Dyspepsia is a digestive disorder caused by organic and functional causes. Symptoms are pain in the upper abdomen of unclear localization, nausea, heartburn, a feeling of fullness of the stomach, rapid saturation after eating, etc. The diagnosis is established only if another pathology of the gastrointestinal tract is excluded, the endoscopic examination of the upper digestive tract is of fundamental importance. Symptomatic treatment: enzyme preparations, means to improve gastrointestinal motility, etc. Psychotherapy is of great importance – after classes with a psychologist, most patients note a decrease in the intensity of complaints.
ICD 10
K30 Dyspepsia
Meaning
Dyspepsia is one of the main problems of modern gastroenterology, since up to 40% of the population of developed countries makes vague complaints about digestive discomfort, while only one in five turns to doctors. Digestive disorders can have an organic or functional basis.
Organic dyspepsia occurs against the background of various pathologies of the digestive organs (gastritis, peptic ulcer, inflammatory diseases of the hepatobiliary system, pancreas and various parts of the intestine, gastrointestinal tumors, etc.). Functional dyspepsia is spoken of in the case when, in the presence of symptoms of impaired gastric activity, no organic pathology is detected that could cause these complaints. Women suffer from functional dyspepsia 1.5 times more often than men; the main age group in which this disease is detected is 17-35 years old.
Causes of dyspepsia
Pathology is considered to be a psychosocial disease in which, as a result of various stress factors, the regulation of the functions of the stomach and the initial parts of the intestine is disrupted. In addition to emotional overstrain, the causes of the development of functional dyspepsia may be eating disorders, taking certain medications, increased secretion of hydrochloric acid, helicobacter contamination of the gastric mucosa, dyskinesia of the initial parts of the digestive tract, impaired digestion of complex sugars, etc. It is known that hypovitaminosis (deficiency of vitamins C and group B) can also contribute to the development of dyspepsia.
As a result of the influence of these factors on the stomach wall, the sensitivity of visceral receptors increases, discoordination of the motility of the stomach and small intestine occurs, normal secretion of digestive juices is disrupted. The manifestations of these disorders are gastroparesis (accompanied by heaviness in the epigastrium, nausea and vomiting), increased visceral susceptibility to stretching (feeling of fullness of the stomach, hunger pains in the epigastric region), incomplete relaxation of the muscular layer of the organ (feeling of early satiety), slowing down the movement of food masses from the stomach into the intestine.
Dyspeptic syndrome is also associated with such diseases as food allergy, gastroesophageal reflux disease, diaphragmatic hernia with displacement of the abdominal esophagus into the thoracic cavity, gastritis, achlorhydria, gastric and duodenal ulcer, cholelithiasis, cholecystitis, condition after cholecystectomy, pancreatitis, pylorostenosis, gastrointestinal tumors, various infections of the digestive tract .
The most common cause of dyspepsia in children are food toxicoinfections, in this case, along with dyspepsia, the syndrome of toxic exicosis comes to the fore. Since the signs of organic dyspepsia are discussed in the sections on the relevant gastrointestinal diseases, this article will focus mainly on functional dyspepsia.
Pathogenesis
As a result of the influence of these factors on the stomach wall, the sensitivity of visceral receptors increases, discoordination of the motility of the stomach and small intestine occurs, normal secretion of digestive juices is disrupted. The manifestations of these disorders are gastroparesis (accompanied by heaviness in the epigastrium, nausea and vomiting), increased visceral susceptibility to stretching (feeling of fullness of the stomach, hunger pains in the epigastric region), incomplete relaxation of the muscular layer of the organ (feeling of early satiety), slowing down the movement of food masses from the stomach into the intestine.
Classification of dyspepsia
Based on the pathogenetic principle, functional and organic dyspepsia are distinguished. Organic pathology accompanies various diseases of the digestive tract, and functional pathology proceeds against the background of the absence of organic lesions of the gastrointestinal tract. According to the causal factor , the following variants of dyspepsia are distinguished:
- Alimentary – usually associated with a violation of the ratio of essential nutrients in the diet. Fermentation dyspepsia develops with the predominance of carbohydrates in the menu, putrid – proteins and stale meat, soapy – with an overabundance of refractory fats.
- Enzymatic – is associated with insufficient production of digestive enzymes. Depending on which organ has developed enzyme deficiency, gastrogenic, pancreatogenic, hepatogenic and enterogenic dyspepsia are isolated.
- Dyspepsia in malabsorption syndrome is associated with impaired absorption of nutrients in the intestine.
- Infectious – develops with various intestinal infections, most often with dysentery and salmonellosis.
- Intoxication – occurs in acute poisoning, severe general infections, extensive injuries.
There are also four clinical forms of functional dyspepsia: ulcerative, dyskinetic, reflux-like and indefinite.
Symptoms of dyspepsia
The diagnosis of a functional disorder is established in the presence of three mandatory criteria. The first of them is complaints of pain and discomfort in the upper half of the abdomen along the median line for one week monthly, or 12 weeks a year. The second is the absence of organic changes in the gastrointestinal tract during physical, endoscopic and ultrasound examination of the upper digestive tract. The third criterion is the absence of signs of irritable bowel syndrome (relief of symptoms after defecation or changes in the nature and frequency of stool).
There are a number of signs in the presence of which the diagnosis is excluded: these are dysphagia, an increase in body temperature, the appearance of blood in the stool, inflammatory changes in clinical tests, causeless weight loss, anemia. In the presence of these symptoms, a deeper examination of the patient is required to make a correct diagnosis.
There are four variants of the course of functional dyspepsia, each of which has its own clinical and physical signs. The ulcer-like variant is manifested by rather severe night or hunger pains in the epigastric region, often occurring after emotional overstrain. Pain syndrome is relieved by eating, administration of antacids. A characteristic feature is a feeling of fear during an attack, obsessive thoughts about the presence of an incurable disease.
The dyskinetic variant is expressed by a feeling of fullness of the stomach after eating, heaviness in the epigastrium, nausea, bloating. Vomiting is possible, bringing relief. Patients note that after eating, rapid saturation occurs. Reflux-like dyspepsia is manifested by heartburn, a feeling of burning pain behind the sternum, belching and acid regurgitation. The last form of the disease – indefinite, or nonspecific – is characterized by a polymorphism of symptoms, while it is not possible to single out one leading one. Functional dyspepsia is characterized by a long course, the absence of progression of symptoms.
Diagnostics
Consultation with a gastroenterologist will allow you to identify the leading complaints, determine the necessary amount of research. The diagnosis of functional dyspepsia is established only after a complete examination of the patient and the exclusion of other gastrointestinal pathology. The following studies are mandatory: consultation of an endoscopist for esophagogastroduodenoscopy, ultrasound of the abdominal cavity, blood tests (general clinical and biochemical blood tests), stool examination to assess digestive activity, detection of hidden blood.
With functional dyspepsia during EGD, mucosal changes are not visualized. On abdominal ultrasound, chronic pancreatitis, cholelithiasis can be detected. There are usually no deviations in the tests with this diagnosis. For differential diagnosis with other gastrointestinal diseases, additional studies may be required. The stomach x-ray may reveal the expansion of the organ cavity, slowing the evacuation of food. Electrogastrography records a violation of gastric peristalsis (most often a decrease in its rhythm).
To determine the acidity, a study of gastric juice, intragastric pH-metry is carried out (both an increase and a decrease in pH is possible). To assess the degree of relaxation of the stomach, antroduodenal manometry is used, during which a special sensor is inserted into the organ cavity that transmits pressure indicators. With functional dyspepsia, manometry may indicate insufficient relaxation or, conversely, relaxation of the walls of the stomach.
In a situation where symptoms progress or do not regress sufficiently against the background of treatment, two different studies are required to identify a helicobacter infection. The use of methods with different diagnostic mechanisms (determination of helicobacter in the feces by ELISA, PCR diagnosis of helicobacter, determination of antibodies to helicobacter in the blood by ELISA, a respiratory test for helicobacter) will avoid mistakes.
Treatment of dyspepsia
The main goals pursued by a doctor when prescribing treatment for functional pathology are to reduce the intensity of symptoms, prevent relapses of the disease. Hospitalization in the department of gastroenterology is usually indicated only for complex studies, with difficulties in differential diagnosis. The main directions of therapy of functional dyspepsia: lifestyle and nutrition correction, medical and psychotherapeutic measures.
To normalize the daily routine, it is necessary to exclude situations that provoke stress and anxiety, physical and emotional overload. It is recommended to stop drinking alcohol and smoking. It is necessary to allocate time for daily physical training – they improve both the general condition of the patient and the function of the digestive organs. It is also necessary to pay great attention to the diet. Fried, extractive and spicy foods, carbonated drinks, coffee are excluded from the diet.
It is necessary to eat in small portions, chew food thoroughly, avoid overeating and long breaks between meals. After eating, you need to move actively, you should not go to rest. In the presence of signs of dyspepsia, it is recommended not to use nonsteroidal anti-inflammatory drugs, since they negatively affect the condition of the gastric mucosa. These measures are leading in the treatment of functional dyspepsia.
If the patient is unable to independently normalize the diet, he may need the help of a nutritionist. The specialist will explain the need to observe the frequency and volume of each meal, the harm of overeating and long breaks in nutrition. Also, the nutritionist will monitor the quality of the food – the presence of sufficient protein and vitamins, dietary fiber.
Recovery from functional dyspepsia is impossible without a deep psycho-emotional restructuring. To do this, it is necessary not only to reduce the amount of stress to a minimum, but also to change the patient’s attitude to negative situations. Sports, water treatments, yoga classes can contribute to this. The attending physician should maintain a trusting relationship with the patient, explain in detail the causes and mechanisms of the development of the disease – only in this case it is possible to obtain the desired effect from treatment. More productive therapy can be achieved with the appointment of sedatives (valerian herb, motherwort), antidepressants (fluvoxamine, fluoxetine).
Medication is prescribed depending on the form of dyspepsia. In the ulcer–like variant, the main group of drugs are antacids and antisecretory agents: aluminum hydroxide in combination with magnesium hydroxide, proton pump inhibitors, H2 receptor blockers and others. In the dyskinetic form of dyspepsia, prokinetics are used: domperidone or metoclopramide. Other variants of functional dyspepsia involve the use of various combinations of antacids and prokinetics.
If the symptoms of dyspepsia do not regress against the background of ongoing treatment, other drugs from these groups should be used, or a combination of medications should be changed. It is also recommended to conduct a study on H.pylori (if it has not been conducted so far), with a positive result – to carry out the eradication of the microorganism with antibacterial agents. Antihelicobacter therapy in 25% of cases significantly facilitates the course of dyspepsia.
Do not forget about the alarming symptoms that may appear in a patient with dyspepsia: dysphagia, bleeding from different parts of the gastrointestinal tract, unmotivated weight loss. If the patient presents the listed complaints, it is necessary to repeat endoscopic and other studies for the timely detection of dangerous gastrointestinal pathology (stomach cancer, small intestine cancer, etc.).
Prognosis and prevention
Functional dyspepsia worsens the patient’s life course, but the prognosis of this disease is favorable. In the absence of the alarming symptoms listed above, the presence of serious gastrointestinal pathology is unlikely. However, dyspepsia is characterized by a wave-like course, therefore, after the course of therapy, there is a high probability of relapse of symptoms. Specific measures for the prevention of dyspepsia have not been developed, but maintaining a healthy lifestyle, rational nutrition and the exclusion of stressful situations significantly reduce the likelihood of developing this disease.