Functional dyspepsia is a common disease with a variety of clinical manifestations, and is most common in young and middle-aged people. Symptoms are most common in upper abdominal fullness and discomfort, including epigastric pain, epigastric distention, early satiety, belching, loss of appetite, nausea, vomiting, etc., but there are no characteristic manifestations, and these symptoms can occur alone or in combination, and the symptoms can also change during the course of the disease. In addition to upper gastrointestinal symptoms, many patients also suffer from insomnia, anxiety, depression, headache, inattention and other mental symptoms. The disease is slow in onset, persistent or recurrent over the years, and many patients have triggering factors such as diet and psychiatric problems.
Clinically, a variety of diseases can show the common symptoms of dyspepsia and require differential diagnosis.
1, chronic gastritis: there are eating triggers, subject to little emotional influence.
The symptoms of chronic gastritis are also dominated by upper abdominal discomfort, pain, epigastric fullness, often occurring after meals, or aggravated after meals, and accompanied by belching, early satiety, decreased appetite, epigastric pain or burning pain, nausea and vomiting, etc., more regular and repeated episodes, and its symptoms and signs are difficult to distinguish from FD. However, chronic gastritis symptoms can have eating triggers and are less affected by emotional factors. Such patients are best to perform gastroscopy, if the gastric mucosa is found to be significantly congested, erosion or bleeding, or even bulging erosion and atrophic changes, then chronic gastritis should be diagnosed.
2, peptic ulcer: mostly periodic and rhythmic episodes.
Clinically, in addition to the typical rhythmic epigastric pain, peptic ulcers can also manifest as symptoms of indigestion such as epigastric fullness, belching, acid reflux, heartburn, nausea, vomiting, and loss of appetite, and can recur for many years. However, in patients with peptic ulcers, these symptoms tend to be distinctly cyclical, occurring mostly in autumn and winter and at the turn of the winter and spring seasons; they can also be rhythmic, with gastric ulcers mostly occurring about half an hour after a meal and duodenal bulb ulcers mostly occurring on an empty stomach before a meal, or pain on an empty stomach in the early hours of the night, with no obvious correlation with factors such as emotion. If there is such regular abdominal pain, endoscopy should be performed, and the diagnosis of peptic ulcer can be clarified if ulcerative lesions can be observed. Recurrent attacks of peptic ulcer can have complications, such as black stool suggesting peptic bleeding, vomiting overnight food suggesting pyloric obstruction, if accompanied by signs of abdominal muscle tension suggesting ulcer perforation, if accompanied by alarm symptoms suggesting gastric ulcer malignancy, gastroscopy should be performed in a timely manner.
3.Gastric cancer: often accompanied by emaciation, weakness and anemia.
Early stage of gastric cancer often has no specific symptoms, but as the tumor grows and affects the stomach function, similar symptoms of indigestion will appear, which mainly manifest clinically as pain or discomfort in the upper abdomen, loss of appetite, nausea and vomiting. However, the age of onset of gastric cancer is more than 40 years old, and it will be accompanied by the so-called “alarm” symptoms that indicate malignant tumor, such as wasting, weakness and anemia. It is not difficult to confirm the diagnosis of gastric cancer through gastroscopy and biopsy.
4.Diabetic gastroparesis: with history of diabetes, delayed gastric emptying and autonomic nerve damage.
Diabetic gastroparesis is a common symptom of diabetic gastrointestinal neuropathy. The clinical manifestations are chronic gastritis, gastric flaccidity and gastric retention, typical symptoms are recurrent bloating, early satiety, anorexia, belching, nausea, vomiting, weight loss, symptoms are usually more obvious after meals, severe cases can still vomit a lot of food several hours after meals, symptoms continue to repeat, not affected by emotions, symptoms can be progressively aggravated, mostly accompanied by a long history of diabetes and complications of diabetes in other systems. Barium radiographs and gastroscopies may not show significant mucosal damage, but there may be more overnight food retained in the stomach. Delayed gastric emptying and impaired autonomic nerves can diagnose gastroparesis.
5. Gastric mucosal prolapse: recurrent intermittent epigastric pain.
The most common clinical symptom of gastric mucosal prolapse is epigastric pain and is not characterized by the rhythmic or nocturnal pain of peptic ulcers; some patients have symptoms such as abdominal distention, nausea, vomiting, and weight loss. Symptoms can be recurrent, and epigastric pain can also be intermittent due to the intermittent appearance of symptoms of prolapse. The condition cannot be relieved by acid-suppressing drugs, but can be relieved by a change of position (left-sided lying or elevation of the foot of the bed). The diagnosis mainly relies on the barium X-ray examination shows that there is a “myxoid” or “umbrella” defect shadow in the duodenal bulb.
6, chronic liver injury: there are symptoms of liver damage.
Chronic liver injury is a common disease, often without clinical symptoms, some patients may have weakness, nausea, loss of appetite, abdominal and rib swelling and other manifestations, mostly without epigastric pain, epigastric distension, early satiety and other common symptoms of indigestion, the late development of cirrhosis and liver cancer risk is high, a serious threat to human health. These patients may have a past medical history of alcohol consumption, drug use, hepatitis, etc. Later if they develop cirrhosis, they will have signs such as jaundice, liver palms, spider nevus, abdominal fluid, abdominal wall varices, etc., which can be distinguished from FD, etc. Liver function, abdominal ultrasound, etc. can assist in the diagnosis.
7, chronic pancreatitis: steatorrhea after greasy diet.
Mild pancreatitis can have no obvious clinical symptoms or only mild indigestion, while moderate to severe chronic pancreatitis can have a variety of clinical manifestations, mainly recurrent abdominal pain, diarrhea, diabetes and other pancreatic endocrine insufficiency and complications. The physical signs manifest as abdominal pressure pain disproportionate to the degree of abdominal pain, mostly only mild pressure pain. Therefore, it is sometimes not easy to distinguish from FD, but these patients have frequent episodes of abdominal pain and diarrhea after eating fatty foods, and the diarrhea is steatorrhea, which can help distinguish. Enhanced CT of the pancreas and magnetic resonance cholangiopancreatography can assist in clear diagnosis.
8, chronic cholecystitis: epigastric pain is obviously aggravated after greasy diet.
Chronic cholecystitis can be asymptomatic for a long time, or there can be recurrent epigastric fullness, nausea, belching and other indigestion symptoms, but mostly accompanied by anorexia for greasy food, symptoms occur after meals, symptoms significantly aggravated after greasy diet, mostly right upper abdominal or mid-upper abdominal pain, can radiate to the back and right shoulder, and sometimes there is right shoulder back discomfort or pain in the right shoulder at night or after dinner and other symptoms, different from indigestion. Abdominal ultrasound, oral cholecystography, CT and other imaging examinations can mostly detect signs of cholecystitis, which can be differentiated from FD.
9, cholelithiasis: Most have a history of associated gallbladder stones.
Most patients with cholelithiasis do not have clinical symptoms. If combined with chronic gallbladder inflammation, they may have recurrent epigastric fullness, nausea, belching and other dyspeptic symptoms. However, patients mostly have a history of associated gallbladder stones and symptoms associated with greasy diet, etc. They may have acute episodes of severe abdominal pain, and anti-infection and control of greasy diet are effective and can be differentiated from FD. Imaging examinations such as abdominal ultrasound, oral cholecystography and CT can mostly detect gallbladder stones and/or signs of cholecystitis, which can be differentiated from FD.
In conclusion, FD is a common clinical disease, and its diagnosis is mainly based on the analysis of clinical symptoms and the necessary auxiliary examinations used to exclude the diagnosis. The diagnosis and treatment of these patients require more detailed information on the characteristics of clinical symptoms, concomitant symptoms, medical history and physical examination to screen for such diseases, and appropriate use of ancillary tests for differential diagnosis and finally confirm the disease.