A tense lifestyle in a modern metropolis, heavy workload, irregular eating habits and the need to snack on the run lead to a significant increase in the functional pathology of the gastrointestinal tract in recent years. According to statistics, an unconditional increase in inorganic diseases (functional dyspepsia, dysfunction of the biliary tract and sphincter of Oddi, functional constipation, functional diarrhea, irritable bowel syndrome) is observed in developed countries with a high proportion of urban population.
Functional dyspepsia (PD) is a complex of symptoms, including abdominal pain in the epigastric region, an unpleasant sensation of heat, a feeling of heaviness after eating, and fast satiety when taking a regular serving of food immediately after starting a meal. It is also important that PD can be suspected of manifesting these symptoms over the past three months, with a total duration of complaints for 6 months. In addition, an important characteristic feature of this disease is the absence of organic damage to the gastrointestinal tract, however, its combination with various organic pathologies is not excluded.
In accordance with which symptom dominates among the remaining complaints, two types of PD are differentiated:
1. epigastric pain syndrome, previously classified as an ulcer-like form of functional dyspepsia
2. postprandial distress syndrome, previously designated as dyskinetic form.
For pain syndrome with PD it is characteristic: moderate intensity, a clear outline of the localization of pain that appears more than once a week, without any connection with the act of defecation and / or flatulence (exhaustion of gases). In addition, there is a correlation with food intake with the addition of a feeling of heaviness after eating, which may also bother patients on an empty stomach. A patient with postprandial distress syndrome complains of a feeling of heaviness after taking a usual volume of food, accompanied by a symptom of nausea, belching, and a feeling of bloating. It should be noted that these complaints arise repeatedly.
Earlier, heartburn was considered a symptom of functional dyspepsia, however, in modern clinical practice, people presented with this complaint are referred to the group of patients with gastroesophageal reflux disease (GERD). At the same time, a combination of GERD and FD is possible. It is also often diagnosed with IBS in patients with PD. Thus, other functional disorders and organic diseases do not exclude the diagnosis of PD and make it difficult to verify the diagnosis.
In some cases, functional diseases occur with a fairly frequent recurrence and sufficient persistence of symptoms. In this case, patients may experience anxiety due to the fact that when examining organic lesions were not detected, and the symptoms recur again and again. This situation leads to an increase in anxiety of patients who turn to different doctors, fearing that there is an incorrectly diagnosed or undetected disease, which causes the recurrence of symptoms that they have previously had again and again.
It is extremely important to note that the frequency of the combination of PD and GERD, chronic gastritis or IBS, possibly emphasizes the common pathophysiological mechanism of the formation of this nosology. The most common and recognized pathophysiological mechanism for the development of PD is a violation of the contractility of the upper gastrointestinal tract. Other causes of this pathology include H. pylori infection, smoking, alcohol, eating habits, psychoemotional factors, and visceral hypersensitivity. This phenomenon occurs when there is a violation of the feedback between the brain and the gastrointestinal tract and is manifested in the form of a rapid onset of a feeling of fullness up to the feeling of fullness of the stomach. The importance of genetic factors in the formation of functional dyspepsia is also discussed.
To confirm the presence of a patient with PD, it is impossible not to exclude the existence of organic lesions of the gastrointestinal tract in the patient, as other reasons for the formation of dyspepsia. In order to verify the diagnosis, laboratory and instrumental examination methods are carried out, a patient is carefully interviewed for complaints, referred to as symptoms of “anxiety” or “red flags”, which indicate damage to internal organs.
These symptoms include:
• unmotivated weight loss,
• recurrent vomiting,
• bleeding (vomiting of blood or coffee grounds, melena, hematochesia),
Identification of such complaints hints at the presence of organic changes in the gastrointestinal tract and requires detailed further examination (for example, endoscopic examination methods). Thus, the conclusion about the presence of a patient with PD can be made as a result of exclusion of diseases of the internal organs, therefore, PD is often called the diagnosis of exclusion.
Given the persistence of clinical manifestations, the disease is very burdensome for patients and reduces the quality of life. It is recommended that individuals with a diagnosis of PD change their lifestyle, abandon bad habits if they exist, follow dietary recommendations (limit the intake of fatty, spicy foods and caffeinated products in the diet, switch to fractional meals in small portions), as well as drug therapy.
If H. pylori infection is detected in individuals with PD, therapeutic measures are carried out aimed at eliminating the infectious agent – eradication therapy, which, as you know, promotes the regression of dyspeptic phenomena.
Drug therapy for PD includes the use of antisecretory drugs and prokinetics. With dominant epigastric pain, antisecretory drugs or proton pump inhibitors (PPIs) are the drugs of choice. In the case of prevalence of postprandial distress syndrome, drugs are used that stimulate contractile activity of the gastrointestinal tract – prokinetics (itoprida hydrochloride – itomed). If it is difficult to identify the dominant symptom, drugs of both groups are used. The dosage of the drugs is standard, the duration of therapy is 4-8 weeks. With positive dynamics during treatment, after completion of the course of therapy, it is advisable to use drugs in the “on demand” mode. Treatment is prescribed by a qualified medical specialist and requires dynamic monitoring to evaluate the effectiveness of the therapy used.
Abdominal discomfort? Do you feel nausea and burping every day after eating? Do not wait until everything goes away by itself. Do not self-medicate, perhaps this will delay the timely detection of the disease and the start of proper treatment. See your doctor and follow his recommendations exactly.
Diana Todorovna Dicheva – gastroenterologist, MD Associate Professor, Department of Propaedeutics of Internal Medicine, Moscow State Medical University named after A.I. Evdokimova. Doctor at the European Medical Center. Member of the Russian Gastroenterological Association and the Russian Hepatological Association.