1, the occurrence of impaired gastric fundus tolerance diastole after feeding, disordered sinus duodenal motor coordination and visceral hypersensitivity are associated with the onset of FD.
2, Psychological, environmental and social factors can influence and aggravate the clinical manifestations of FD patients.
Clinical manifestations
FD has no characteristic clinical manifestations, mainly epigastric pain, epigastric distension, early satiety, belching, loss of appetite, nausea, vomiting, etc. It can appear alone or as a group of symptoms.
1, early satiety refers to a feeling of fullness soon after eating, resulting in a significant reduction in food intake.
2, epigastric distension mostly occurs after meals, or is persistent after eating aggravated.
3, early saturation epigastric distension is often accompanied by belching. Nausea, vomiting is not common, often occurring in patients with significantly delayed gastric emptying, vomiting mostly when the stomach contents of the meal.
4, many patients are accompanied by insomnia, anxiety, depression, headache, inattention and other mental symptoms. These symptoms are related to the psychology of “fear of cancer” in some patients.
5.Symptoms may change during the course of the disease, with slow onset, persistent or recurrent attacks over the years, and many patients have diet and mental triggering factors.
Examination
The purpose of examination is to exclude organic lesions of gastrointestinal tract, liver, gallbladder, pancreas, spleen, kidney, etc.
1.Laboratory examination
Blood, urine and stool routine; liver and kidney function, biochemical routine, blood sedimentation, etc.
2.Imaging examination
B ultrasound, X-ray, CT, MRI, etc.
3.Endoscopy.
Diagnosis
FD is divided into 2 subtypes in the Rome III diagnostic criteria, namely postprandial discomfort syndrome and epigastric pain syndrome. According to the Rome III diagnostic criteria, functional dyspepsia must meet one or more of the following points: postprandial discomfort; early satiety; epigastric pain; and burning sensation in the epigastrium.
FD is an exclusionary diagnostic disease, in clinical practice, not only requires not to miss the diagnosis of organic disease, but also should not be selective for each patient to conduct a comprehensive laboratory and special examination.
On the basis of comprehensive history taking and physical examination, we should determine whether the patient has the following “alarm symptoms and signs” of organic disease: 45 years of age or older, recent symptoms of dyspepsia, wasting, anemia, vomiting blood, black feces, dysphagia, abdominal mass, jaundice, etc., and progressive aggravation of dyspepsia symptoms.
2.For those who have “alarm signs and symptoms”, thorough examination must be conducted until the cause of the disease is found.
3.For those who are under 45 years old and do not have “alarming symptoms and signs”, basic tests such as blood routine, urine routine, fecal occult blood test, blood sedimentation, liver function test, gastroscopy, abdominal ultrasound (liver, bile and pancreas) can be selected, or empirical treatment can be given for 2 to 4 weeks to observe the efficacy, and those with suspicious diagnosis or ineffective treatment can be selected in a targeted manner. Further examination.
Treatment
The main treatment is symptomatic treatment, following the principle of comprehensive and individualized treatment.
1.General treatment
Establish good lifestyle habits, avoid smoking, alcohol and taking NSAIDs. 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. Those with insomnia and anxiety can be appropriately sedated.
2.Medication
No special drugs, mainly empirical treatment.
(1) Inhibitors of gastric acid secretion are generally used in patients with abdominal pain as the main symptom, and H2 receptor antagonists or proton pump inhibitors can be used selectively.
(2) Gastrointestinal stimulants Generally used for patients with epigastric distension, early satiety and belching as the main symptoms. Domperidone and itopride are selectively administered.
(3) Helicobacter pylori eradication therapy May be effective for a small proportion of FD patients with H. pylori infection, and may be tried for those with severe symptoms.
(4) Antidepressants The above treatment is ineffective and can be tried for those with significant psychiatric symptoms. Commonly used are tricyclic antidepressants; selective inhibitors of 5-hydroxytryptamine reuptake, haloperidol melitrexin tablets, etc. It is advisable to start with small doses and pay attention to the adverse effects of drugs. It is recommended to take them under the guidance of a specialist.
(5) Other available mucosal protective agents, such as aluminum hydroxide gel, bismuth, aluminum thioglycollate, Metzolim-S, etc.
Prevention
(1) Reduce mental stress, appropriate physical exercise, reasonable diet structure, etc.
2.Need to pay attention to the identification with organic diseases, pay attention to the follow-up follow-up.