The prevalence of gastric cancer in China is higher than that in the West, and further examination should be done when dyspepsia with alarm symptoms is encountered. Family history of tumor should be paid attention to, and age above 40 years should be used as reference, but it should be closely combined with clinical. Patients with obvious emotional factors or psychological disorders should have relevant examinations in time, which is more favorable for clear diagnosis and explanation of the disease. If the patient does not have the above conditions and is in good general condition, or has received the relevant examination in the past and the symptoms have recently recurred, or is temporarily unable to receive the relevant examination, empirical treatment can be used. Empirical treatment should be combined with the symptom characteristics of dyspepsia and the relationship between symptoms and meals to speculate on its possible pathophysiological basis. In healthy individuals, gastroduodenal motility during the interdigestive period is characterized by characteristic migratory compound motility (MMC), in which MMC
III phase flag is normal, but postprandial gastric food distribution is abnormal. Impaired postprandial gastric fundus relaxation or abnormal sensation of dilation may be associated with early satiety. About 50% of FD patients have hypersensitivity of the stomach and duodenum to mechanical stimuli, which could explain the ease of epigastric fullness symptoms in FD patients despite the small amount of food eaten. In addition, reduced duodenal acid clearance due to duodenal motility disorders is associated with nausea. the basis for symptoms in FD patients during fasting may be their MMC
The basis for the symptoms of FD patients during fasting may be their abnormal MMC activity, including a reduced number of MMC III episodes, reduced MMC
These may explain the fact that some patients have symptoms on an empty stomach that do not diminish or even worsen after a meal. Patients are often afraid to eat more to avoid aggravating their symptoms. Focusing on the relationship between meals and dyspepsia symptoms helps to analyze the pathophysiological basis of dyspepsia, i.e., whether it is an acid-related disease or a power-related dyspepsia. Food buffers gastric acid and raises gastric pH, thus reducing the symptoms caused by acid irritation. If a patient has epigastric discomfort, pain, or distention on an empty stomach that is relieved after a meal, it is likely to be an acid-related disorder. If a patient has symptoms such as epigastric discomfort, pain, and early saturated epigastric distension after a meal, but no symptoms on an empty stomach, or symptoms also on an empty stomach that worsen after a meal, attention should be paid to the presence of excessive or inappropriate food, resulting in an increased gastric digestive load or a condition that is not consistent with gastric digestive physiology. If there is no food factor, the above symptoms can be regarded as dyspepsia associated with gastric motility disorder. In these cases, it is recommended to choose antacids or acid suppressants for acid-related diseases and prokinetic agents for dyspepsia associated with gastric dysmotility. The duration of medication is 2 weeks. If the symptoms are reduced or disappear, the above judgment is further supported; if it is not effective, further examination is recommended. After more than 2 years of discussion and consultation, we now propose the diagnosis and treatment process of dyspepsia in China (see the attached figure), taking into account the international diagnosis and treatment process of dyspepsia, the common gastric diseases in China and the characteristics of the diagnosis and treatment of dyspepsia, and summarizing the above basis. The diagnosis and treatment flow is 2 times to ask questions (diamond symbol) in order to choose further treatment options (arrow symbol), i.e., further examination is needed or empirical treatment is chosen according to the relationship between symptoms and meals. In cases where empirical treatment is effective, the case may be judged as acid-related disease or dysmotility-related dyspepsia (long box symbol). In cases where empirical treatment is ineffective, further investigations, including biochemical tests, ultrasound and gastroscopy, should be performed and treated accordingly according to the findings. If the relevant tests show negative results or positive results that do not explain their symptoms, further tests should be performed if necessary, including gastric electrograms, gastric emptying tests, etc., to understand the gastric power function, the use of visceral perception tests to understand whether there are abnormalities in perception, and psychological tests if necessary. At present, the development of endoscopy is quite common in our country, and the cost is relatively low. Combining with the medical care system of our patients, endoscopy is proposed as the main means to diagnose dyspepsia. Due to the high prevalence of dyspepsia, it is difficult to arrange endoscopy for all patients, thus empirical treatment is still necessary.
Appendix The flow of diagnosis and treatment of dyspepsia in China. The pathogenesis of FD is not fully understood. It is believed that patients with FD often do not have abnormal gastric acid secretion, but the stomach may have increased sensitivity to physical or chemical stimuli, abnormal gastric, pyloric and duodenal dynamics, the role of H. pylori infection in dyspepsia remains to be clarified, mental stress may have a role in the pathogenesis of FD, and the relationship between FD and chronic gastritis remains to be explored. The relationship between FD and chronic gastritis remains to be explored. Excessive fasting and the stimulation of the food itself can aggravate dyspepsia. Thus, the etiology and pathogenesis of FD still need to be studied in depth. In China, H.pylori screening is commonly performed routinely during endoscopy, and the eradication of H.pylori-positive patients depends on their underlying pathology. Since the relationship between FD and H.pylori is still controversial, there is no consensus on whether H.pylori eradication therapy should be performed in patients with H.pylori-positive FD or chronic inactive gastritis, and evidence-based medical support is needed.