By functional dyspepsia is understood as a complex of symptoms. In this case, an organic disease that would explain the occurrence of these symptoms, can not be identified in patient tests.
- feeling of early saturation;
- pain and burning;
- overflow in the epigastric region.
- 1 Development of criteria
- 2 Statistics
- 1 Criteria development
- 2 Statistics
- 3 Criteria FD
- 4 Diagnosis FD
- 5 Variations of gastric motility disorder resulting in FD
- 6 Mental pathology with FD
- 7 Other symptoms of FD
- 8 Diagnostic tasks
- 9 Recommendations in the presence of patient FD
- 10 Treatment of FD
- 11 The role of eradication H. pyloriin the treatment of FD
- 12 Suppression of the release of hydrochloric acid in FD
Development of criteria
Since 1998, systematic work has been carried out to determine the criteria for stomach and duodenal diseasestnoj intestine functional character. There are Roman criteria, which for decades have been revised and refined.
In 2006, new criteria and diagnostic categories for functional dyspepsia( PD) were proposed. These categories were postprandial distress syndrome( PPSA), which is a syndrome of dyspepsia caused by food intake, and epigastric pain( EB).With EB, the most common symptom is pain and burning in this area. With PPDD, there is a feeling of overflow after eating, fast saturation, that is, a feeling of satiety. These symptoms do not allow you to eat the usual amount of food for an individual.
Symptoms of PD do not include bloating and nausea.
To date, dyspeptic disorders affect almost 20-44% of people living in Europe and America. Of these patients, almost a third reveal organic problems. In other cases, diagnose FD.
In Russia functional dyspepsia occurs in 20-27% of cases. This is similar to the prevalence figures in the US and Norway. A study in Novosibirsk showed that about 55.4% of women and slightly more men experience dyspepsia. Therefore, the problem of dyspepsia is extremely urgent.
Unexpected dyspepsia also occurs and its prevalence ranges from 10 to 40% of all those suffering from this disease.
Criteria of FD
From the criteria of PD, we can note the time parameter, which is a rather important diagnostic moment. If the patient's complaints last about 3 months, but the first manifestations arose not less than six months ago. You can talk about the possibility of the presence of functional dyspepsia.
Diagnosis functional dyspepsia can only be set after excluding the following diseases of the gastrointestinal tract( GIT):
- peptic ulcer of the stomach and duodenum;
- stomach tumors;
- erosive and ulcerative lesions of the gastroduodenal region;
- gastropathies caused by the use of non-steroidal anti-inflammatory drugs;
- chronic gastritis.
Chronic gastritis from functional dyspepsia is difficult to distinguish, since several biopsies of the gastric mucosa are required to verify the diagnosis, which in principle is not performed. In this case, PD can accompany chronic gastritis, but it can be a completely independent disease.
The diagnosis of FD
PD does not imply any organic changes in the gastrointestinal mucosa. The Russian medical community does not risk inserting the diagnosis functional dyspepsia in most cases and uses mainly the definition of chronic gastritis.
Treatment of FD is very costly from an economic point of view, because as for the diagnosis and therapy of the disease, one patient costs about 5 thousand dollars.
Variations of gastric motility disorder that lead to FD
In the world, scientists distinguish several variants of abnormalities of gastric motility. Of these, disruption of accommodation is present in 40% of patients. Also there is a delayed excretion of food from the stomach. In this case, patients will experience nausea and vomiting more often. In China, a study was conducted and found a link between delayed evacuation of food from the stomach and hyperreactivity to its extension. In the Italian study, there was a link between delayed evacuation of food from the stomach and the presence of PD.
With ultrasonography, stomach hypomotorism was noted, that is, a decrease in the tone of the muscular wall of the stomach, in patients with PD.
In addition, in the literature are not uncommon marks about the impact of psychological factors on motor skills and the state of the gastrointestinal tract. There is a wealth of data on the relationship between psychology and FD, but many of them are being questioned.
Also note that two-thirds of patients have problems in the correct functioning of the myoelectric component of the stomach, that is, there are tachigastria, antral fibrillation, bradygastria. In healthy people, such changes were detected. In the end, there was no clear association between the arrhythmias of the stomach and the symptoms of PD.
It is known from experience that when gastric acid enters the duodenum from stomach, in some patients with PD it begins nausea and vomiting. In healthy individuals, this phenomenon is not observed. From this it can be concluded that in patients with PD there is an increased sensitivity to hydrochloric acid in the stomach.
The role of H. pylori in the development of PD is currently unclear, because there is no reliable data on the prevalence and severity of the clinical symptoms of dyspepsia. The direct connection of H. pylori and burning, abdominal pain was detected in early clinical trials, but later such a connection could not be found any more.
Often, such a disease as functional dyspepsia of is associated with a violation of the patient's diet. Often there is an intolerance of fatty foods, coffee, dairy products.
Mental pathology with FD
Very often there are mental illnesses in people with FD.They can be identified as:
- Anxiety Disorder;
- hysteroneurotic disorders;
- excessive concern for one's health;
- adjustment disorders.
Other symptoms of FD
In addition to the complaints described above, patients are troubled by pathological manifestations from other organs and systems. For example, there is such a thing as syndrome of functional cross, that is, the coexistence of FD and irritable bowel syndrome or FD and dyskinesia of the bile ducts.
Diagnostic tasks of
The main tasks of diagnosing a disease are the exclusion of more severe pathological processes that can lead to the development of emergency life-threatening conditions.
Recommendations in the presence of the patient's FD
There are no detailed and specific recommendations to date. Of the available at this time, note:
- exception of acute and irritating gastrointestinal mucosa;
- food intake in small portions and often;
- reduction of fatty foods;
- exclusion of food, which leads to an exacerbation of the disease;
- to stop smoking and drinking alcohol.
Treatment of FD
When PD is justified, the appointment of prokinetic drugs( metaklopramid, cisapride), which normalizes the motility of the gastrointestinal tract. However, after major studies, it was shown that these drugs are ineffective in PD, or their effect is negligible. In this case, metaklopramid with prolonged use causes extrapyramidal disorders of the nervous system, and cisapride leads to cardiac disorders. Role of H. pylori eradication in the treatment of FD
Many scientists believed that when removed from the stomach of this microorganism will improve the recovery, but these actions have been much less effective than with peptic ulcer. Therefore, the appointment of eradication drugs with FD is questionable.
Other studies have shown that eradication measures are insignificant, but still reduced the symptoms of FD.
Suppression of hydrochloric acid release with FD
One of the effective treatment methods in PD is suppression of hydrochloric acid release with the help of proton pump inhibitors( PPI), and this is omeprazole, rabeprazole, pantoprazole, etc.
Omeprazole is a safe drug and is widely used not only in PD, but with gastroesophageal reflux disease, NSAID-gastropathy, peptic ulcer.