Indigestion

Symptoms

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 abdomen along the midline for one week every month, 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 (symptom relief after defecation or changes in the nature and frequency of stools).

There are a number of signs in the presence of which the diagnosis is excluded: these are dysphagia , fever, 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 strong nocturnal or hungry pains in the epigastric region, often occurring after emotional overstrain. The pain syndrome is stopped by food intake, the introduction of antacids. A characteristic sign 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 in the stomach after eating, heaviness in the epigastrium, nausea , and bloating. Possible vomiting, which brings relief. Patients note that after eating, rapid satiety 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 non-specific - is characterized by a polymorphism of symptoms, while it is not possible to single out one leader. Functional dyspepsia is characterized by a long course, the absence of progression of symptoms.

Causes

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 sections of the intestine is disturbed. In addition to emotional overstrain, the causes of functional dyspepsia may be malnutrition, taking certain medications, increased secretion of hydrochloric acid, Helicobacter pylori contamination of the gastric mucosa, dyskinesia of the initial sections of the digestive tract, impaired digestion of complex sugars, etc. It is known that hypovitaminosis (insufficiency of vitamins C and group B) can also contribute to the development of dyspepsia.

As a result of the impact of these factors on the wall of the stomach, the sensitivity of visceral receptors increases, there is a discoordination of the motility of the stomach and small intestine, and the normal secretion of digestive juices is disturbed. The manifestations of these disorders are gastroparesis (accompanied by heaviness in the epigastrium, nausea and vomiting), increased visceral susceptibility to stretching (feeling of stomach fullness, hungry pain in the epigastric region), incomplete relaxation of the muscle layer of the organ (feeling of early satiety), slowing down the movement of food masses from the stomach into the intestines.

Diseases such as food allergy , gastroesophageal reflux disease, diaphragmatic hernia with displacement of the abdominal esophagus into the chest cavity, gastritis, achlorhydria , peptic ulcer of the stomach and duodenum, cholelithiasis , cholecystitis, condition after cholecystectomy, pancreatitis , pyloric stenosis also occur with dyspeptic syndrome. , tumors of the gastrointestinal tract, various infections of the digestive tract.

The most common cause of dyspepsia in children is food poisoning , in this case, along with dyspeptic syndrome, toxic-exicosis syndrome comes to the fore. Since the signs of organic dyspepsia are discussed in the sections on the corresponding diseases of the gastrointestinal tract, this article will focus mainly on functional dyspepsia.
 

Treatment

The main goals pursued by the doctor when prescribing the treatment of functional pathology are to reduce the intensity of symptoms and 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 for functional dyspepsia: correction of lifestyle and nutrition, medication and psychotherapeutic measures.

Situations that cause stress, worry, and physical and emotional exhaustion should be avoided in order to normalise daily life. It is advised to give up smoking and consuming alcohol. Daily physical education must be scheduled since it helps the patient's overall health and the way their digestive systems work. Additionally, it's important to pay close attention to your food. Fried, hot, spicy, carbonated beverages, and coffee are not allowed on the diet.

You need to eat in small portions, chew food thoroughly, avoid overeating and long breaks between meals. After eating, you need to actively move, do not lie down to rest. If there are signs of dyspepsia, it is recommended to refuse the use of non-steroidal anti-inflammatory drugs, as they adversely affect the condition of the gastric mucosa. These measures are leading in the treatment of functional dyspepsia.

If the patient is not able to normalize the diet on his own, he may need the help of a nutritionist. The specialist will explain the need to comply with the frequency and volume of each meal, the harm of overeating and long breaks in nutrition. Also, the nutritionist will control the qualitative composition of food - the presence of a sufficient amount of protein and vitamins, dietary fiber.

A cure for 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 procedures, yoga classes can contribute to this. The attending physician must 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 the treatment. Greater productivity of therapy can be achieved by prescribing sedatives (valerian herb, motherwort), antidepressants (fluvoxamine, fluoxetine).

Drug treatment is prescribed depending on the form of dyspepsia. With an ulcer-like variant, the main group of drugs is antacids and antisecretory agents: aluminum hydroxide in combination with magnesium hydroxide, proton pump inhibitors, H2 receptor blockers, and others. Prokinetics, such as domperidone or metoclopramide, are used to treat the dyskinetic type of dyspepsia. Various antacid and prokinetic drug combinations are used in other functional dyspepsia variations.

If the symptoms of dyspepsia do not regress during treatment, other drugs from these groups should be used, or the combination of drugs should be changed. Pylori (if it has not been carried out so far), with a positive result, to carry out the eradication of the microorganism with antibacterial agents. Antihelicobacter therapy in 25% of cases greatly facilitates the course of dyspepsia.

We should 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 makes the listed complaints, it is necessary to repeat endoscopic and other studies for the timely detection of a dangerous pathology of the gastrointestinal tract (stomach cancer, cancer of the small intestine , etc.).
 

Tests Required for Diagnosis

A consultation with a gastroenterologist will allow you to identify the leading complaints, determine the required amount of research. The diagnosis of functional dyspepsia is established only after a complete examination of the patient and the exclusion of other pathologies of the gastrointestinal tract. The following studies are obligatory: consultation of an endoscopist for esophagogastroduodenoscopy , ultrasound of the abdominal organs, blood tests (general clinical and biochemical blood tests), stool examination to assess digestive activity, detection of latent blood.

With functional dyspepsia during endoscopy, mucosal changes are not visualized. On ultrasound of the abdominal organs, chronic pancreatitis , cholelithiasis can be detected . Deviations in the analyzes with this diagnosis usually do not happen. For differential diagnosis with other diseases of the gastrointestinal tract, additional studies may be required. An x-ray of the stomach can reveal an expansion of the organ cavity, a slowdown in the evacuation of food. On electrogastrography, a violation of gastric peristalsis is recorded (most often a decrease in its rhythm).

To determine the acidity, a study of gastric juice is carried out, intragastric pH-metry (both an increase and a decrease in pH are 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 enough during treatment, two different studies are required to detect Helicobacter pylori infection. The use of methods with different diagnostic mechanisms (determination of Helicobacter in feces by ELISA, PCR diagnostics of Helicobacter, determination of antibodies to Helicobacter in the blood by ELISA, breath test for Helicobacter) will avoid errors.

Repeated consultation with a gastroenterologist after receiving the results of all studies makes it possible to exclude organic pathology, establish a diagnosis of functional dyspepsia and prescribe the correct treatment. It is known that the organic causes of the disorder are found in 40% of patients with complaints characteristic of this disease, so the diagnostic search should first of all be aimed at identifying these diseases. Functional dyspepsia should be differentiated from irritable bowel syndrome, functional vomiting, aerophagia.