Clinical syndrome with chronic or recurrent gastrointestinal symptoms without organic disease mainly characterized by postprandial fullness, early satiety, epigastric pain, and burning sensation Functional dyspepsia may be associated with psychological and social factors use of medication, psychotherapy, etc.
Definition
Functional dyspepsia is defined as the presence of chronic or recurrent gastrointestinal symptoms without abnormal findings on routine examination, and is one of the most common functional gastrointestinal disorders in clinical practice.
Morbidity
The prevalence of functional dyspepsia in China ranges from 19% to 37%, which is slightly lower than the world average.
Women are more susceptible to this disease than men, which may be psychologically related.
Causes
Causes
The cause of functional dyspepsia is not well understood and may be related to the following factors.
Visceral hypersensitivity
May be the main cause of this disease. It is characterized by hypersensitivity of the gastrointestinal tract to external stimuli, accompanied by central sensory hypersensitivity.
Dynamic disorders of the gastrointestinal system
Delayed gastric emptying, accelerated and slowed intestinal passage time may be inextricably linked to the disease.
Gastrointestinal infections
Acute gastrointestinal infections may be associated with some functional dyspepsia and may predispose to the disease.
Pathogens include bacteria and parasites. Some of the common ones are Helicobacter pylori, Salmonella and Giardia lamblia.
Psychological factors
The disease is highly prevalent in people with mental abnormalities, which may be accompanied by anxiety, depression, and disturbed sleep habits.
Other factors
Genetic, environmental, and food factors may be associated with some functional dyspepsia.
Symptoms
Main Symptoms
Post-meal fullness: stomach discomfort after meals, a constant feeling of fullness, a feeling that food has been stored in the stomach without being digested.
Early satiety: feeling full after eating a little, no appetite at all, unable to eat regular amount of food.
Epigastric pain: mostly manifested as irregular pain, some people manifested as epigastric pain after eating.
The epigastrium is accompanied by a burning sensation.
Some people also experience epigastric bloating, belching, nausea and vomiting.
Other symptoms
May be accompanied by mental symptoms of varying degrees, such as insomnia, anxiety, depression, fear, nervousness and even hostility, but are not psychological disorders.
Consultation
Department of Medicine
Gastroenterology
Feeling of abdominal fullness, early satiety during meals, epigastric pain, burning sensation, timely consultation is recommended.
Preparation
Consultation: Registration, Preparation of Documents, Frequently Asked Questions
Tips
Try to keep a record of the symptoms you have experienced and how long they have lasted before going to the doctor.
Prolonged indigestion may require a gastroenteroscopy.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
Are there any symptoms such as abdominal pain, bloating, nausea, vomiting, etc.? How long have they lasted?
Any change in bowel habits? For example, the number of bowel movements, the nature of the feces, etc.
Any recent eating of unclean food or drinking of unsanitary water?
Have you recently taken certain medications? Such as salicylates, glucocorticoids, antibiotics, etc.?
Have you had a gastroscopy or other related tests?
Medical History Checklist
Any previous intestinal diseases?
Have family members experienced similar symptoms?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
The main manifestations are postprandial fullness, early satiety, epigastric pain and burning sensation.
Laboratory Tests
Blood tests
Blood routine: to understand the level of red blood cells and white blood cells, to determine the presence of anemia and to exclude infectious gastroenteritis.
Blood biochemistry: blood biochemistry test to understand the function of liver, gallbladder and pancreas, to exclude the abnormal function of liver, gallbladder and pancreas.
Stool test
Detect whether there are red blood cells in the feces to determine whether there is gastrointestinal bleeding.
3 days before the test, abstain from eating meat and animal blood, and abstain from taking iron and vitamin C.
Helicobacter pylori test
Urea breath test is one of the “gold standard” methods for detecting Helicobacter pylori, and it is non-invasive, highly accurate, and widely used in clinical practice.
The principle is that radioactive ¹³C, ¹⁴C-labeled urea (taken orally) is broken down by the urease enzyme produced by H. pylori, resulting in the production and exhaling of CO2, and the presence of H. pylori infection is determined by measuring the concentration of CO2.
Endoscopy
Endoscopy is used to rule out organic lesions of the gastrointestinal tract, and is characterized by safety, reliability, and other features that allow direct observation of pathological changes in the gastric mucosa.
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Gastroscopy can also be performed at the same time by taking diseased tissues for pathologic examination and Helicobacter pylori testing.
You should not eat anything or drink water at least 6 hours before the examination. If you have removable dentures, please remove them before the examination. Generally 2 hours after the examination before eating water, warm and cool fluid or semi-fluid is appropriate, avoid eating stimulating food, later return to normal.
Imaging examination
Gastrointestinal barium meal examination can show the roughness of the lesion mucosa, which is helpful in confirming the differential diagnosis.
Bowel preparation should be carried out as prescribed by the doctor before the examination.
Fasting should be started 6 to 12 hours before the examination, and water fasting should be started 4 hours before the examination.
Differential diagnosis
Gastric cancer
Similarities: Both may present with symptoms such as decreased appetite, epigastric discomfort, fullness, and anemia. X-ray signs of a few gastric sinus gastritis are also very similar to gastric cancer.
Differences: Differential diagnosis can be made by endoscopy and tissue biopsy.
Peptic ulcer
Similarity: chronic epigastric pain and other symptoms can occur.
Difference: Peptic ulcer is characterized by regular and periodic pain in the upper abdomen, while functional dyspepsia pain is rarely regular and is characterized by dyspeptic symptoms. It can be differentiated by endoscopy.
Treatment
General treatment
Diet modification
Frequency of diet
Functional dyspepsia requires small, frequent meals to avoid eating large amounts of food at once to increase the burden on the digestive tract.
It is recommended to eat smaller meals, up to 6 meals per day.
Dietary precautions
Avoid oily, stimulating and gas-producing foods, and choose foods that are easy to digest and rich in protein and vitamins.
Dietary taboos
It is necessary to prohibit drinking alcohol, coffee and strong tea, etc. during the treatment.
Others
Medication management
Need to stop taking non-steroidal anti-inflammatory drugs, if you need to take, please consult your doctor or pharmacist.
Medication
Medication is the mainstay of treatment for functional dyspepsia.
Drugs that reduce visceral sensitivity, such as 5-hydroxytryptamine inhibitors, inhibitors of gastric acid secretion, gastric mucosal protectors, gastrointestinal motility enhancers, regulators of intestinal flora, and antispasmodics are usually prescribed.
Patients who experience significant mental or emotional depression and anxiety are treated with antidepressants and anxiolytics.
Special note: All medications should be used as prescribed by a physician and should not be adjusted in dosage or discontinued on their own.
Drugs to reduce visceral sensitization
Opioids: can reduce visceral pain and effectively inhibit gastrointestinal motility.
5-hydroxytryptamine receptor antagonists: common drugs include ondansetron, which can effectively inhibit gastrointestinal hypersensitivity.
Alpha-adrenergic drugs: can effectively increase intestinal compliance and improve abdominal pain and other related symptoms.
Inhibition of gastric acid secretion
Application of drugs to inhibit gastric acid secretion aims to relieve pain, promote ulcer healing and prevent complications.
Drugs to inhibit gastric acid secretion include proton pump inhibitors such as omeprazole, rabeprazole, lansoprazole, epprazole and so on; H2 receptor blockers such as cimetidine, ranitidine, famotidine and so on.
Gastric mucosa protective agents
Protective drugs for gastric mucosa include aluminum preparation and bismuth agent, which can form high viscosity sol under acidic environment and produce strong affinity to the ulcer surface, forming a strong protective film on the surface of gastric mucosa, which has good therapeutic effect on peptic ulcer and chronic inflammation.
Drugs to promote gastrointestinal dynamics
It can improve the symptoms of epigastric fullness associated with meals.
Commonly used drugs include domperidone and mosapride.
Need to be taken before meals.
Adverse reactions such as diarrhea and abdominal pain may occur, which can usually be relieved on their own after stopping the drug.
Intestinal Flora Regulators
The main way to regulate intestinal flora is to take oral probiotics. Probiotics can correct the intestinal flora imbalance and have a certain effect on functional gastrointestinal diseases.
At present, the main commonly used ones are Bifidobacterium, Lactobacillus, Bacillus licheniformis and Bacillus cereus.
Antispasmodics
Scopolamine is an anticholinergic acting on M cholinergic receptors, with obvious peripheral anticholinergic effects, which can relax smooth muscle and effectively improve intestinal spasm.
Antidepressant, anxiety treatment
People with obvious psychiatric and psychological disorders can choose antipsychotic drug treatment as prescribed by the doctor, and should be adhered to for at least 3 to 6 months.
Drugs used for anti-anxiety mainly include selective 5-hydroxytryptamine reuptake inhibitors (SSRI), 5-hydroxytryptamine-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants, newer anxiolytics, benzodiazepines, and so on.
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Other Classes
Benzodiazepines, Glutamine, etc.
Psychotherapy
Effects: It can significantly reduce anxiety, depression and other emotions, which in turn can improve gastrointestinal symptoms.
Commonly used methods: mainly psychodynamic therapy, cognitive therapy, thought therapy and hypnotherapy.
Prognosis
Cure
Repeated, intermittent episodes are possible, and it is generally believed that the heavier the psychosocial burden and the more skeptical the person is, the less likely the symptoms will disappear.
Harmfulness
Functional dyspepsia can be recurrent and interfere with normal life and work.
Daily
Daily management
Functional dyspepsia should be managed in a number of ways in daily life.
Eat regularly, have meals on time, do not overeat, and may eat small, frequent meals.
Do not eat spicy, fried, raw and cold foods or hot foods, such as chili peppers, barbecue, doughnuts, etc.
Do not eat unwashed fruits and vegetables and spoiled food.
Prohibit smoking and drinking.
Maintain a good state of mind and reduce the frequency and intensity of psycho-emotional stress.
Prevention
Maintain a positive and optimistic state of mind and avoid prolonged exposure to adverse emotions such as anxiety and depression.
Adopt good eating habits and avoid starving or overeating.
If you are infected with Helicobacter pylori and meet the indications for treatment, you need timely treatment.