Health education on functional dyspepsia Q&A
1.Can functional dyspepsia be prevented?
Functional dyspepsia can be effectively prevented, mainly in the following areas.
(1) prevention of dietary management: regular diet, pay attention to hygiene, light and easy to digest diet, avoid spicy and stimulating, raw, cold and hard, high-fat food, avoid hunger and satiety; such as abdominal discomfort, as far as possible to avoid raw, cold, hard, hot food, semi-liquid food as the main, appropriate to reduce the amount of food, up to 8 to 9 percent full, when the symptoms are relieved and then eat normally.
(2) Prevention of environmental adaptation: improve your own resilience to avoid gastrointestinal symptoms caused by environmental stress; increase and decrease clothing accordingly with the change of hot and cold temperature, increase clothing when the temperature is colder, pay attention to abdominal warmth, and reduce clothing when the temperature is hotter.
(3) Sleep quality adjustment prevention; develop a good biological clock, ensure sufficient sleep, drug intervention if necessary; go to bed on time, as far as possible to adjust to make their sleep regular physiological requirements.
(4) prevention of mental and psychological adjustment; good at adjusting mood, relieving psychological burden and anxiety.
(5) the prevention of drug application; such as symptoms of timely application of acid suppressants, antacids, etc., can effectively reduce the symptoms of indigestion. For example, for epigastric pain, abdominal distension, early satiety, belching, nausea, vomiting and other symptoms of the application of drugs we call symptomatic treatment, one of the program for epigastric pain drug treatment program: ranitidine (0.15g per time twice a day in water half an hour before breakfast and dinner); famotidine (20mg per time in water half an hour before breakfast and dinner); omeprazole (20mg per time in water half an hour before breakfast and dinner) (each time 20mg in water half an hour before breakfast and dinner); pantoprazole 40mg (each time 20mg in water half an hour before breakfast and dinner); lansoprazole 30mg (each time 20mg in water half an hour before breakfast and dinner); esomeprazole magnesium enteric tablets 20mg (each time 1 tablet twice a day in water half an hour before breakfast and dinner) One of the above drugs plus one of the following drugs: Gastropin tablets (2-4 tablets each time 3 times a day chewed); Gastropin tablets (2-4 tablets each time 3 times a day 3 times a day chewed); magnesium aluminum carbonate tablets (2 tablets each time 3 times a day chewed); aluminum thioglycollate suspension 5ml (1 sachet each time 3 to 4 times a day); aluminum hydroxide suspension 10ml (1 sachet each time 3 to 4 times a day); aluminum magnesium plus suspension 15ml (1 sachet each time 3 to 4 times a day); aluminum and magnesium Suspension 15ml (each 1 bag 3 times a day to 4 times a day); belladonna tablets (each 5mg ~ 10mg water to take as needed when the symptoms are relieved to stop) one of the above programs such as symptom relief application 3 days to 7 days to consolidate treatment.
2.What is functional dyspepsia?
Dyspepsia (dyspepsia) is a persistent or recurrent episodes, including epigastric pain, epigastric distension, early satiety, belching, nausea, vomiting, loss of appetite and other upper abdominal symptoms of a group of clinical syndromes. This clinical syndrome is called functional dyspepsia (FD) when organic diseases that can cause these symptoms are excluded by blood biochemical and endoscopic examinations.
3.What are the symptoms and manifestations of functional dyspepsia or physical discomfort?
Common symptoms of functional dyspepsia are.
(1) post-prandial fullness: the discomfort of fullness caused by food remaining in the stomach for a long time after meals.
(2) Early satiety: a feeling of hunger, but soon after eating, the feeling of fullness, eating a small amount of food that the stomach is full, can not continue to eat or no appetite.
(3) Epigastric pain: pain in the area located below the level of the sternal glabella and above the umbilicus and between the midclavicular line on both sides.
(4) Burning sensation in the epigastrium: burning discomfort in the abdomen above the umbilicus.
(5) epigastric distension: occurs mostly after meals, or is persistent and worsens after meals, and early saturation of epigastric distension is often accompanied by belching.
(6) nausea and vomiting: uncommon, often occurring in patients with markedly delayed gastric emptying, vomiting may be dry vomiting or vomiting of the stomach contents of the meal.
(7) Other symptoms: Many patients have insomnia, anxiety, depression, headache, inattention and other mental symptoms, which are related to the psychology of “cancer fear” in some patients.
The first four are the main symptoms.
4.What factors can cause functional dyspepsia?
(1) motor dysfunction: patients with functional dyspepsia have abnormal adaptive regulation of the stomach, delayed gastric emptying, abnormal gastric electrical rhythm, etc. Motor dysfunction is the main pathogenesis of functional dyspepsia, about 40% of functional dyspepsia functional dyspepsia patients have delayed gastric emptying; (2) visceral hypersensitivity: visceral hypersensitivity refers to the lowering of the threshold for causing visceral pain or discomfort stimuli, and Visceral discomfort to physiological stimuli or a strong response to injurious stimuli. (3) Increased secretion of gastric acid: In patients with functional dyspepsia, the secretion of basic gastric acid is within the normal range, but the increase in acid secretion caused by stimulation or after eating can lead to acid-related symptoms, such as: pain and discomfort in the epigastrium during fasting, which is relieved after eating, or taking acid suppression therapy is effective, suggesting that it is related to gastric acid secretion; (4) Brain-gut axis Dysfunction: The gastrointestinal tract is the only system in the human body that is jointly innervated by the central nervous system, enteric nerves and autonomic nerves. The neuroendocrine network linking the gastrointestinal tract with the central nervous system at different levels is called the brain-gut axis, and the regulation of gastrointestinal function by the body through the neuroendocrine bidirectional loop of the brain-gut axis is called brain-gut interaction. It is through this complex and fine regulation that the gastrointestinal tract can normally complete its physiological functions, and abnormalities in any of these links can cause damage to gastrointestinal functions or structures and produce disease; (5) inflammatory factors: clinically, about 1/3 of patients with irritable bowel syndrome or dyspepsia develop symptoms after acute intestinal infections, and more than 25% of patients with acute intestinal infections develop symptoms similar to those of irritable bowel syndrome or dyspepsia. More than 25% of patients with acute intestinal infections present with symptoms similar to those of irritable bowel syndrome or dyspepsia. These patients do have increased inflammatory cells and increased expression of inflammatory factors in the intestinal mucosa. A retrospective study in Spain found that the incidence of dyspepsia can increase 5-fold 1 year after acute Salmonella gastroenteritis; (6) related to psychiatric and psychological factors. Because of the abnormal regulation of the brain-gut axis in patients with functional dyspepsia, when emotions and mental states act on the body as stress factors, the brain’s stress stimulus response can be transmitted to the visceral system through the brain-gut axis, causing abnormal gastrointestinal movement and sensation.
5.Why does functional indigestion occur?
When irregular diet and living habits, long-term constipation or diarrhea, mental tension, anxiety or depression, can lead to gastrointestinal tract dysfunction, causing postprandial fullness, epigastric pain, epigastric burning sensation and other discomfort.
6.How to diagnose functional dyspepsia? How to self-judge whether there is functional dyspepsia?
Functional dyspepsia diagnosis.
(1) assessment of dyspepsia and related symptoms: assessment of the degree and frequency, correlation with meals, posture, defecation, whether there is a reduction in the amount of food eaten, whether the symptoms of dyspepsia affect the quality of life, whether there are alarm signs, namely: wasting, anemia, epigastric masses, frequent vomiting, vomiting blood or, black stool, age 40 years or older, family history of tumors, etc..
(2) Related examination: Detailed history should be taken and physical examination should be conducted for patients with initial dyspepsia, gastroscopy can be done as a routine item, in addition to liver function, renal function, biochemical examination and abdominal ultrasound, abdominal CT scan examination and other system related examination if necessary to avoid misdiagnosis causing delay. H. pylori testing is performed for patients who have failed to respond to empirical treatment or conventional treatment. If necessary, gastric emptying, gastric electrogram, gastric accommodation, gastric perception and other gastric function tests are performed, which have certain guiding significance for adjusting the treatment plan.
7, functional dyspepsia and which diseases are easily confused or which diseases need to be distinguished?
(1) digestive system diseases: peptic ulcer, gastrointestinal tumor, cholecystitis, gallbladder stones, pancreatitis, hepatitis, cirrhosis, etc., serological examination and imaging examination have related organic lesions.
(2) Metabolic diseases: diabetes mellitus, thyroid abnormalities, etc. can cause gastrointestinal tract dysfunction and dyspeptic symptoms, which can be identified by performing tests related to the underlying disease.
(3) Other systemic pathologies: renal diseases, connective tissue diseases, etc. have relevant clinical clues and laboratory evidence.
(4) drug-related dyspepsia: non-steroidal anti-inflammatory drugs (aspirin enteric tablets, antipyretics, fen-phen, etc.), ethanol, digitalis and other drugs can cause dyspepsia symptoms, detailed questioning of drug history can be identified, the symptoms can be relieved after discontinuation of drugs.
8, which tests help to confirm the diagnosis of functional dyspepsia?
There are many diseases that cause dyspepsia symptoms, so the diagnosis of functional dyspepsia is a diagnosis of exclusion. (1) gastroscopy is the main means of diagnosis of functional dyspepsia, endoscopy did not find gastric and duodenal ulcers, erosion, tumors and other organic lesions, esophagitis, and no history of the above diseases; (2) liver function, renal function, biochemical examination and abdominal B ultrasound, abdominal CT scan examination and other system-related examinations if necessary. Hp testing was performed in patients with empirical treatment or conventional treatment that was ineffective. (3) Gastric function tests: gastric emptying, gastric electrogram, gastric accommodative function and perceptual function tests may be helpful in the subgroup with functional digestive
(3) Gastric function tests: gastric emptying, gastric electrogram, gastric accommodation function and perception function tests may be helpful for the subgroup of functional dyspepsia, but are not recommended as routine clinical tests. These tests can be performed for patients with severe symptoms or those who are not significantly treated by conventional treatment.
9.How to treat functional dyspepsia?
The main treatment is symptomatic treatment, following the principle of comprehensive treatment and individualized treatment.
(1) General treatment: Establish good living habits, avoid smoking, alcohol and taking non-steroidal anti-inflammatory drugs. No special recipes, avoid foods that induce symptoms in personal life experience. Pay attention to the psychological treatment according to the different characteristics of patients. Sedatives can be given appropriately for insomnia and anxiety.
(2) Pharmacological treatment: mainly empirical treatment, applicable to patients under 40 years old, without alarm signs and without obvious psycho-psychological disorders.
a. Acid suppressants: Applicable to patients with non-meal-related dyspepsia in which upper abdominal pain and burning sensation are the main symptoms. Including H2 receptor antagonists (ranitidine, famotidine) or proton pump inhibitors (omeprazole, lansoprazole, rabeprazole, etc.).
b. Pro-gastrointestinal motility drugs: generally indicated for patients with abdominal distension, early satiety and belching as the main symptoms. Domperidone 10mg, 3 times/day, or cisapride 5~10mg, 3 times/day, or mosapride 20mg, 3 times/day, all taken 15~30 minutes before meals, for a course of 2~8 weeks. Cisapride and mosapride are reported to be slightly more effective than domperidone, but because of the effect of promoting small intestine movement, a small number of patients have abdominal rumbling, loose stools or diarrhea, abdominal pain side effects, reduce the dose or use a period of time after the side effects can be reduced to disappear. It has been reported abroad that cisapride can occasionally cause serious arrhythmia side effects, mainly when the dose is too high, when the patient has pre-existing heart disease or arrhythmia, especially when combined with certain antifungal drugs and macrolide antibiotics, attention should be paid. Metoclopramide is now used sparingly in the treatment of functional dyspepsia because of the large side effects of long-term administration.
For those who are not effective, acid suppressants and gastrointestinal motility drugs can be used in combination with each other.
(3) eradication of H. pylori treatment: eradication of H. pylori can make long-term improvement in some patients with functional dyspepsia, for patients with functional dyspepsia combined with H. pylori infection, when acid suppression or prokinetic therapy is ineffective, eradication of H. pylori treatment can be given.
(4) Psycho-psychotherapy: the above treatment is not effective and accompanied by psychiatric symptoms can be tried. Commonly used tricyclic antidepressants such as amitriptyline, antidepressants with specific 5-hydroxytryptamine reuptake inhibition such as fluoxetine hydrochloride, etc. It is advisable to start with small doses and pay attention to drug side effects.
10, functional dyspepsia drug treatment and prevention of what are the precautions?
The meal-related dyspepsia can be preferred to prokinetic agents or combined with acid suppressants, and non-meal-related dyspepsia or acid-related dyspepsia can be selected acid suppressants or combined with prokinetic agents, in the selection of drugs to pay attention to the toxic side effects of drugs.
11, functional dyspepsia prevention and treatment of dietary management should be how?
(1) dietary management: to develop good dietary habits, regular diet, pay attention to hygiene, avoid spicy stimulation, cold, hard, greasy food, avoid overfed, the combination of functional dyspepsia patients with constipation, do not advocate the use of stimulant laxative such as guide, senna, etc., can be oral lactulose oral solution and regulate intestinal flora drug therapy, while giving instructions on bowel habits, to encourage patients to re-establish the defecation reflex. In addition, patients can be instructed to drink 1 cup of 250 m l of warm water in the morning on an empty stomach and massage the abdomen 30 times each in a circular motion with both hands in a clockwise and counterclockwise direction [5].
Psychological guidance and health education: helping patients to recognize and understand their condition, eliminating their concerns, keeping them in a happy mood, and mobilizing their motivation can help to relieve their symptoms, and using anxiolytic or antidepressant treatment for depressed patients can make them heal or relieve their symptoms.