1. What is functional dyspepsia?
Functional dyspesia (FD) is a group of clinical syndromes with symptoms such as epigastric pain, epigastric distension, early satiety, belching, loss of appetite, nausea, vomiting, etc., and the organic diseases causing these symptoms are excluded by examination. The most common type of functional gastrointestinal disorder in clinical practice.
2. What are the causes of functional dyspepsia?
The pathogenesis of functional dyspepsia has not been fully elucidated. Factors associated with its development include acid, H. pylori infection, fatty diet and psychological factors.
1) Acid: The role of acid in the pathophysiological mechanism of the disease is not known. Most FD patients have normal gastric acid secretion and no abnormal sensitivity of gastric mucosa to acid or duodenal contents, but acid suppression therapy does work to relieve dyspeptic symptoms in a few patients.
(2) H. pylori infection: Epidemiological studies have failed to confirm a strong association between H. pylori infection and the disease, but there is insufficient evidence to exclude a causal relationship between the two. Studies correlating H. pylori infection with dyspeptic symptoms or their pathophysiological mechanisms have shown no significant differences in the incidence, severity, rate of gastric emptying, level of postprandial gastric relaxation, or susceptibility to gastric dilation between H. pylori-positive and -negative patients. However, given that some patients did have improvement in dyspeptic symptoms after H. pylori eradication, H. pylori infection may still play a role in the causation of the disease.
3) Fatty diet:dyspeptic symptoms often worsen after high-fat meals.
4) Psychological factors: It is not clear whether psychological factors are a causative factor in this disease, especially in patients hypersensitive to gastric dilatation, and whether they act as modifiers of the disease, determine the patient’s visit, perception of symptoms, and disease prognosis. However, there is evidence that the central nervous system plays an important role in the development of visceral hypersensitivity. Experimental animal studies have found that acute mental stress predisposes the organism to increased sensitivity to visceral stimuli, and that visceral sensitivity is significantly increased in rats in a state of anxiety. Similarly, in humans, the sensitivity of the body to gastrointestinal dilation decreases when the body is not concentrated, while the sensitivity increases when the body is concentrated or in a state of mental stress such as anxiety.
3. What are the manifestations of functional dyspepsia and how to diagnose it?
(1) persistent or recurrent epigastric discomfort.
2) Abdominal distension, belching, early satiety, anorexia, nausea, vomiting, acid reflux, heartburn.
3) Discomfort or pain behind the sternum.
4) Restlessness, anxiety, depression, insomnia, excessive dreaming, palpitations, sweaty hands and feet, low blood pressure, etc.
Functional dyspepsia is mostly seen as epigastric and retrosternal distention, pain, belching, bloating and intestinal tinnitus. The distention or pain can often be worsened after eating. In addition, there are neurological syndromes such as anorexia, nausea, dyspareunia, and anxiety or depression. However, organic lesions such as peptic ulcers or tumors cannot be found through various examinations.
4. What tests should be done for functional dyspepsia?
1）Blood routine, urine routine, fecal routine.
2) Liver function, kidney function.
3) Immunological examination of viral hepatitis.
4）X-ray examination, B ultrasound examination.
5）Electrolyte and inorganic element test.
6）Gastric fluid test.
7）Cardiovascular examination.
8）Endoscopy: such as electronic gastroscopy, colonoscopy, endoscopy can find ulcers, erosions, tumors and other organic lesions.
(9) Radionuclide (isotope) examination.
5) What diseases are easily confused with functional dyspepsia?
As a functional disease, functional dyspepsia should be distinguished from the following organic lesions.
(1) peptic ulcer: peptic ulcer is an ulcer that occurs in the bulb of the stomach or duodenum. Clinically, peptic ulcer can also be manifested as epigastric pain, feeling of fullness, belching, acid reflux, heartburn, nausea, vomiting, loss of appetite and other symptoms of indigestion, but barium fluoroscopy of the upper gastrointestinal tract can reveal an opaque shadow called “niche” protruding into the gastric wall, and gastroscopy can directly see the size of the ulcer lesion and the severity of the ulcer. The size of the ulcer lesion and the severity of the surrounding inflammation can be seen more directly on gastroscopy.
(2) Chronic cholecystitis and cholelithiasis: People with chronic cholecystitis or cholelithiasis often have pain in the right upper abdomen and symptoms of dyspepsia such as fullness and belching, and some patients may have a history of recurrent acute epigastric colic (this is called biliary colic). The diagnosis can often be made through abdominal B-type ultrasonography and cholecystography, combined with the recurrent epigastric colic.
(3) Gastric cancer: Gastric cancer often has no specific symptoms in the early stage and can only be detected by gastroscopy and pathological examination. However, as the tumor grows and affects the function of stomach, similar symptoms of indigestion will appear, which are mainly manifested clinically as pain or discomfort in upper abdomen, loss of appetite, nausea and vomiting. However, the age of onset of gastric cancer is mostly above 40 years old, and it will be accompanied by the so-called “alarm” symptoms of malignant tumor, such as wasting, weakness and anemia.
6. What is the relationship between functional dyspepsia and chronic gastritis?
Many patients with functional dyspepsia find that their symptoms are very similar to those of chronic gastritis and want to know how they are related to each other.
From the research data related to functional dyspepsia and gastritis, we can see that 30% to 50% of the patients diagnosed with functional dyspepsia are accompanied by chronic gastritis. However, the degree of inflammatory lesions is not parallel to the severity of functional dyspepsia symptoms, and many patients with “chronic gastritis” can significantly improve their symptoms or even disappear by improving motor function, such as the administration of prokinetic drugs. In view of the above, some scholars at home and abroad are now advocating the inclusion of endoscopically diagnosed and histologically confirmed gastritis in the category of this disease. However, so far, it is still under debate whether chronic gastritis and this disease are the same disease under different names.
Endoscopically, chronic gastritis is divided into two basic types: non-atrophic (superficial) gastritis and atrophic gastritis. Domestic scholars attach importance to mild mucosal changes, which often account for 80-90% of cases. Superficial gastritis is often present in a large healthy population census, but can be clinically asymptomatic and thus often does not require treatment. In contrast, dyspepsia is a common clinical syndrome, with a prevalence of 20-40% in the adult population abroad; a domestic study reported that dyspepsia accounts for about 52.6% of gastroenterology patients, more than half of which are functional dyspepsia. Clinically, it is common to see a portion of effectively treated cases of chronic superficial gastritis or atrophic gastritis with no significant change in the microscopic and pathological findings compared to those before treatment when the gastroscopy is reviewed after treatment. This suggests that symptomatic mild chronic gastritis and functional dyspepsia may be equivalent concepts. Therefore, the clinician must explain clearly to the patient that chronic superficial gastritis or atrophic gastritis is a microscopic diagnosis, while the clinical diagnosis is functional dyspepsia. The improvement of symptoms is the goal, to avoid patients to pursue the cure of chronic gastritis and needlessly take a large number of commercially available so-called “treatment of gastritis” drugs, resulting in drug and economic waste.
7. How does modern medicine treat functional dyspepsia?
Modern medicine treats functional dyspepsia mainly in the following aspects.
(1) General treatment Eliminating the causative factors is the basis of treating this disease, such as avoiding long-term strain, irregular life, smoking and alcoholism. Secondly, psychological treatment has a certain role in the treatment of functional diseases, especially to eliminate the bad mood, mental tension and depression caused by social, work and family factors. Finally, regulate the diet and lifestyle. The intake of some low-fat foods should be the main focus, and avoid over-stimulating diet. In the way of eating, you can eat less and more meals, and avoid picky eating, partial eating and irregular eating.
(2) Acid-suppressing drugs For patients with reflux-like or ulcer-like symptoms, acid-suppressing agents, such as acid-neutralizing drugs, H2 receptor antagonists, proton pump inhibitors, etc., can be used appropriately.
(3) Anti-Helicobacter pylori It is still controversial whether anti-HP treatment is necessary for functional dyspepsia. However, for a portion of patients with HP-positive chronic gastritis with acute activity, anti-HP therapy is necessary. The common method is to choose a proton pump inhibitor or bismuth plus two antibiotics penicillin, clarithromycin or metronidazole and other triple or quadruple therapy.
4) Gastric stimulants
Gastrofacial and morphine are dopamine receptor antagonists, which can promote gastric emptying, increase the tone of the lower esophageal sphincter, and promote the coordination of the pyloric duodenum of the gastric sinus. Gastrofluan is gradually replaced by a new generation of gastroprokinetic drug, morbutaline, because of its extrapyramidal side effects, and its relief rate of functional dyspepsia is about 70%.
5）Mucosal protective agent
For patients with functional dyspepsia with chronic gastritis can be given mucosal protective agents such as bismuth, aluminum thioglycollate, Metzolim, Simethicone, etc.
8.How does Chinese medicine know about the pathogenesis of functional dyspepsia?
Chinese medicine has certain advantages for the treatment of functional diseases. Let us first look at the understanding of Chinese medicine for the pathogenesis of the disease.
(1) Liver qi stagnation – disturbance of gastrointestinal rhythm function, mental anxiety and tension
It is believed that the liver has the function of draining, and if the liver can drain normally, it can guarantee the relaxation of emotions, the flow of qi and blood and the gradual prosperity of digestion. The result of liver stagnation is mental anxiety, nervousness and irritability, as well as the violation of the spleen and stomach, leading to malfunction of gastrointestinal digestive and motor functions; there are also long-term diseases of the spleen and stomach that involve the liver (e.g., indigestion affecting the patient’s sleep and causing mental tension and discomfort). The pathology of both is characterized by the loss of drainage of the liver, stagnation of qi, transverse flow of gas, stagnation of qi in the middle jiao, loss of harmony and descent of the stomach, and pain, fullness and belching in the upper abdomen. A survey has shown that patients with functional dyspepsia often have personality characteristics such as neuroticism, introversion and anxiety. On the basis of character defects, adverse psychosocial factors such as acute and chronic threatening life events can be used as triggers to cause dyspepsia symptoms and depression and anxiety. Psychological factors and dyspepsia interact with each other as cause and effect, forming a vicious circle. Chinese medicine is mostly attributed to the dysfunction between the liver and the spleen and stomach.
2) Weak spleen and stomach – low digestive and absorption function, slow gastrointestinal movement
In Chinese medicine, the spleen and stomach are located in the middle jiao, which is the main organ of transportation and muscles of the limbs, mainly including digestive and motor systems. The disorder of digestive function is ultimately the malfunction of the spleen and stomach, in which the spleen is the main organ of ascending and clearing, and the spleen qi can ascend so that nutrients can be distributed throughout the body; the stomach is the main organ of descending, and the stomach qi can descend so that the digested dregs can be discharged from the body. Once the spleen and stomach qi rise and fall is disturbed, there is bound to be a reduction in digestion and disruption of motor function. There are many reasons for the weakness of the spleen and stomach, such as congenital endowment deficiency and weak digestive function, or overwork and fatigue that damage the spleen and stomach, or serious illnesses that extend to the spleen and stomach, or poor diet that damage the spleen and stomach, resulting in weakness of the spleen and stomach, abnormal transportation, inability to digest food, failure to lift and lower, stagnation of turbid Qi in the stomach and wrist, and stomach abdominal distension, vague pain, and loss of appetite. In addition to symptoms of dyspepsia and dyskinesia, the former is often accompanied by symptoms of low function such as lack of desire to eat and drink, fatigue, lack of energy and laziness, or fear of cold; the latter is often combined with symptoms of internal heat such as hunger without desire to eat, heartburn, dry mouth without desire to drink, heat in the heart of the hands and feet, and red tongue without moss.
(3) Food (damp) stagnation in the stomach and epigastrium – gastric emptying disorder
Clinically, functional dyspepsia patients commonly suffer from upper abdominal fullness, aggravation after eating, pain, early satiety, anorexia, thick and greasy tongue coating, which are mostly attributed to stagnation of diet and obstruction of dampness in Chinese medicine. This is not only easy to cause the stagnation of food, but also easy to brew the evil of dampness and turbidity, which is embedded in the spleen and stomach in the middle jiao, so that the lifting and lowering of the qi is not normal, gangrene, manifested as the evidence of fullness, which is also the main factor that induces functional dyspepsia and the key to the pathogenesis.
9, functional dyspepsia of Chinese medicine to identify the key points is what?
The symptoms of functional dyspepsia include fullness, stomach pain and noisy.
(1) fullness of the evidence fullness is mainly seen in dyskinesia dyspepsia, the evidence of clinical need to identify the deficiency of cold and heat. The fullness is deficient if the patient cannot eat, or has little food that does not dissolve, and the stool is closed, and deficient if the patient can eat and the stool is closed, and deficient if the fullness decreases at times and the patient likes to press, and deficient if the fullness decreases at times or decreases, or if the patient also has pain and refuses to press. The pulse is stringent and slippery, and suddenly the chest is stuffy, which is caused by liver qi and food stagnation, and is real; the pulse is stringent, or sunken and stringent, or astringent, or weak and large, and the qi mouth is very strong, which is caused by injury to the spleen and stomach for a long time, or by taking overly aggressive drugs, and is deficient. The chest and diaphragm is stuffy and the pulse at the mouth of the inch is sunken and slippery, or late and slippery is heat; the tongue is white and greasy, or thin and white, the tongue is pale, the pulse is sunken and late, sunken and astringent, the mouth is not thirsty or thirsty without thinking of drinking and fullness is cold.
(2) Gastroparesis is mainly seen in ulcerative dyspepsia. The clinical evidence needs to distinguish between cold and heat, and identify the difference between deficiency and reality and qi and blood.
(1) Identification of cold and heat: cold stagnates and attracts, so the pain of cold offending the stomach is mostly accompanied by distension and fullness of the stomach and abdomen, refusal to press, dullness, white fur, tight pulse, etc. Cold stomach pain due to deficiency of the spleen and stomach, mostly seen as vague pain, warmth and pressure, aggravated by cold, unheated extremities, light tongue with thin coating, weak pulse, etc. Stomach pain caused by heat and fire stagnation and loss of circulation in the stomach is mostly accompanied by irritability and thirst for drinking, aversion to heat and preference for cold, red urine, knotted stool, yellow moss and less fluid, and stringiness of the pulse.
(2) Identifying deficiency: those with stomach pain and distension, but no pain in the stool; those with pain but no distension and no pain in the stool are more deficient; those who like cold are more real; those who like warmth are more deficient; those who refuse to press are more real; those who like to press are more deficient; those with pain after eating are more real; those with abdominal pain after hunger are more deficient; those with solid pulse and rebellious qi are more real; those with deficient pulse and less qi are more deficient; those with sharp and firm pain, fixed and not moving are more real; those with slow pain and indefinite pain are more deficient; those with new illness and strong body are more real; those with long illness and declining body are more deficient. Most deficient; those with ineffective treatment by tonic method are more real; those with aggravated treatment by attack method are more deficient.
(3) Identification of qi and blood: stomach pain is divided into qi and blood. Generally, the initial illness is in Qi and the prolonged illness is in Blood. Where the disease belongs to qi, it is mostly seen that the pain is both distended and painful, with distension being the main cause, and the pain is indefinite, stopping at times and gathering and dispersing invisibly, which is invisible qi pain; where the pain belongs to blood, it is mostly seen that the pain is continuous and stabbing, with a definite place, and the tongue is purple and dark, which is tangible blood pain; others, such as food accumulation and phlegm obstruction, are also among the tangible pains.
(3) Noisy evidence Mainly seen in reflux-type power dyspepsia. Lin Peiqin’s “The Treatment of Noisy Evidence? If the stomach is too dry, it is noisy like hunger, and is temporarily stopped by food, the treatment should be to cool and nourish the stomach yin, or slightly with a slight acid; if the stomach is not restored after a fever, it is also easy to be noisy, the treatment should be sweet and cool to produce gastric juice, or but to regulate its diet; if the stomach has phlegm and fire, or nausea and swallowing acid, slightly annoyed and less sleep, like acid and non-acid, like spicy and non-spicy, the treatment should be warm; but by the spleen and stomach diet does not transform, vomiting and belching rot, the treatment should be healthy. The treatment should be to strengthen the circulation.”
10, Chinese medicine evidence-based treatment of functional dyspepsia of the common symptoms and commonly used formulas are?
(1) Spleen deficiency and gas stagnation evidence
The main symptoms: ① stomach and epigastric stuffiness or distension; ② less food and dullness.
Secondary symptoms: ① attack or aggravation due to emotional discomfort; ② belching; ③ erratic; ④ fatigue and weakness; ⑤ light red tongue with thin white coating; ⑥ thin string pulse.
Determination of symptoms: Any person who has the main symptoms plus two secondary symptoms can be diagnosed as having spleen deficiency and qi stagnation.
Treatment: Strengthen the spleen, harmonize the stomach, regulate qi and eliminate distention.
Main formula: Si Jun Zi Tang (Tai Ping Hui Ming and Pharmaceutical Bureau Formula) and Xiang Sha Hao Jiao Wan (Regimen’s Secret Dissection) plus and minus.
Drugs: Radix Codonopsis Pilosulae 9-15g, Atractylodes Macrocephalae 6-12g, Poria 9-15g, Radix Glycyrrhiza Uralensis 6-9g, Ginger Thicket 3-9g, Muxiang 1.5-6g, Sharen 3-6g, Vinegar Yuanhu 3-9g, Fa Xianxia 3-9g.
(2) Evidence of disharmony between liver and stomach
Main symptoms: ① distension and pain in the stomach; ② distension and fullness in both sides.
Secondary symptoms: (1) poor appetite and generalized disgust; (2) stuffiness and unrest; (3) irritability; (4) good sighing; (5) light red tongue with thin white fur; (6) stringent pulse.
Determination of symptoms: Diagnosis can be made by having 2 main symptoms plus 2 secondary symptoms.
Treatment: Relieve depression, harmonize the stomach and subdue rebellion.
Main formula: Chai Hu Dredging Liver San (Jing Yue Quan Shu) plus and minus.
Drugs: Chai Hu 3-9g, Citrus aurantium 10g, Chuanxiong 3-9g, Radix Aromaticus 6-9g, Su Stem 4.5-9g, Bai Shao 6-15g, Chen Pi 10g, Fa Xian Xia 10g, Sheng Gan Cao 6-9g.
(3) Evidence of deficiency cold in the spleen and stomach
Main symptoms: ① cold stomach with vague pain or fullness; ② preference for warmth and pressure.
Secondary symptoms: ① vomiting water; ② dullness; ③ fatigue; ④ lack of warmth in the hands and feet; ⑤ loose stools; ⑥ pale tongue with white fur; ⑦ weak pulse.
Determination of symptoms: Any person who has the main symptoms plus 2 secondary symptoms can be diagnosed as having deficiency cold in the spleen and stomach.
Treatment: Strengthening the spleen and stomach, warming the middle and dispersing cold.
Main formula: Rizhong Pill “Treatise on Typhoid and Cold” with addition and subtraction.
Drugs: Radix Codonopsis Pilosulae 10-15g, Atractylodes Macrocephala 6-12g, Radix Ginger 10g, Radix Glycyrrhiza Uralensis 6-9g, Radix Sulforaphane 10g, Radix Ginger Thicket 10g, Radix Shen Qu 15g, Radix Wickerwork 10g, Radix Aromaticus 10g.
(4) Dampness and heat in the spleen and stomach
Main symptoms: ① abdominal fullness or pain; ② yellow, thick and greasy coating.
Secondary symptoms: ① dry mouth and bitterness; ② heavy body and sleepiness; ③ nausea and vomiting; ④ short yellow urine; ⑤ little food and dullness; ⑥ slippery pulse.
Determination of symptoms: Any person with 2 main symptoms plus secondary symptoms can be diagnosed as damp-heat evidence of spleen and stomach.
Treatment: Clear heat and remove dampness, regulate qi and harmonize the middle.
Main formula: Lian-Pu-Drink, “Treatise on Cholera” with addition and reduction.
Effects: Huang Lian 5g, Jiang Hou Pu 10g, Shi Calamus 10g, Fa Han Xia 10g, Scutellaria 15g, Chen Pi 10g, Lu Gen 15g, Yin Chen 10g, raw barley 20g.
(5) Mixed symptoms of cold and heat
Main symptoms: ① fullness or pain in the stomach and epigastrium; ② noisy and acidic.
Secondary symptoms: ① aggravated by cold; ② dry mouth and bitterness; ③ cold limbs and loose stools; ④ belching; ⑤ dullness; ⑥ pale tongue with white fur; ⑦ stringy pulse.
Determination of symptoms: Any person who has the main symptoms plus 2 secondary symptoms can be diagnosed as cold-heat mismatch.
Treatment: Pungent, open and bitter, harmonize the stomach and open the lumps.
Main formula: Han Xia Di Xuan Xin Tang (Addition and subtraction of “Treatise on Typhoid Fever”).
Effects: Clearing the half summer 10g, Scutellaria baicalensis 10g, Huang Lian 5g, Dry ginger 10g, Radix Codonopsis pilosulae 10-15g, Radix Glycyrrhiza glabra 6-9g, Ginger Thicket 10g, Fried Shen Qu 15g, Calcined corrugated seeds 30g.
11. How should functional dyspepsia be prevented?
Patients with functional dyspepsia should avoid greasy and stimulating food in the diet, quit smoking, quit drinking, develop good habits, avoid overeating and overeating before bedtime; take the method of eating less and more meals; strengthen physical exercise; pay special attention to maintain a happy mood and good state of mind.
Prevention of functional indigestion ten.
First, meals should be kept in a relaxed mood, do not rush to eat, and do not swallow it whole, and do not stand or walk while eating.
Second, do not soak rice or and water to eat, do not drink a lot of liquid before or immediately after the meal.
Third, do not discuss problems or argue during meals. These discussions should be left until an hour after the meal.
Fourth, do not drink alcohol during meals, do not smoke immediately after meals.
Fifth, do not wear tight waist clothing and pants for meals.
Sixth, meals should be timed.
Seven, avoid eating and drinking, especially spicy and fat-rich diet.
Eight, the conditions can drink a glass of milk between meals to avoid excessive stomach acid.
Nine, eat less sweet and salty food, too much candy will stimulate the secretion of stomach acid.
Ten, do not eat too cold or too hot.