Functional dyspepsia

Introduction to functional dyspepsia Functional dyspepsia (FD) refers to upper abdominal pain, upper abdominal distension, early satiety, belching, loss of appetite, nausea, vomiting and other symptoms of upper abdominal discomfort. The gastrointestinal tract and hepatobiliary tract that cause these symptoms are excluded. A group of clinical syndromes of organic diseases such as the pancreas, with persistent or recurrent symptoms, with symptoms occurring more than one month per year. Epidemiological surveys show that the number of patients with dyspepsia accounts for about 30% of the total number of internal medicine clinics, accounting for 70% of the specialist departments of gastroenterology. Among them, functional dyspepsia accounts for 30% to 40% of the specialist departments of gastroenterology. basic knowledge The proportion of the disease: the population is 8.3% Susceptible people: no specific population Mode of infection: non-infectious Complications: nausea and vomiting

Cause of functional dyspepsia

(1) Causes of the disease

Healthy people in the digestive phase are characterized by a characteristic transitional complex motor wave (MMC), in which MMC III plays an important role in the scavenger, enters the digestive period after the meal, and the proximal stomach is adaptively relaxed, containing food, distal Stomach contraction, peristalsis, digestion of food, making it into small particles, the coordinated movement of the antrum, pylorus and duodenum plays an important role in the emptying process, antrum, pyloric and duodenal motility of FD patients Abnormalities, not only in the digestive phase, but also in the digestive phase, the latter including the reduction in the number of MMC stage III, the weakening of the MMC II phase and duodenogastric reflux, so patients have symptoms on an empty stomach and do not reduce after meals Or even worse.

(two) pathogenesis

The etiology and pathogenesis of FD are still not fully understood, and may be related to many factors. It is currently believed that upper gastrointestinal motility disorder is the main pathophysiological basis, and mental factors and stress factors have always been considered to be closely related to their pathogenesis. Patients with FD had abnormal personality, anxiety, and depression scores significantly higher than those in the normal population and duodenal ulcer group.

Functional dyspepsia prevention

Patients with functional dyspepsia should avoid greasy and irritating foods in the diet, quit smoking, stop drinking, develop good habits, avoid overeating and sleep overeating; take small meals and eat more; strengthen physical exercise; Pay special attention to maintaining a happy mood and a good mood.

First, you should maintain a relaxed mood when eating, do not rush to promote food, do not swallow, do not stand or walk while eating.

Second, do not eat rice or eat with water, do not drink plenty of liquid immediately before or after meals.

3. Do not discuss problems or quarrels during meals. These discussions should be held one hour after the meal.

4. Don't drink alcohol while eating. Do not smoke immediately after eating.

5. Don't eat in the underwear with a tight waist.

Sixth, meals should be timed.

Seven, avoid eating and drinking, especially spicy and fat-rich diet.

Eight, there are conditions to drink a cup of milk between meals, to avoid excessive acidosis.

Nine, eat less sweet and salty food, too much to eat candy will stimulate gastric acid secretion.

Ten, do not eat too cold or too hot.

Functional dyspepsia Complications, nausea and vomiting

If the clinical symptoms (premature suffocation, loss of appetite, nausea, vomiting, etc.) can not be alleviated, vitamin deficiency, low protein disease, etc. may occur.

Symptoms of functional dyspepsia Common symptoms Indigestion Abdominal discomfort Xenon stagnation plant hemagglutinin dripping... Diarrhea feces excretion process abnormally vomiting heart bloating fart and stink

Symptom

Symptoms of FD include upper abdominal pain, upper abdominal distension, early fullness, belching, loss of appetite, nausea, vomiting, etc., often in a certain group or a group of symptoms, at least sustained or accumulated for 4 weeks / year or more, symptoms during the course of the disease It can also change, the onset is slow, the course of disease often lasts for several months, and it is persistent or recurrent. Many patients are induced by diet, mental and other factors. Some patients are accompanied by insomnia, anxiety, depression, headache, inattention and other spirits. Symptoms, no anemia, weight loss and other symptoms of wasting disease, clinically divided into three types of FD: ulcer type (upper abdominal pain and acid reflux), dysmotility (premature, loss of appetite and abdominal distension) and non-specific type.

2. Signs

The signs of FD are mostly non-specific, and most patients have tenderness or discomfort in the upper abdomen.

Functional dyspepsia

1. Determination of Fat in Feces Fat quantitative analysis is a simple and reliable test for the diagnosis of steatorrhea. The amount of fat excreted in the feces of normal people within 24 hours is less than 6g, or the fat absorption coefficient is >94%; the absorption test with 14C-triolein The normal person's hourly respiratory discharge marker is greater than 3.5% of the administered amount.

2. Schilling test of vitamin B12 absorption Differently often suggest end-ileal lesions, patients with pancreatic exocrine insufficiency often have vitamin B12 malabsorption, Schilling test is also helpful in diagnosing intestinal bacterial overgrowth, especially blind hernia syndrome, scleroderma In the case of multiple small bowel diverticulum, such as the blind syndrome, the first and second parts of the Schilling test are abnormal. After appropriate antibiotic treatment, the Schilling test can return to normal.

3. Imaging examination B-ultrasound and endoscopy, other imaging examinations (including X-ray examination, CT, MRI, etc.), its significance is to exclude organic diseases, is conducive to gastric and duodenal ulcers, esophagitis Identification of organic diseases such as liver, gallbladder, pancreatic diseases and tumors. X-ray and MRI imaging techniques can also reflect gastric emptying rate at different times to some extent.

4. Gastric emptying measurement technique Nuclide scanning is considered to be the gold standard for measuring gastric emptying. The gastric semi-empty time is prolonged in 25% to 50% of patients, mainly due to the extension of the semi-empty time of solid food.

Diagnosis and diagnosis of functional dyspepsia

diagnosis

1. The above symptoms of dyspepsia persist for more than 4 weeks in one year.

2. Endoscopy examination of no esophagus, ulcers of the stomach and duodenum, erosion and neoplastic lesions, and no history of such diseases.

3. B-ultrasound, X-ray, CT, MRI and related laboratory tests exclude liver, gallbladder, and pancreatic diseases.

4. No mental illness, connective tissue disease, endocrine and metabolic diseases and kidney disease.

5. No history of abdominal surgery.

Differential diagnosis

1. Chronic gastritis The symptoms and signs of chronic gastritis are difficult to distinguish with FD. Gastroscopic examination reveals that the gastric mucosa is obviously congested, erosive or hemorrhagic, and even atrophic changes, often suggesting chronic gastritis.

2. Peptic ulcer The periodic and rhythmic pain of peptic ulcer can also be seen in patients with FD. X-ray barium meal is found to have a diagnosis of peptic ulcer with sputum and gastroscopic examination.

3. Chronic cholecystitis Chronic cholecystitis and gallstones coexist, can also appear upper abdominal fullness, nausea, qi and other dyspepsia symptoms, abdominal B-ultrasound, oral gallbladder angiography, CT and other imaging examinations can find gallstones and gallbladder Signs of inflammation can be identified with FD.

4. Gastric cancer: There are no specific symptoms in the early stage of gastric cancer. Only gastroscopy and pathological examination can be found. However, as the tumor grows, the similar symptoms of indigestion will occur when the function of the stomach is affected. Abdominal pain or discomfort, loss of appetite, nausea, vomiting, etc., but the age of onset of gastric cancer is more than 40 years old, accompanied by weight loss, fatigue, anemia and other so-called "alarm" symptoms suggesting malignant tumors, through gastroscopy and live Histopathological examination is not difficult to diagnose.

5. Other FDs need to be differentiated from other secondary gastric dyskinesia diseases, such as diabetic gastroparesis and gastrointestinal neuromuscular lesions, and the clinical manifestations and signs characteristic of these diseases can be generally identified.

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