What happens when there is fullness and discomfort after meals, early satiety; or epigastric pain, burning in the epigastrium, or belching, nausea, etc., but physical examination does not reveal any significant lesions in the digestive tract?
This is a sign of indigestion.
Indigestion-related knowledge.
1, indigestion-related symptoms: postprandial fullness, epigastric distention, early satiety, epigastric pain, epigastric burning, belching, nausea, vomiting.
2.Symptom analysis
Postprandial fullness: the uncomfortable feeling caused by the food staying in the stomach for too long after eating.
Early satiety: The stomach feels too bloated soon after starting to eat, and the appetite disappears in the process of eating. This feeling is not proportional to the amount of food eaten, so that the whole meal cannot be finished.
Epigastric pain: unpleasant sensation in the area below the sternum, above the navel, and between the midclavicular line on both sides.
Epigastric distention: subjective sensation of tightness and distension in the upper abdomen.
Belching: gas is expelled from the mouth through the stomach or esophagus.
3, indigestion can be divided into two categories: organic indigestion and functional indigestion.
Organic dyspepsia: there is a clear organic or metabolic disease caused by indigestion symptoms. Such as: gastric ulcer, duodenal ulcer, gastric tumor, pyloric obstruction, some gallbladder stones, pancreatic factors, drug factors, diabetes, etc.. With the treatment and control of the original disease, the dyspepsia symptoms will be reduced or disappear.
Functional dyspepsia: dyspeptic symptoms exist, and the examination does not reveal organic or metabolic diseases, or the diseases found in the examination cannot explain the occurrence of dyspeptic symptoms. For example.
Helicobacter pylori infection (HP infection), where symptoms persist despite eradication of HP.
Superficial gastritis, superficial gastritis does not cause indigestion symptoms.
4, the relationship between the two: long-term functional dyspepsia can cause organic lesions, can be transformed into organic dyspepsia.
Functional dyspepsia
1, definition: functional dyspepsia is abbreviated as FD, refers to one or a group of dyspeptic symptoms originating from the gastroduodenal region, and the lack of organic or metabolic diseases that can explain these symptoms. Clinical manifestations include postprandial fullness, epigastric distention, early satiety, epigastric pain, epigastric burning, belching, nausea, vomiting.
2.Epidemiological data
The incidence of FD is high, with 20-40% of gastroenterology outpatient visits in China with FD symptoms, and epidemiological findings show an increasing trend in its incidence. Patients with chronic and recurrent symptoms, reduced quality of life, often accompanied by psychiatric disorders, and the need for long-term medication or repeated visits to the hospital, resulting in the consumption of a large amount of medical resources and a heavy economic burden on patients.
3.Pathogenesis
The pathogenesis of functional dyspepsia is complex: delayed gastric emptying, decreased gastric compliance, hypersensitivity of gastric/duodenal visceral nerves, abnormal gastrointestinal hormones, autonomic dysfunction, and psychosomatic disorders.
4.Auxiliary examination
Gastroscopy: Gastroscopy can be used to understand the specific conditions of the esophagus, stomach and duodenum and to find the cause of organic dyspepsia.
Nuclear gastric emptying test/barium strip gastric emptying: gastric emptying test to understand whether there is delayed gastric emptying, impaired gastric solid emptying function.
Gastric compliance and sensitivity test: To find out whether there is abnormal gastric compliance and hypersensitivity of gastric visceral nerves.
Gastrointestinal hormone: Check the blood gastrointestinal hormone to understand whether there are abnormalities in the gastrointestinal tract and the central neurological and endocrine functions.
5.Treatment
(1) Western medicine treatment
The guidelines for the treatment of functional dyspepsia in western medicine recommend the use of acid-suppressing drugs (such as omeprazole, esomeprazole), prokinetic drugs (such as morpholine, mosapride), or a combination of drugs, and for those who fail to treat, low-dose antidepressant therapy (such as Dextran) or psychological intervention.
For some patients, acid suppression, motivation and antidepressant treatment can achieve good results, but some patients still do not get satisfactory results after the above treatments. For example: symptomatic treatment can only target some of the symptoms, but cannot effectively relieve the main symptoms or only partially relieve the symptoms; can only relieve the gastrointestinal symptoms, but can hardly improve the mental and psychological status and quality of life; can hardly change the patient’s disease physique and pathophysiological state, and can hardly completely relieve the symptoms, solve the problem of relapse after stopping the medication, and require long-term maintenance medication.
(2) Chinese medicine treatment
In Chinese medicine, functional dyspepsia belongs to the category of “fullness” and “stomach pain”, etc. The postprandial discomfort syndrome of the Rome III standard and typology of FD is equivalent to “fullness” in Chinese medicine, while epigastric pain syndrome belongs to the category of “fullness” in Chinese medicine. In contrast, epigastric pain syndrome belongs to the category of “stomach pain” in TCM. From the distribution of the symptoms, FD is most closely related to spleen deficiency (including spleen deficiency and dampness, spleen deficiency and qi stagnation, etc.), followed by liver depression (including liver and stomach qi stagnation, liver and stomach heat, etc.). According to the clinical distribution pattern, functional dyspepsia is mainly divided into 4 types of evidence.
Damp-heat-induced obstruction evidence.
Spleen deficiency and qi stagnation evidence.
Liver and Stomach Qi Stagnation Evidence.
Liver and Stomach Stagnation and Heat.
Under the guidance of holistic concept and evidence-based treatment, the clinical treatment of this disease in Chinese medicine has achieved good clinical efficacy, with an effective rate of 75-90%.