he are mildly uneasy or upset just after feeding and quite comfortable when belch released. The advice carbo veg 30, 4-5 pills of 40no just 5-10 minutes after every feeding ,start with this instruction that when kid child is comfortable after feed not given the medicine. after two week she(mother of kid ) inform that her kid increase the intake of meal and discomfort nature after the feed are markedly reduce and currently occasionally medicine is need .
- Many cases of digestive discomfort after meal are associated with anxiety and mild to moderate disturbance in the sleep, show the moderate response by the carbo veg 200 include the case of elder kid i.e. more the 10 year and adult along with age group of the more than sixty years .
- The many case of the general mild weakness or physical work intolerant after meal are also associated with this indisposition, and non noticeable this disorder and when ask it he unable to the focus but after administration of medicine patient report that discomfort after meal are change and it intake capacity increased .
- Digestive disorder are associated with many other disorder e. urinary tract infection and respiratory tract infection are Also control by the help of this medicine
- During the second wave of covid 19 many patient during and after covid 19 suffering found the benefit from the carbo veg dose in the improvement of loss of meal intakes with improvement in the sleep .
- The performance of carbo veg are well known in the digestive disorder , but its performance enhanced when it given after meal with before meal or empty stomach administration of phosphorus in the uppar GIT disorder. It also use full with mag phos and nux vomica when the whole GIT are disorder .
- The many case of the continues hair fall with the anaemia are also show improvement with the help of carbo veg but such kind case need the 4-5 weeks continues drug administration and good nutrient .
- Lastly I discuss one most important use of this medicine in many occasion mild to moderate chest pain and headache due to gastric origin are rapidly control by its within the very short duration and proofed its efficacy in the emergency event .
Indication of indisposition is start in the upper GIT are mild to moderate intolerance of mild food and drinking item of daily use and it is not marked but it is good indicator of carbo veg administration and when use the person found good health and improved the quality of life and inhibit the progression of disorder in adverse state, but this medicine also play an important role in an advance state of indisposition of the upper GIT including whole GI.
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Dr Puneet Kumar Misra
Lecturer(Practice of Medicine)
Govt Pt J LN H M C Kanpur