Functional dyspepsia: symptoms and treatment. Dyspepsia - treatment, prevention, nutrition How long is functional dyspepsia treated

Definition: Functional dyspepsia syndrome is defined as a symptom complex related to the gastroduodenal region, in the absence of any organic, systemic or metabolic diseases that could explain these manifestations (Rome criteria IIΙ, 2006). Patients presenting with one or more of the following symptoms (feeling of fullness after eating, rapid satiety, epigastric pain or burning) are defined as having dyspepsia.

The conciliation meeting of the International Working Group on the Improvement of Diagnostic Criteria for Functional Gastrointestinal Diseases (Rome criteria IIΙ, 2006) gave a detailed definition of each of the symptoms included in this syndrome (Table 1).

Table 1

Symptoms included in the syndrome of dyspepsia, and their definition

Epidemiology. Approximately 20-30% of the population constantly or periodically experience dyspeptic symptoms. At the same time, studies have shown that a smaller part (35–40%) falls on the group of diseases included in the group of organic dyspepsia, and a large part (60–65%) falls on functional dyspepsia (FD). Based on prospective studies, it has been established that for the first time complaints appear in approximately 1% of the population per year. The presence of dyspeptic complaints significantly reduces the quality of life of such patients.

In most cases, dyspeptic symptoms are observed for a long time, although periods of remission are possible. Approximately every second patient with dyspepsia sooner or later seeks medical help during his life. Pain and fear of serious illness are the main reasons for seeking medical advice. The costs incurred by health care for the examination and treatment of patients with functional dyspepsia are enormous due to the high prevalence and amount, for example, in Sweden to 400 million dollars per 10 million population.

Etiology and pathogenesis.

The issues of etiology and pathogenesis of functional dyspepsia syndrome are still insufficiently studied. There is evidence of impaired motility of the stomach and duodenum in the pathogenesis of functional dyspepsia. The disorders of gastroduodenal motility characteristic of this disease include a weakening of the motility of the antrum of the stomach, followed by a slowdown in evacuation from the stomach (gastroparesis), disturbances in antroduodenal coordination, disorders of the rhythm of gastric peristalsis (tachygastria, bradygastria), disturbances in the accommodation of the stomach (i.e., the ability of the proximal stomach to relax after eating).

With a normal evacuation function of the stomach, the causes of dyspeptic complaints may be an increased sensitivity of the receptor apparatus of the stomach wall to stretching (the so-called visceral hypersensitivity), associated either with a true increase in the sensitivity of the mechanoreceptors of the stomach wall or with an increased tone of its fundus.

The role of H. pylori infection in FD is controversial. The currently accumulated data do not give grounds to consider H. pylori as a significant etiological factor in the occurrence of dyspeptic disorders in the majority of patients with functional dyspepsia. Eradication may be useful only in some of these patients.

There is strong evidence for the association of dyspepsia with psychopathological factors and comorbid psychiatric disorders, especially anxiety. The role of this association in the development of functional dyspepsia is currently being studied. An association of psychosocial abnormalities with epigastric pain and hypersensitivity to gastric distension in FD has been found.

Unexplored and examined dyspepsia. It is important, especially based on epidemiological data, to distinguish between unexamined dyspepsia from the examined, when, after the examinations, the cause of the existing symptoms can be found (or not found). For the population of our patients, this provision of the Consensus is of particular importance, given the significant prevalence of gastric cancer in comparison with the countries of Western Europe and the USA. In fact, fibroesophagogastroduodenoscopy (FEGDS) provides a transfer of unexamined dyspepsia to the examined one.

Organic and functional dyspepsia

In cases where the symptoms of dyspepsia are due to diseases such as peptic ulcer, gastroesophageal reflux disease (with and without esophagitis), malignant tumors, cholelithiasis and chronic pancreatitis, or metabolic causes (side effects of drugs), it is customary to talk about the syndrome of organic dyspepsia. In the case of organic dyspepsia, if the disease is cured, the symptoms decrease or disappear.

If a thorough examination of the patient fails to identify these diseases, it is legitimate to diagnose functional dyspepsia.

The relationship between the concepts of "chronic gastritis" and "functional dyspepsia"

There is a contradiction in the approaches to the interpretation of patients with dyspepsia syndrome among Russian and foreign clinicians. So, in our country, doctors in the absence of diseases included in the group of organic dyspepsia, a patient with dyspepsia syndrome will be diagnosed with chronic gastritis. Abroad, a doctor in a similar situation will use the diagnosis of “functional dyspepsia”. The term "chronic gastritis" is mainly used by morphologists. Numerous studies conducted in recent years have repeatedly proven the absence of any connection between gastric changes in the gastric mucosa and the presence of dyspeptic complaints in patients.

The frequency of chronic gastritis in the population is very high and reaches 80%. At the same time, however, in the vast majority of cases it is asymptomatic and many patients feel practically healthy.

“Clinical” diagnosis of gastritis, i.e. without a morphological study of gastrobiopsy specimens, it practically does not make sense. In the case of complaints of pain and discomfort in the epigastric region (in the absence of ulceration, according to endoscopic examination) for both the doctor and the patient, a syndromic diagnosis of functional dyspepsia is convenient. Often, such a diagnosis is also distinguished - “chronic gastritis with functional dyspepsia”, although the same thing is meant (of course, in the presence of morphologically confirmed gastritis).

Classification.

In the classification of functional dyspepsia, there are:

postprandial distress syndrome (PDS) (dyspeptic symptoms caused by eating.

Epigastric pain syndrome (EPS).

Diagnosis and differential diagnosis

The Expert Committee (Rome criteria IIΙ, 2006) proposed diagnostic criteria for functional dyspepsia at two levels: functional dyspepsia proper (B1) and its variants (Table 2).

Table 2.

Thus, the diagnosis of functional dyspepsia involves, first of all, the exclusion of organic diseases that occur with similar symptoms: gastroesophageal reflux disease, peptic ulcer, stomach cancer, cholelithiasis, chronic pancreatitis. In addition, the symptom complex characteristic of dyspepsia can occur with endocrine diseases (for example, diabetic gastroparesis), systemic scleroderma, and pregnancy.

For the diagnosis of functional dyspepsia, the following are mandatory:

1. FEGDS with a biopsy for H. pylori

2. Clinical and biochemical blood tests.

3. Analysis of feces for occult blood.

According to indications are carried out:

Ultrasound examination of the abdominal organs (with clinical and biochemical data indicating pancreatoduodenal pathology).

X-ray examination of the stomach.

Daily monitoring of intraesophageal ROP (to exclude GERD)

When conducting differential diagnosis in cases of dyspepsia syndrome, it is important to timely identify “alarm symptoms” or “red flags”. The detection of at least one of the “anxiety symptoms” in a patient calls into question the presence of functional dyspepsia and requires a thorough examination in order to search for a serious organic disease.

Table 3

“Anxiety symptoms” in dyspepsia syndrome

Dysphagia

Vomiting blood, melena, hematochezia

(scarlet blood in stool)

Fever

Unmotivated weight loss

Symptoms of dyspepsia first appeared in

over 45 years of age

Leukocytosis

ESR increase

Combination (overlap-syndrome) of FD with GERD and IBS. Heartburn, regarded as the leading symptom, GERD, like dyspepsia, is extremely common and can co-exist. The Rome II Consensus excluded patients with a predominance of heartburn from the group of dyspepsia, but recent studies have shown that heartburn, as the dominant symptom, does not always distinguish patients with GERD. In general, the combination of GERD with FD (PDS or EBS) is probably observed quite often, which must be taken into account both in clinical practice and in research. The Expert Committee recommends that in the presence of frequent and typical reflux symptoms, a preliminary diagnosis of GERD be performed. In clinical practice and in clinical studies for the preliminary diagnosis of GERD, the presence of frequent heartburn can be confirmed using simple questionnaires. The presence of heartburn does not preclude the diagnosis of FD (PDS or EPS) if dyspepsia persists despite adequate acid suppression therapy. Layering of symptoms of dyspepsia and IBS is also quite common. Perhaps the simultaneous presence of IBS and PD (PDS or EBS).

With the persistent nature of dyspeptic symptoms, it may be useful to consult a psychiatrist to rule out depression and somatoform disorders.

According to international recommendations, non-invasive determination of H. pylori infection and subsequent eradication (“test and treat”) is an economically viable strategy and reduces the number of FEGDS. This strategy is indicated for patients without anxiety symptoms. A "test and treat" strategy is recommended because it treats most cases of peptic ulcer disease and prevents future gastroduodenal disease, although many patients with FD do not improve after eradication. In such cases, the next step in treatment is the administration of a PPI. The "test and treat" strategy is most appropriate in regions with a high prevalence of H. pylori, a dependent peptic ulcer. As is known, in our regions (in Russia) H. pylori infection is extremely high (60-90%), and in duodenal ulcers, according to our data, it is close to absolute. From these positions, the “test and treat” strategy is justified in our country. However, one should take into account the high incidence of stomach cancer, several times higher than in the US and Western Europe. In addition, today we have almost no non-invasive diagnosis of Helicobacter pylori infection, and the cost of endoscopy is several times lower than in the above-mentioned countries. At the same time, Russian authors support the point of view of preliminary esophagogastroduodenoscopy to exclude organic pathology, and then treatment. Therefore, in our clinical practice, in the presence of dyspeptic complaints, it is advisable to schedule FEGDS.

Functional dyspepsia (FD) is a disorder of the function of the stomach, as a result of which the activity of the digestive system is disturbed.

This condition is often confused with other diseases of the gastrointestinal tract (GIT). But in the formulation of an accurate diagnosis lies the success of proper treatment and recovery. Highly qualified gastroenterologists of the CELT clinic will help to effectively solve problems associated with the work of the gastrointestinal tract.

Clinical manifestations of FD

Symptoms of functional (non-ulcerative) dyspepsia are observed in patients for 3 to 6 months and are characterized by the following complaints:

• Pain in the epigastrium (upper abdomen). It can disturb constantly or occur periodically. This complaint is not associated with bowel movements, the frequency and consistency of feces also do not affect the nature of the pain.
• Heartburn, frequent belching, hunger pains. These symptoms may be a sign of an increased content of hydrochloric acid in the gastric juice.
• Feeling of heaviness in the stomach after eating, which is associated with a violation of peristalsis and a slowdown in gastric motility (antral hypokinesia). This, in turn, can provoke the development of gastroesophageal and duodenogastric reflux.
• General discomfort - nausea, bloating, a feeling of early saturation of the stomach with food.

Often there are several symptoms at once in one patient, so it is extremely difficult to determine the leading symptom of the disease.

The reasons

The etiology of functional dyspepsia is still not clear. Many possible causes play an important role in the mechanism of formation of clinical manifestations of the disease. Risk factors for developing FD include:

• Psycho-emotional overstrain, stress.
• Overstretching of the walls of the stomach (frequent overeating).
• Slowing of the motility of the upper gastrointestinal tract.
• colonization of the stomach by the bacterium Helicobacter pylori.
• High concentration of hydrochloric acid in gastric juice.
• Insufficient production of digestive enzymes.
• Wrong diet and poor quality products.
• Taking drugs that have a detrimental effect on the gastric mucosa (for example, NSAIDs).

Classification

Depending on the predominance of one or another symptomatology of the disease. There are the following clinical forms of functional dyspepsia:

• Ulcerative. It is manifested by hunger pains that disappear after eating. Pain can also be stopped by taking medications that reduce acidity in the stomach.
• Reflux. It is characterized by heartburn, belching and epigastric pain. Symptoms intensify against the background of psycho-emotional stress, as well as when changing the position of the body - from vertical to horizontal or when the body is tilted forward.
• Dyskinetic. This clinical form is characterized by complaints of a feeling of early satiety, nausea, up to vomiting, flatulence.
• Nonspecific. With this form of dyspepsia, the patient is concerned about a variety of complaints that are difficult to combine into a single symptom complex characteristic of a particular variant of the disease.

Diagnostics

The diagnosis of functional dyspepsia is valid only if another pathology is excluded - peptic ulcer, gastritis, oncological process, pancreatitis, cholecystitis, etc. Often, manifestations of dyspepsia are accompanied by other organic diseases of the gastrointestinal tract. FD should also be differentiated from some other functional disorders of the digestive tract.

Three criteria have been identified, the presence of which is mandatory when making a diagnosis of FD:

• Constant or intermittent epigastric pain. In total, their duration should be more than 3 months in one year of observation.
• Exclusion of organic pathology of the gastrointestinal tract with similar complaints.
• The severity of clinical manifestations does not depend on the act of defecation, its frequency and other features of bowel movement.

To clarify the diagnosis, a number of examinations are carried out:

• Laboratory - general blood and urine analysis, fecal analysis (including occult blood), blood biochemistry, analysis for Helicobacter pylori.
• Instrumental - FGDS, ultrasound of the abdominal organs, contrast X-ray examination, intragastric pH-metry, scintigraphy and other additional diagnostic methods.

To assess the condition and select an individual examination plan, you need to contact a gastroenterologist.

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Features of the course of the disease in children

Organic pathology of the gastrointestinal tract in children occurs in only 30% of cases. Basically, there are functional disorders of the digestive system. As for the clinical manifestations of FD, the symptom complex characteristic of adults is also observed in children. In addition, the complaints of young patients are characterized by lack of appetite, sleep disturbance, headaches, dizziness, and increased sweating.

Of the etiological factors, psycho-emotional overload, a violation of the diet, an unbalanced intake of nutrients into the body, or the harmful effects of certain drugs come to the fore.

If a child has a suspicion of functional dyspepsia, he must be consulted by three doctors at once - a pediatrician, a pediatric gastroenterologist and a psychotherapist. This will ensure accurate diagnosis, timely adequate therapy and prevent the development of organic pathology in the future.

Treatment

Treatment is selected purely individual, depending on the cause of the disease, clinical manifestations and other characteristics of the patient. Therapeutic effects are aimed at normalizing the general condition and preventing exacerbations of dyspepsia. In general, there are two main approaches to the treatment of FD: drug and non-drug.

Treatment without medication implies a change in diet and diet, psychotherapeutic methods of correction, refusal of coffee, alcohol and smoking, as well as medicinal substances that negatively affect the gastric mucosa. The help of a psychotherapist is especially relevant if a long course of treatment is needed.

Diet

Proper nutrition is a very important factor in recovery. There is a clear relationship between errors in the diet and exacerbation of certain symptoms of dyspepsia.

• Flatulence - it is necessary to exclude from the diet products that cause gas formation.
• Early saturation - it is recommended to increase the frequency of meals up to 6 times a day, eat small portions.
• Heaviness in the stomach - you should avoid eating hard-to-digest foods, fatty foods and overeating.
• Heartburn - involves the rejection of fatty, fried foods, limiting salt and spices.

Of course, it is important to eat a balanced diet, as well as adhere to a healthy lifestyle, observe the established regime of work and rest.

Medical therapy

Taking medications in combination with the above measures gives the maximum effect. The choice of drug therapy depends on many factors. The clinical form of FD, its cause, the duration of the disease, the prevalence of certain complaints, and the patient's personal characteristics are always taken into account.

In the treatment of FD, drugs of the following pharmacological groups are used:

• prokinetics that improve the motor activity of the upper gastrointestinal tract;
• proton pump inhibitors, antacids and other groups of drugs that reduce the acidity of gastric juice;
• antispasmodics;
• antidepressants that improve the patient's neuropsychic state;
• drugs included in the eradication therapy for Helicobacter pylori infection.

The duration of drug therapy, as a rule, does not exceed 2 months.

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Treatment of dyspepsia

Medicines for dyspepsia

• prokinetics;
• antibiotics;

Prokinetics prescribed for dyspepsia

Treatment of Helicobacter pylori infection
Before carrying out treatment aimed at eliminating Helicobacter, this microorganism is initially identified. The gold standard for detecting H. pylori infection is the breath test. It is carried out before and after antibiotic treatment in order to confirm the success of therapy.
In this case, several treatment regimens are used.

Treatment regimens against Helicobacter pylori infection

Scheme

Combination of antibiotics

Three-component scheme, option 1

The use of products that inhibit fermentation processes There are plant crops that suppress fermentation processes. Of these, it is recommended to prepare drinks, which should be consumed 200 milliliters per day, dividing the total volume into several doses. Some plants are recommended for use in desserts, salads, and other culinary uses. Cultures that inhibit fermentation in the intestines are: mint ( can be used for making tea, salads, desserts); cowberry ( used for compote, tea, stuffing in baking); raspberry ( cottage cheese additive, baking stuffing); dogwood ( used for tea, compote, jam). Herbal teas can also be prepared with marigold, chamomile, sage. Reduce fermentation processes such spices as bay leaf, cloves, rosemary. Nutrition for putrefactive dyspepsia Excessive consumption of foods rich in protein against the background of a lack of carbohydrates is one of the main conditions for the development of putrefactive dyspepsia. Protein becomes the cause of putrefactive processes that occur with the formation of toxins. That is why putrefactive dyspepsia is characterized by general weakness, headache and other symptoms of intoxication. To stop rotting in the intestines, patients with this disease should follow a number of rules when compiling a daily diet. The rules of nutrition for putrefactive dyspepsia are as follows: limited intake of protein foods; reduction in fat intake; increase in carbohydrates in the diet; the use of products that suppress putrefaction in the intestines. Limited protein intake With putrefactive dyspepsia, the norm of protein food per day is 50 grams. At the same time, it is recommended to minimize or completely abandon meat for a while. Fish should be consumed in doses, 2-3 times a week, 100-150 grams. Preference should be given to river fish species ( carp, crucian carp, pike, catfish). The daily norm of protein must be replenished with dairy products, since the cultures of bacteria contained in them normalize the composition of the microflora. curdled milk - 2.8; sour cream - from 2.5 to 3; kefir - 3; milk - 3; yogurt - 5; ryazhenka - 5; sweet curd masses - 7; glazed curds - 8; cottage cheese - from 14 to 18. The numbers indicate the amount of protein in 100 grams of the product. Reduced fat intake The amount of fat consumed with food for putrefactive dyspepsia should be reduced to 25-30 grams per day. At the same time, at least 70 percent of the fats consumed should be vegetable ( vegetable oil, nuts). The norm of animal fats should be replenished by using butter, eggs. The products that should replenish the norm of fats for putrefactive dyspepsia are: corn oil - 100; sunflower oil - 100; butter - 82; pine nuts - 62; hazelnuts - 67; walnuts - 62; eggs - 11.5. The numbers indicate the amount of fat in 100 grams of the product. Increasing carbohydrates in the diet With putrefactive dyspepsia, it is recommended to consume from 400 to 450 grams of carbohydrates per day. To do this, the menu should include cereals, crackers from wheat and / or rye bread, dry cookies. Much attention in this disease should be given to vegetables and fruits. In the acute stage, only baked or boiled vegetable crops should be eaten. Subsequently, you need to gradually introduce dishes from raw vegetables and fruits. Vegetarian fasting days are useful for putrefactive dyspepsia. The use of foods that suppress putrefaction in the intestines In putrefactive processes, it is recommended to eat acidophilus. Acidophilus is a dairy product that is produced using an acidophilus bacillus. In stores, acidophilus can be sold as a starter or present in milk, yogurt ( the presence of acidophilus in the product is indicated on the packaging). You can prepare acidophilus on your own using acidophilus starter, which is sold at a pharmacy or grocery store. Prepare an acidophilus drink in several stages. The steps for preparing acidophilus at home are as follows: milk should be brought to a boil and simmered over low heat for 30 minutes; then the milk should be cooled to 40 degrees; acidophilus bacteria must be added to the cooled milk; mix thoroughly and leave for 10 hours, maintaining a temperature of 25 degrees ( better to use a thermos). Some plants also contribute to the inhibition of putrefactive processes. From these cultures, decoctions, teas or compotes should be prepared. You need to drink them daily, 1 - 2 glasses a day. Plants that suppress putrefaction in the intestines are: black currant ; red rowan; pomegranate ( juice); thyme ( can be used as seasoning); Prevention of dyspepsia Prevention of dyspepsia consists in observing a number of rules that ensure the normal functionality of the digestive system. Also, in order to prevent the disease, factors that contribute to the development of this disorder should be limited. Measures to prevent dyspepsia are as follows: adherence to the rules of a healthy diet; control of bad habits; adequate response to stress; control of one's own state. Compliance with the rules of a healthy diet Healthy nutrition is the main requirement for the prevention of dyspepsia of any type. A healthy diet is based on several rules related to the quality, quantity and culture of food consumption. The healthy eating guidelines are as follows: refusal of rigid diets; compliance with the proportions between proteins, fats and carbohydrates; limited consumption of fast food, semi-finished products; sufficient consumption of vegetables and fruits; salt intake in accordance with the recommended norm. Refusal of rigid diets In order to prevent dyspepsia, it is recommended to abandon any diet that involves a strong reduction in calories. The daily calorie intake for an adult in the absence of systematic physical activity is approximately 2200 ( for women) and 2800 ( for men). In the case of hard physical work or regular sports, the daily rate should not be less than 2700 ( for women) and 3200 ( for men) calories. If you need to lose weight, the daily intake can be reduced by 400 - 600 calories. More severe restrictions are stressful for the digestive system and can lead to various diseases. Protein diets are another type of weight loss diets that are common today. The predominance of protein foods against the background of a lack of carbohydrates is one of the main causes of putrefactive dyspepsia. Therefore, such diets should also be abandoned. The only type of diet that should be followed is a diet prescribed by a doctor for medical reasons. Compliance with the proportions between proteins, fats and carbohydrates A healthy diet should consist of one part protein, one part fat and 4 parts carbohydrates. Since these elements can be of different types, it is necessary to take into account the recommendations for the consumption of protein, fat and carbohydrate-containing foods. The rules for the consumption of proteins, fats and carbohydrates are as follows: Squirrels. To replenish the norm of proteins, which varies from 80 to 120 grams, it is necessary to include meat, fish, and dairy products in the diet. In this case, preference should be given to natural, rather than canned products. Fats. The norm of fat is 80 - 120 grams per day. Among fats, 70 percent should be of vegetable origin ( vegetable oil, nuts). The rest must be represented by natural animals ( not modified) fats ( meat, fish and dairy products). Carbohydrates. The norm of carbohydrates varies from 350 to 500 grams per day. From carbohydrates, preference should be given to those that are slowly digested ( cereals, vegetables). The amount of these products should be 65 - 70 percent of the total amount of carbohydrates consumed. The rest should be represented by fast carbohydrates, namely fruits that are rich in glucose. Dietary sugar and foods that contain it should account for no more than 5 percent of your total carbohydrate intake. Limited consumption of fast food, convenience foods A healthy diet implies the rejection or maximum restriction of fast food products, which include fast food ( hamburgers, hot dogs, shawarma) and semi-finished products. Factors that indicate the harmfulness of these products are: Increased calories. Fast food and convenience foods use modified and saturated fats, sauces, fatty meats, wheat flour, and other high-calorie ingredients. All this provides a high calorie content of the finished product. Minimum nutritional value. Mostly fast food and convenience foods consist of fast carbohydrates, therefore, despite the high calorie content, they do not provide a long-lasting feeling of satiety. The value of such food is also low, since it contains a minimum amount of vitamins, fiber and other elements necessary for the body. Binge eating. Fast food and semi-finished products contain a large number of additives to improve consumer properties ( aroma, taste, appearance) product. Under the influence of these components, a person does not distinguish satiety signals, resulting in overeating. preservatives. To increase the shelf life, a large amount of preservatives is added to the components from which fast food is prepared. Many preservatives are also found in semi-finished products. Getting into the body along with the food product, preservatives have a complex negative effect. So, some of them destroy vitamins, others disturb the balance of beneficial intestinal microflora. Sufficient intake of vegetables and fruits Plant products are the main source of such elements necessary for the body as vitamins, minerals, antioxidants, and fiber. Therefore, a healthy diet involves eating at least 400 grams of vegetables and 300 grams of fruits per day. In order to maximize the benefits of vegetables and fruits, a number of rules must be observed when choosing and preparing them. When buying, you should choose local products grown in the open field. Imported vegetables and fruits are treated with preservatives and other harmful substances to increase their shelf life. The best choice is seasonal vegetables and fruits that are grown outdoors. Greenhouse products contain a lot of nitrates. Exotic products should be included in the diet in limited quantities. Before use, the peel of vegetables and fruits should be poured over with boiling water. Products that do not require heat treatment should preferably be consumed raw. Potatoes and other crops that require cooking should be baked or boiled. During frying, many valuable elements are destroyed, and the benefits of vegetables become minimal. Salt intake according to the recommended amount The recommended amount of table salt per day is 6 grams ( a teaspoon without a slide). According to studies, the average person exceeds the recommended amount of salt by 50 percent. Excess salt in the body leads to numerous health problems. For example, this product irritates the stomach lining and can cause indigestion, gastritis, and ulcers. Therefore, given that the daily menu includes many ready-made food products that already contain salt, adding salt to food should be minimal. Bad habit control Bad habits negatively affect both the digestive system and human health in general. Smoking, which is one of the most common bad habits, provokes vasospasm. As a result, the organs of the digestive system are worse supplied with blood, they begin to secrete insufficient enzymes, as a result of which their functionality decreases. Nicotine, getting into the blood, has a negative effect on the nervous system and specifically on the area that controls the processes of saturation. Therefore, many smokers with experience have problems with appetite. Bad habits, along with smoking, include other human habits that must be abandoned in order to ensure the health of the digestive system. Bad habits that impair the digestive process include: frequent use of alcohol; binge eating; snacks on the go dry food; abuse of caffeine; plentiful food at night; lack of proper breakfasts. Appropriate response to stress During stress, hormones are synthesized in the body, which negatively affect the functioning of the digestive organs. Also, when stressed, a person, eating food, swallows a lot of air, which provokes gas formation and can lead to dyspepsia. Therefore, the prevention of this disease requires the development of resistance to stressful circumstances. Measures that help to adequately respond to stress are: case planning; work with negative emotions; doing what you love; soothing techniques; physical activity; complete rest. Case Planning Planning work and household affairs allows you to minimize unforeseen situations that are a frequent source of stress. Often a person experiences negative emotions from the need to keep a large number of tasks in memory. The problem of choosing the highest priority case at the moment is also among the frequent causes of stress. If you first fix the things that need to be done on paper ( or other media), there is no need to remember all the tasks and choose the most important ones. Also, planning allows you to foresee many problems ( e.g. being late) that cause stress. In order for planning to be effective, it is necessary to adhere to a number of rules. The planning rules are as follows: when planning things, it is necessary to determine the priority of each task; time should be allocated for the implementation of each task, taking into account the fact that unforeseen circumstances may arise; if possible, the most important cases should be scheduled for the first half of the day; Among tasks, you should always leave time for rest. Plans can be made for the next day, week. It is also recommended to plan individual events - a trip, shopping, repairs. Dealing with negative emotions Negative emotions that have been suppressed sooner or later manifest themselves in the form of stress. Therefore, experts recommend working with feelings of discontent, anger, or other negative emotions. So, if a negative situation occurs, after a while ( not right away) should be analyzed. This will make it possible to objectively assess the factors that provoked it, and to foresee the development of a similar situation in the future. A person should not be silent in cases where relatives, friends or colleagues neglect his interests or infringe on rights. Talking about your own negative emotions due to the incorrect behavior of others should be done without getting personal, in compliance with all the rules of politeness. In some cases, especially in intra-family conflicts, it is advisable to contact a psychologist or psychotherapist. Doing what you love According to scientific research, people who have hobbies endure the consequences of stressful circumstances much easier. Doing what you love allows you to escape from experiences and brings positive emotions. In addition, doing dancing, embroidery or other hobbies and achieving certain results, a person experiences joy, which allows him to more effectively cope with stress. Calming Techniques Meditation, breathing exercises and other calming techniques have a positive effect on the nervous system. Useful for relaxation and classical music, listening to which can be combined with soothing baths. Since physical and mental processes are interconnected in the human body, it is also recommended to practice yoga or do exercises to eliminate muscle tension to relax the nervous system. Physical activity Physical activity normalizes the level of hormones that provoke and increase the negative effects of stress. According to the recommendations of experts, if a person experiences negative emotions, he needs to take a quick walk in the fresh air, run or swim. Daily exercises in the morning, systematic sports, dancing or other active activities are also useful. Complete rest In order for the body to fully recover from the stresses experienced, it needs to provide high-quality timely rest. Night sleep should last at least 7 - 8 hours. At the same time, it should begin no later than 23.00 hours, since it is during this period that sleep is most useful. It is also necessary to arrange breaks during the day to rest from work or household chores. Before use, you should consult with a specialist.

Functional dyspepsia is a pathological syndrome that includes symptoms of digestive disorders that begin to progress in the absence of organic pathologies of the gastrointestinal tract. Medical statistics today are such that 70% of patients who turn to a gastroenterologist with indigestion are diagnosed with "functional dyspepsia". It is worth noting that in the fair sex, such a violation occurs one and a half times more often than in men. According to ICD-10, the disease has its own code - K30.

Usually, the pathological condition manifests itself in people between the ages of twenty and forty-five years. This disease is rare in older people. The main symptoms indicating that a person is progressing with functional dyspepsia syndrome include pain in the epigastric region, heartburn, a feeling of heaviness in the abdomen, nausea, belching and bloating. If these signs appear, it is important to contact a qualified gastroenterologist as soon as possible so that he can conduct a comprehensive diagnosis, confirm or refute the preliminary diagnosis, and prescribe the most effective treatment tactics.

Diagnosis is based on the use of both laboratory and instrumental techniques. The patient undergoes EFGDS, ultrasound examination of organs, radiography of the stomach (using a contrast agent), electrogastrography, blood biochemistry, stomach scintigraphy, and so on. Treatment of functional dyspepsia can be carried out both in stationary and at home. Usually, specialists resort to conservative therapy, which includes taking medications, as well as diet therapy. In some cases, therapy can be supplemented with traditional medicine, but only after obtaining permission from the attending physician.

Reasons for development

Experts suggest that the development of functional dyspepsia is based on severe stress, psycho-emotional trauma. In addition, the predisposition of the walls of the stomach to overstretching can lead to the manifestation of unpleasant symptoms. There is a theory that functional dyspepsia may occur due to impaired motility of the digestive system.

Other etiological factors include:

• increased secretion of hydrochloric acid in the stomach;
• violation of the mode of consumption of food products;
• unbalanced diet;
• functional dyspepsia in people of any age can develop with the use (especially without prescription) of drugs that aggressively affect the gastric mucosa;
• violation of the process of digestion of disaccharides;
• inadequate production of required digestive enzymes.

Separately, it is worth highlighting the reasons due to which functional dyspepsia manifests itself in children. In young children, this pathological condition manifests itself due to a discrepancy between the still not fully functioning digestive system and the amount of food that they are given.

Symptoms of functional dyspepsia in children under one year old are manifested due to overeating or at the wrong time introduced complementary foods (age discrepancy). In adolescents during puberty, hormonal imbalance becomes the cause of the disease. Because of it, the digestive system becomes hypersensitive and reacts sharply to any errors in nutrition. As a result, the teenager shows symptoms of functional dyspepsia syndrome.

Varieties

Depending on the symptoms manifested, clinicians distinguish three options for the course of dyspepsia:

• ulcerative. The main symptom indicating this form of the disease is acute pain, which manifests itself over a long period of time. The place of localization is the epigastric region. The most intense pain is expressed if the person is hungry, as well as at night. This form of the disease rarely manifests itself in young children;
• dyskinetic variant or non-ulcer functional dyspepsia. In this case, several symptoms appear at once - bloating, a person is satiated early (even if he ate little), a feeling that the stomach is full, nausea. The non-ulcer form of pathology is diagnosed in patients most often;
• nonspecific. In this case, it is difficult to make a diagnosis, since this form is accompanied by symptoms characteristic of many diseases of the digestive system. Most often, there is a combination of signs of dyskinetic and ulcer-like variant of the disease.

Symptoms

Each form of functional dyspepsia is characterized by its own signs, which further help the gastroenterologist to make the correct diagnosis. But there are also symptoms that are characteristic of all variants of the pathology:

• lack of mood;
• aerophagia;
• malaise and weakness;
• burning sensation in the stomach;
• increased formation of gases in the intestines;
• rumbling in the stomach;
• diarrhea;
• in young children there is diarrhea, frequent regurgitation, pain in the abdomen, lack of desire to eat, sleep is disturbed.

If these symptoms appear, it is recommended to immediately contact a gastroenterologist for a comprehensive diagnosis. This is necessary in order to accurately diagnose, since the signs of dyspepsia are very similar to the signs of many pathologies of the digestive system.

Diagnostics

The main task of diagnosis is to exclude organic pathologies of the stomach and the entire digestive tract, which occur with the same symptoms as functional dyspepsia. For this purpose, the following examinations are prescribed:

• stool analysis;
• ultrasound diagnostics of organs localized in the abdominal cavity;
• EFGDS;
• general clinical blood and urine analysis;
• blood biochemistry;
• blood test to detect occult blood;
• radiography of the stomach with the use of a contrast agent;
• electrogastrography;
• stomach scintigraphy;
• manometry;
• measuring the pH level in the esophagus and stomach (daily).

Therapeutic measures

If the patient was diagnosed with "functional dyspepsia", then first of all he needs to normalize the diet, as well as follow the diet compiled by the nutritionist. Alcoholic beverages, spices, chemicals are completely excluded from the diet. additives, foodstuffs with chemical dyes. It also strongly recommends reducing your intake of saturated fatty acids and fried foods. At the time of exacerbation, it is also shown to exclude:

• grape;
• sour fruits;
• chocolate;
• cherry;
• soda;
• citrus.

All of these foods can increase the manifestation of unpleasant symptoms, such as stomach pain, heartburn, belching, flatulence, and others.

Therapy with drugs is signed based on what type of functional dyspepsia was diagnosed in the patient. In the ulcer-like form, antisecretory drugs and antacids are primarily prescribed. With a dyskinetic variant of dyspepsia, the treatment plan includes agents that restore the peristalsis of the digestive tract, as well as pharmaceuticals to eliminate unpleasant symptoms of the pathology. If a non-specific variant is detected, prokinetics, antacids, and antisecretory agents are prescribed simultaneously.

If the bacterium Helicobacter pylori was detected during the examination in the patient's stomach, then in this case a special scheme is signed for its destruction. Several drugs are prescribed at the same time, the main one is an antibiotic.

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Fermentative dyspepsia is a pathological condition accompanied by the main symptoms of digestive disorders, such as rumbling in the abdomen, nausea, flatulence, heartburn, and so on. The main cause of this type of dyspepsia in adults and children is the inadequate digestion of carbohydrates entering the stomach. In the fair sex, the disease occurs several times more often than in men. It is also possible the development of fermentative dyspepsia in young children (even infancy).

Putrefactive dyspepsia is a pathological condition characterized by a violation of the process of protein digestion in the intestine. It progresses due to their excessive intake into the gastrointestinal tract along with food, as well as due to disturbances in the functioning of the digestive tract. Putrefactive processes in children and adults are usually localized in the large intestine, but can also occur in the small intestine. This disease has no restrictions regarding gender and age category. It develops somewhat more often in children and the elderly. Putrefactive dyspepsia is not a fatal disease, but it can cause the formation of irreversible processes in the body, which in the future will lead to disastrous consequences.

Dyspepsia is a pathological condition that is characterized by a violation of the digestive process, due to etiological factors of a functional and organic nature. This disease is often diagnosed in patients from different age categories. Organic gastric dyspepsia progresses due to the presence in the human body of pathologies of the digestive system, such as gastritis, peptic ulcer, tumor-like neoplasms, inflammatory processes in the esophageal tube, stomach, pancreas. The fact that the patient progresses functional or simple dyspepsia is said if all the symptoms of the disease are present, but there is no organic pathology that could provoke them.

Esophageal diverticula are a pathological process characterized by deformation of the esophageal wall and protrusion of all its layers in the form of a sac towards the mediastinum. In the medical literature, the esophageal diverticulum also has another name - esophageal diverticulum. In gastroenterology, it is precisely this localization of the saccular protrusion that accounts for about forty percent of cases. Most often, pathology is diagnosed in males who have crossed the fifty-year milestone. But it is also worth noting that usually such individuals have one or more predisposing factors - gastric ulcer, cholecystitis and others. ICD code 10 - acquired type K22.5, esophageal diverticulum - Q39.6.

Functional dyspepsia (synonyms: epigastric distress syndrome, pseudo-ulcerative syndrome, essential, non-ulcerative, idiopathic dyspepsia) is a fairly common condition, which is a complex of symptoms of functional digestive disorders in the absence of any stomach disease or other organic pathology of the gastrointestinal tract.

Causes

The main provoking factors are neuropsychic stress and psychoemotional trauma, as well as the predisposition of the walls of the stomach to overstretch while maintaining the normal motor function of the organ. Variants with impaired motor skills are possible.

Other reasons include:

• excessive release of hydrochloric acid;
• violation of the process of digestion of disaccharides;
• insufficient secretion of digestive enzymes, leading to malabsorption of nutrients;
• unbalanced diet, coupled with constant errors in nutrition;
• violation of the diet;
• taking certain medications that aggressively affect the gastric mucosa.

Functional dyspepsia in children begins as a result of a discrepancy between the still insufficiently perfect digestive system of the child (the possibilities of splitting and absorption) and the composition or amount of food given to him.

Dyspepsia in children under one year old occurs after late feeding or overfeeding. In adolescents in puberty, due to hormonal imbalance, the digestive system becomes very susceptible to various alimentary errors, which inevitably leads to dyspeptic disorders.

Classification

Regarding this or that symptomatology, functional dyspepsia is divided into three options:

1. Ulcerative.
2. Dyskinetic.
3. Non-specific.

Clinical manifestations

The main manifestation of the ulcer-like variant of dyspepsia is the presence of pain in the epigastric region. The dyskinetic type is characterized by a feeling of fullness in the stomach and nausea, even after taking a small amount of food. The syndrome of functional dyspepsia of a nonspecific type is clinically manifested by symptoms related to both the first and second options.

Symptoms of functional dyspepsia, characteristic of all variants:

• aerophagia;
• heartburn and burning in the sternum or stomach;
• increased gas formation in the intestines, bloating, rumbling in the abdomen;
• stool disorder, usually diarrhea;
• unpleasant odor and taste in the mouth;
• Bad mood;
• malaise, weakness;
• in babies - diarrhea, regurgitation, abdominal pain, loss of appetite and sleep disturbance.

Diagnostics

The algorithm of actions in differential diagnosis consists in the appointment of examination methods aimed at excluding diseases with similar symptoms. For this purpose, a number of methods are provided to help identify peptic ulcer, reflux esophagitis, pancreatitis, malignant lesions of the stomach, and so on.

Mandatory diagnostic measures:

• Laboratory diagnostics:

a) study of blood tests (clinical and biochemical);

b) coprogram;

c) analysis of feces for the detection of occult blood.

• Non-invasive methods:

a) esophagogastroduodenoscopy;

b) X-ray diagnostics;

c) ultrasound examination;

d) stomach scintigraphy;

e) esophagomanometry and/or antroduodenal manometry;

f) electrogastrography;

g) daily monitoring of the level of acidity of gastric juice.

The removal of manifestations of functional non-ulcer dyspepsia is facilitated by the normalization of the diet and the observance of a balanced diet that excludes food dyes, chemical additives, alcohol, and spices from the diet. It is also necessary to significantly reduce saturated fatty acids: the consumption of fatty and fried foods is not recommended. During the period of severe symptoms, it is desirable to drastically reduce or not consume acidic fruits, citrus fruits, grapes, cherries, chocolate, carbonated drinks, as they can cause flatulence, heartburn, belching and stomach pain.

Drug treatment of functional dyspepsia of the ulcer-like variant consists of taking antisecretory drugs - peripheral M-cholinolytics (platifillin, metacin), proton pump inhibitors (omeprazole), histamine H2 receptor antagonists (cimetidine, famocidin). Antacids are also prescribed (Almagel, Maalox, Rennie).

If the examination revealed infection with the Helicobacter pylori bacterium, then it is eradicated according to specially designed schemes, including the simultaneous administration of several drugs, the leading of which is an antibiotic.

The main drugs for the dyskenetic type are prokinetics - drugs that normalize the motility (peristalsis) of the walls of the digestive tract. These include domperidone, cisapride, metoclopramide, itopride. Other drugs are prescribed depending on the complaints.

Treatment of the non-specific variant includes the appointment of both prokinetics and antisecretory agents with antacids. It depends on the predominance of certain complaints related to either dyskinetic or ulcer-like variant of the epigastric syndrome.