The main manifestation of dyspepsia is pain or discomfort in the upper abdomen, manifested by bloating, early satiety, feeling full after eating, nausea and other symptoms. According to the epidemiological data, we know that the incidence of dyspepsia is quite common, in the general population abroad can reach 7% to 41%, a group of reports in Guangdong reached 18.9%, Tianjin reported 23.3%. When we look at the hospital situation, the general outpatient clinic reaches 11%, while the gastroenterology clinic reaches 53%, which shows that dyspepsia is a very common disease. What are the causes of dyspepsia? We know that there is a large group of diseases that can cause dyspepsia, such as gastrointestinal lesions: gastric cancer, ulcer disease, reflux esophagitis, gastritis; and diseases related to gastric dynamics: diabetes, scleroderma, post-surgical gastroparesis; and anorexia nervosa, which I saw this morning. The patient can’t eat because he thinks people say he’s gained a little weight, so in a short time, tens of kilos fall off. Such cases, of course, are also caused by some drug factors. In addition to this, we now find that there are many patients who cannot be detected after many tests, and this category is now called functional dyspepsia. According to the 1999 Rome II diagnostic criteria, what is the definition of functional dyspepsia? It is defined as having a feeling of discomfort or pain in the upper abdomen for at least 12 weeks in the past year, and the symptoms can be continuous or recurrent. However, tests are done to find the cause, or a lesion is found that does not explain its symptoms. Of course, what I am saying here is that these patients should not be confused with irritable bowel syndrome, that is, their symptoms are not related to defecation. Then functional dyspepsia can be classified as dysmotic, ulcer-like or non-specific according to its clinical characteristics. The so-called power disorder type refers to the symptoms of early satiety, bloating, fullness and nausea, which are aggravated after meals. The ulcer-like type is (predominantly) epigastric pain that appears on an empty stomach and decreases after a meal. If the epigastric distress of these patients does not depend on the first type and does not depend on the second type, then we classify it as non-specific. It should be noted that functional dyspepsia has overlap with other diseases, such as irritable bowel syndrome and reflux disease. It should also be noted that functional dyspepsia is not one of those types of diseases: for example, gagging. Sometimes we often see patients in outpatient clinics, constantly burping, constantly swallowing, belching, very loud, a dozen (is), this is called gagging. In addition, functional vomiting, after eating will vomit. There is also a category of regurgitation syndrome, after eating, and a while back up, and then re-chewed, and then swallowed, this is regurgitation syndrome. These three categories are not the same as the concept of functional dyspepsia we mentioned earlier. You will certainly ask how functional dyspepsia is caused (by)? We know from our research that it is related to power disorders and visceral sensory hypersensitivity. Why are these causes? Many studies have proved that local stimuli, such as food factors, biological factors or inflammatory factors, as well as neurological abnormalities, central nervous system regulation, psychological factors, autonomic disorders and enteric nervous system dysfunction, all these may be involved in the development of functional dyspepsia. So let’s first look at how much gastrointestinal motility disorders account for in functional dyspepsia? About 50% of patients will have dysfunction, what is the main manifestation (is)? After eating, the proximal end of the stomach does not open, and a meal stays in the stomach for a long time, and then can not be discharged, this is the main problem. And just mentioned the sensory disorder, we say what is the sensory disorder? That is, a little (eat) into a little thing, a little stimulation, the general public do not feel anything, but these patients are very sensitive. Not necessarily he has a special power problem, he feels hypersensitivity, and now it is found that this sensory hypersensitivity is not only in the stomach, the entire gastrointestinal tract have similar conditions. Just now mentioned physical disorders, psychological disorders. We know that nowadays the pace of society is very fast and stressful, so psychosocial and emotional depression plays a very important role in the development. We sometimes see patients very unhappy, unhappy patients can not eat a lot of things, which led to a disease, this is also seen a lot. In the diagnosis and treatment of dyspepsia, there are many causes, so how can we sort out the clues? First of all, we need to know whether there is an organic cause. We need to find out. Especially the important diseases, such as gastric ulcer and tumor, cannot be missed. It is better to use some limited resources as much as possible, not to let the patient spread a big net, we do many many tests, in this case, the patient is very hard. We should try to avoid the disadvantages of some tests, because doing tests, the patient is very nervous, because taking something finally caused complications, that is actually also unnecessary. Of course all of them should be directed to the patient to relieve his symptoms and relieve the patient’s pain, which is very important. People will ask, do we do the examination first or do we do the empirical treatment, we are depending on the condition. We propose to do the examination in the near future. If the patient has alarming symptoms, such as recent severe weight loss, anemia, epigastric mass, etc., or if there is a family history of tumor in the family, or if the patient has ulcer disease in the past, or has taken some NSAID drugs, I am afraid that these cases should be examined. Some patients are very anxious and depressed after they come in. In this case, sometimes it is better to give him a lot of tests, which may not solve the problem, than to give him a test right away. Especially for patients over 45 years old, I think we need to be more aggressive in arranging for him to undergo some diagnostic tests. Of course these tests mainly include gastroscopy, ultrasound, biochemical and routine tests and so on. The basis of today’s treatment is mainly to analyze the relationship between symptoms and meals, and thus determine what is the relationship between it and a basis of pathophysiology. The first is that the symptoms appear when the patient is fasting, which often indicates that the gastric mucosa is irritated; the second is that the symptoms appear after eating, which is often a problem with the digestive function of the stomach; the third is both, some patients will tell you that fasting is also uncomfortable, eating is also not good, no (what) time is good, then this situation, there may be an overlap of the two conditions, of course, may also It means that there is still a problem with the digestive function of the stomach. From this, we can show you a process of dyspepsia: a patient with dyspepsia comes with the following symptoms, such as alarm symptoms, suspicion of an organic disease, or obvious psychological disorders. If yes, please go to the right side for further examination, gastroscopy, ultrasound, biochemical tests, and if problems are found, treat accordingly, if no problems are found, you may go to the following route. See, at this time we have to ask the patient the relationship between his symptoms and meals, if his symptoms are reduced after meals, we will give him acid suppression for two weeks, if it is effective, it means that he is likely to be acid-related disease, if the symptoms appear after meals, or if they are aggravated, it means that it may be related to power disorders, we will give him power promotion for two weeks, if it is effective, we can classify him as power disorder-like dyspepsia. These two types of dyspepsia, either acid-related or dyspepsia related to power disorders, if both are ineffective in treatment, please see, this line is back to the previous relevant examination, to do further examination, this is the process of diagnosis and treatment of dyspepsia introduced to you. Look at the following types. Some dyspepsia (patients) came, is the first diagnosis of patients, medical history is very important, there are no alarm symptoms —- gastroscopy is very convenient, in our country is very economical —- to exclude the liver, gallbladder and pancreas there is no disease. If these patients are not willing to undergo the examination, you can give him empirical treatment. If the patient is a patient with recurrent dyspepsia, you can ask such questions as whether he has any change in symptoms, whether there are alarming symptoms, whether this patient needs repeat examinations, including some functional examination methods. On this basis, we will decide whether to use the same drugs or not, but if the attacks are constant, frequent and affect the quality of life, I am afraid that we have to maintain the medication or even use more drugs. There is a group of patients whose treatment is ineffective, and we need to pay attention to this time. The first question to ask is whether your diagnosis is accurate, whether the patient has any concomitant diseases, and whether our program was chosen appropriately. Another is whether the patient has taken the medication or not. Some patients take the medication and do not take it, that is, how compliant the patient is. There is also a group of patients who have persistent dyspepsia, which means that after taking multiple treatment regimens, there is no relief and the quality of life is seriously affected. In this case, we think we should re-evaluate his condition and give him antipsychotic drugs, such as tricyclic antidepressants or 5-hydroxytryptamine reuptake inhibitors, for at least three months, and then increase or decrease them according to the situation. In addition to this, there should be a psychological treatment for these patients, (improve) dietary conditions, improve nutrition and so on. Finally we will mention the pharmacological treatment of functional dyspepsia, there is a large group of medications that will be effective, even placebo. A blanket drug, if you give him a placebo in clinical validation, you will also see an effect, in addition to this, antacid, acid suppressant, mucosal protector, prokinetic agent, etc.. But the first line of treatment here should be acid suppressants and prokinetic agents. The evaluation of functional dyspepsia treatment, in general, the selection of drugs is based on speculation of its possible pathophysiology and pathogenesis. The first-line treatment is mainly prokinetic and acid suppressants, and if the patient has anxiety and depression, antidepressants should be used. If the patient has HP infection, i.e., H. pylori infection, anti-HP therapy should be given if all other treatments are ineffective. Of course, the efficacy of all drugs should be further confirmed, that is, after the use of drugs, his effect is good. But when treating, one must be careful not to start the treatment with a lot of drugs, and the efficacy should be evaluated for at least one to two weeks. If it is not effective, you should re-evaluate, change or combine the drugs. Of course, in the process of follow-up, we must pay attention to consider whether our diagnosis is accurate and to consider whether there is organic disease. Finally, I would like to summarize with you the indigestion that we just talked about. Dyspepsia is very common, and it has organic and functional causes. The symptoms of functional dyspepsia are related to the abnormalities of power perception, and its onset is related to local irritation and abnormalities of nerve regulation. Clinically, depending on his condition, you can take the first line of examination, or empirical examination, and finally talk about the first line of drugs for functional dyspepsia are prokinetic agents and acid suppressants, and the treatment is subject to further evaluation.