Functional dyspepsia is a common clinical syndrome with various clinical symptoms, mainly manifesting as upper abdominal discomfort, pain, bloating, early satiety, postprandial fullness, burping, belching, nausea and vomiting. After a number of tests to exclude organic diseases, the symptoms persist and recur, seriously affecting the quality of life and psychological health of patients.
The treatment of functional dyspepsia requires a combination of comprehensive treatment and individualized treatment.
I. General treatment.
Establish good lifestyle habits and avoid the stimulation of tobacco, alcohol, spicy foods, and NSAIDs. Avoid foods that induce symptoms in personal life experiences. Mild functional dyspepsia patients can get partial relief of their symptoms with explanation and lifestyle adjustment. However, persistent functional dyspepsia is more difficult to manage, and symptoms are persistent and recurrent.
Among the treatment measures for patients with functional dyspepsia should include.
1, careful questioning of the patient’s social, family and medical history, so as to understand the stress factors that cause the patient’s acute attacks or chronic migratory gradual aggravation.
2.Take medical history carefully and meticulously and conduct physical examination carefully, which can enhance the patient’s trust in diagnosis and treatment, as well as provide detailed information about the condition.
3.Carefully ask about the recent diet and the relationship between diet, treatment and symptom changes.
4.The diagnostic process begins with the necessary relevant tests to exclude organic diseases. However, it is not advisable to conduct too many laboratory tests.
5, when making the diagnosis of “functional dyspepsia”, the patient should emphasize that this is a disease, rather than the subjective “disease of the mind”, “neurosis” “mental allergy” and so on.
6.Listen patiently to the patient’s statement, and discuss with the patient the pathophysiology of the symptoms, including abnormal gastrointestinal dynamics, the hypersensitivity of internal organs, and the influence of mental, psychological and emotional effects on the symptoms.
7.Discuss and discuss with the patient practical and feasible treatment goals, and emphasize the importance of lifestyle modification.
8. Clarify the influence of dietary, emotional and environmental factors on symptoms, pay attention to the link between food and symptoms, and encourage patients to take proactive measures to prevent the occurrence or recurrence of symptoms. However, no special recipes are recommended for functional dyspepsia, and coffee, caffeine, and excessive alcohol intake should be avoided as much as possible.
9.Insist patients to follow up regularly and establish a good follow-up examination system in order to clarify the change of symptoms and response to treatment.
10.For patients with persistent psychological or psychiatric symptoms, such as those with anxiety and depression, consultation with psychological or psychiatric specialists should be recommended for collaborative treatment.
Second, drug treatment
Since the pathogenesis of functional dyspepsia is not fully understood, the pathogenesis of individuals varies. For different individuals, according to different symptoms, using different treatment is the main measure for the treatment of functional dyspepsia at present.
1, inhibition of gastric acid secretion drugs: including proton pump inhibitors and H2 receptor antagonists.
They are generally used for patients with upper abdominal pain, acid reflux and heartburn as the main symptoms.
2.Promoting gastrointestinal power drugs
Generally used in patients with epigastric distension, early satiety and belching as the main symptoms. Domperidone 10mg, 3 times/day, or Mosapride 5-10mg, 3 times/day, both taken 15-30 minutes before meals, for two weeks first. It can improve patients with functional dyspepsia due to gastrointestinal motility disorder and can promote gastric emptying.
3.H. pylori eradication treatment
Patients with Hp-positive functional dyspepsia can achieve up to 87% symptom relief by eradicating H. pylori infection. The American Gastroenterological Association suggests that, given the risk of peptic ulcers, the application of non-invasive Hp testing and treatment is recommended for young patients without alarm symptoms. Therefore, anti-H. pylori treatment is recommended for patients with functional dyspepsia with Hp infection, but the benefits and risks of treatment need to be explained to the patient before treatment, and after explaining its efficacy, adverse effects and therapeutic value, the doctor-patient consultation will decide on treatment together.
4.Antidepressants
Psychotropic drugs can be used to treat intractable functional dyspepsia. Commonly used drugs are tricyclic and 5-HT reuptake inhibitors (SSRI) such as Prozac and Sellett. It has been found that antidepressant treatment can significantly improve the clinical symptoms of some patients with intractable functional dyspepsia, and the mechanism may be accomplished by altering the mechanosensory threshold of the patient’s stomach and sleep. Depression such as amitriptyline; the new Jane has selective inhibition of 5-hydroxytryptamine reuptake of antidepressants such as paroxetine, etc. It is advisable to start with small doses and pay attention to the adverse effects of drugs.
5.Gastrointestinal dynamics and sensory modulators
The 5-HT4 agonist tegaserod (Zemac) has been used to treat constipation-type irritable bowel syndrome. Tegaserod can enhance intestinal motility, while being effective for symptoms such as bloating and abdominal pain caused by sensory hypersensitivity of the intestine. Thus, it can improve the symptoms of epigastric distension and early satiety in patients with functional dyspepsia, but recently it has been found to have serious adverse effects, limiting its application in clinical practice.
6, visceral analgesics.
Visceral analgesics can relieve the symptoms of dyspepsia caused by abnormal sensory afferents from the gastroduodenum. Foreign research data show that the visceral analgesic Fedotozine, as an agonist of terminal k receptors of gastrointestinal afferent neurons, can significantly improve the symptoms of epigastric pain and nausea, and the overall symptom score is significantly improved.
5-HT3 receptor antagonists can be used in dysmotile functional dyspepsia. Endanserone significantly improves upper gastrointestinal symptoms such as postprandial discomfort, fullness and heartburn, and is currently considered to be used in the treatment of functional dyspepsia.
Octreotide is a long-acting analogue of growth hormone. In healthy individuals, it can induce motility in the MMC III phase of the duodenum and is thought to have a prokinetic and visceral sensory-reducing effect.
Mucosal protective agents, such as aluminum hydroxide gel, bismuth, aluminum thioglycollate, and Metzolim-S, are available.
In conclusion, functional dyspepsia, as a group of the most common clinical upper gastrointestinal syndromes, seriously affects the quality of human life, with unclear etiology and complex mechanisms, and the diagnosis is mainly an exclusionary diagnostic method. At present, there is no consensus as the diagnosis and treatment plan for functional dyspepsia. However, adherence to individualization of treatment and lifestyle modification interventions are the basis of treatment.