Functional Dyspepsia Diagnosis and Treatment

Definition

Functional dyspepsia is a functional disease(without organic reason), characterized by a symptomatology located in the upper abdomen, its manifestation are epigastric pain, satiety, flatulence or discomfort.

Etiopathogenesis of functional dyspepsia

In cases with quasiulcerous symptomp the role of Helicobacter Pylori or hypersecretory status may be incriminated; in those with flatulence, a disorder in gastric emptying(dismotility)or even disorders of the sensorial digestive perception(the patient perceives as abnormal a usual quantity of gas located in the digestive tube).

Classification of functional dyspepsia

It is done in accordance with the dominant symptoms:

• functional dyspepsia ”ulcer-like”;
• functional dyspepsia type dismotility “dismotility dyspepsia”;
• essential  functional dyspepsia.

In the ulcer-like dyspepsia:

• epigastric pain,
• discomfort,
• frequently painful hungers are prevalent, but the superior digestive endoscopy reveals the absence of ulcer.

In dismotility dyspepsia, the patient complains of  epigastric satiety, a sensation of epigastric “load”, flatulence, eructations, but the digestive investigations will reveal the absence of lesion. Essential functional dyspepsia will contain a mixture of the symptoms above.

Diagnosis

Clinical diagnosis consists of an epigastric symtomatology more or less noisy,but in which loss, digestive hemorrhage or anemia are absent. The prevalent type of symptoms will allow the “framing” into one of dyspepsia forms.

Paraclinic diagnosis consists into a series of explorations, which will demonstrate the absence of organic lesions. Firstly, the abdominal ultrasonography will show a gallbladder without calculi, a normal pancreas, and a liver without changes. The superior digestive endoscopy will show a normal esophagus, stomach and duoden. The barium enemaor colonoscopy will be proved by the absence of organic lesions.

Differential diagnosis in functional dyspepsia must be done with all the organic lesions of the upper abdomen (reflux esophagitis, esophageal neoplasia, achalasia, gastro-duodenal ulcer, gastric neoplasm, gastric lymphoma, acute or chronic pancreatitis, gallstones etc.).

-the irritable colon (characterized by disorders of transit, flatulence, sensation of incomplete  stool, discomfort in the lower abdomen etc.).

Evolution is favorable, with more or less in time, generally according to alimentation, stress etc. The prognosis is favorable.


Treatment of functional dyspepsia

It addresses mainly to the symptoms and it will be administered at their apparition.

Treatment of “ulcer-like” dyspepsia

Antisecretory drugs of the class H2 histaminic blockers:

• Ranitidine 300mg/day
• Famotidine 20-40mg/day,
• or PPI given during the symptomatic periods or PPI (20-40mg)

Eradication of Helicobacter Pylori

In  approximately a half of patients in which the triple the therapy Helicobacter Pylori is eradicated, the symptoms may disappear or reduce, but in the others, the symptoms persist.

Treatment of “dismotility” functional dyspepsia consists generally in prokinetics.

• Metoclopramide(1 tb 30 minutes before principal meals)
• Domperidone(Motilium 1 tb 30 minutes before principal meals)
• Cisaprid(Coordxinax, Prepulsid 5-10 mg 30 minutes before principal meals). Digestive ferments at meals(Digestal, Mezym, Festal, Kreon etc.) or intestinal gas absorbents, such as dimeticon(Sab-simplex) may also be administered.

Treatment of essential functional dyspepsia, disease with symptoms of the two entities above,will be made with medication addressed to the dominant manifestations(pain or satiety).

In all forms of dyspepsia,if stress plays a role in the apparition of symptoms,an easy sedative treatment should be administered or even psychotherapy(often when the patient find out he has no organic lesions,the psychic effect is positive).