Dyspepsia

Dyspepsia is a collective term for subjective manifestations of digestive disorders, including pain, heaviness, a feeling of fullness in the epigastric region, rapid satiety, burning, nausea, vomiting, belching, heartburn, regurgitation, anorexia, and sometimes abdominal pain, flatulence, diarrhea and constipation In recent years, dyspepsia has been proposed to mean only pain or discomfort localized by the patient in the epigastric region closer to the midline. The feeling of discomfort includes heaviness, distension in the epigastric region, nausea, and early satiety.

There are organic and functional (non-ulcer) dyspepsia.

Etiology. The cause of organic dyspepsia can be gastroesophageal reflux disease, peptic ulcer, stomach tumor, cholelithiasis, chronic pancreatitis, etc.

If these diseases are excluded during examination, and signs of dyspepsia persist for 12 weeks during the year, functional dyspepsia syndrome is diagnosed. The signs of gastritis found in some patients with functional dyspepsia cannot explain the clinical symptoms, since most patients with chronic gastritis have no complaints at all. The patient’s personal characteristics may play a role in the origin of functional dyspepsia, contributing to the formation of an asthenic state with frequent episodes of anxiety, as well as alcohol abuse, smoking, and poor quality and diet.

An important role in the pathogenesis of functional dyspepsia is played by disturbances in the motility of the stomach and duodenum. Disorders of the ability of the fundus of the stomach to relax after eating cause a feeling of early satiety, gastroparesis - a feeling of fullness in the epigastric region, nausea, vomiting; with normal evacuation function of the stomach, the cause of functional dyspepsia may be the increased sensitivity of the receptors of the stomach wall to stretching.

Symptoms, course. Conventionally, ulcer-like and dyskinetic variants of functional dyspepsia are distinguished. With ulcer-like dyspepsia, pain in the epigastric region can occur on an empty stomach, at night, and disappear after taking antacids. The dyskinetic variant is characterized by complaints of early satiety, a feeling of fullness in the stomach, nausea, a feeling of bloating in the upper abdomen, and discomfort that increases after eating.

The symptoms of dyspepsia are often accompanied by signs of depression and anxiety. Functional dyspepsia is often combined with irritable bowel syndrome, which is explained by the commonality of their pathogenetic mechanisms. If symptoms such as fever, dysphagia, blood in the stool, unmotivated weight loss, anemia, leukocytosis, increased ESR are detected, as well as when dyspepsia occurs for the first time over the age of 45 years, the diagnosis of functional dyspepsia is excluded.

To clarify the cause of dyspepsia, X-ray, endoscopic and ultrasound examination methods, blood tests, and stool testing for occult blood are used; If necessary, perform 24-hour monitoring of esophageal pH and computed tomography.

Treatment. For organic dyspepsia, treatment of the underlying disease is indicated.

For functional dyspepsia, diet therapy is recommended - it is advisable to eat small portions of food and reduce the total amount of food, limit fat, coffee, alcohol, quit smoking, etc. For the ulcer-like variant, antacids, H2-histamine blockers (ranitidine, famotidine), proton pump blockers ( omeprazole); for the dyskinetic variant, prokinetics (metoclopramide, domperidone, cisapride). It is possible to use psychotherapeutic methods, use anxiolytics and antidepressants in small doses.