Functional dyspepsia is an ulcer-like variant. Dyspepsia

Non-ulcer dyspepsia, also called “functional”, is a characteristic symptom complex that covers various manifestations of discomfort in the digestive system in the absence of signs of any organic pathology.

Functional dyspeptic disorders occur in a third of the population at least once a year. However, it is worth talking about “non-ulcer dyspepsia” only in cases where unpleasant sensations in the epigastric region are observed regularly for three months or more. Episodic pain, heaviness, and bloating are most often caused by diet errors and represent a one-time natural reaction of the digestive system to difficult-to-digest food. With functional dyspepsia, these phenomena may not be associated with diet and the range of foods eaten. Even with the most gentle diet and split meals, people with chronic functional dyspepsia experience the following unpleasant phenomena:

• various pain sensations in the stomach and intestines (aching, shooting, pulling);
• early satiety, feeling of fullness in the stomach;
• bloating;
• nausea and vomiting;
• heartburn, regurgitation, burning in the esophagus.

In chronic non-ulcer dyspepsia, it is often difficult to associate the occurrence of symptoms with food intake. Discomfort can develop for no apparent reason between meals, outside of physical activity, stress and other possible stress factors.

2. Classification of functional dyspepsia

In addition to the nonspecific type, there are three most characteristic types of non-ulcer dyspepsia:

• Reflux-like dyspepsia (the development of symptoms is closely related to meals, after which heartburn, acid belching, and epigastric pain occur; exacerbation can also be caused by stress, physical exertion, and bending the body).
• Ulcerative-type dyspepsia (discomfort and pain appear on an empty stomach; sometimes a person wakes up even at night and is forced to take food or antacids, after which the unpleasant symptoms subside).
• Motor type dyspepsia – dyskinetic (heaviness, belching, flatulence, nausea and vomiting, a feeling of “lightheadedness” in combination with neurotic manifestations – headache, weakness, sleep disturbance, cardialgia, psycho-emotional lability).

3. Causes and diagnosis of functional dyspepsia

It is worth immediately noting that in 10% of cases, hidden depression is masked under non-ulcer dyspepsia. Recently, this pathology has been detected more and more often and is manifested by disturbances in the functioning of various systems (digestive, cardiovascular, respiratory). Diagnosis and treatment of such patients often require the participation of a psychologist and neurologist.

In other cases, the causes may be secretory disorders, delays in gastroduodenal motility, changes in the mechanisms of visceral sensitivity and the response of the walls of the stomach and intestines to receptor irritation, and decreased accommodation of the digestive organs. Thus, it can be argued that the diagnosis of “non-ulcer dyspepsia” is not morphological, but rather clinical. During the diagnostic process, after a patient complains of pain in the epigastric region, stomach and intestines, all possible organically caused diseases are excluded, and only then is the fact of functional pathology established. The clinical picture of non-ulcer dyspepsia is similar to the symptom complex inherent in the following diseases:

• stomach and duodenal ulcers;
• pathology of the biliary tract;
• chronic pancreatitis;
• malignant neoplasms and vascular malformations in the digestive organs;
• liver diseases;
• hyper- and hypothyroidism.

If the symptoms are directional - only one type of disorder is regularly observed - then they talk about a narrower pathology (functional heartburn, functional flatulence, functional stomach pain, etc.). The main diagnostic methods that allow us to exclude the organic genesis of the pathology and establish the fact of functional dyspepsia are:

• gastroduodenoscopy;
• stool analysis;
• blood chemistry;
• examination of gastric secretions for the presence of infections.

4. Treatment of functional dyspepsia

Non-ulcer dyspepsia as a cause of chronic functional disorders can provoke the development of true organic pathology, and therefore is subject to mandatory treatment. First of all, the factors that provoke attacks of gastrointestinal dyspeptic phenomena are identified. It is necessary to make adjustments to your lifestyle, work and rest schedule, possibly reduce physical activity, and eliminate stress factors. It is also necessary to develop a gentle diet and a balanced meal schedule that excludes both overeating and starvation. Quitting smoking, alcohol, and strong coffee can significantly reduce the frequency and severity of attacks.

In some cases, patients cannot do without drug therapy, which may include:

• drugs providing symptomatic relief;
• sedatives and psychotherapeutic agents;
• proton pump inhibitors;
• prokinetics;
• antispasmodics.

Description:

Synonyms of non-ulcer dyspepsia: gastric dyskinesia, irritable stomach, essential, neurotic, stomach, functional syndrome of the upper abdomen, functional dyspepsia.

Functional (non-ulcer) dyspepsia is considered chronic if more than 3 months pass from the onset of its occurrence.

Symptoms:

Non-ulcer dyspepsia can have several manifestations. These are: ulcer-like, reflux-like, dyskinetic, nonspecific.

Regardless of the prevailing variant of non-ulcer dyspepsia, the presence of a “vegetative syndrome” of varying severity is characteristic. Vegetative syndrome can manifest itself as fatigue, sleep disturbances, decreased performance, periodic feelings of heat, sweating, and “irritation” of the bladder (frequent urination in small portions).

The absence of vegetative syndrome rather indicates the presence of organic pathology.

Ulcer-like non-ulcer dyspepsia is characterized by intense pain or a feeling of pressure in the epigastric region or on the right at the level of the navel, occurring spontaneously or one to two hours after eating. Sometimes it can be "night" or "fasting" pain, which decreases or disappears during or after eating. The secretory function of the stomach is usually increased.

For the reflux-like variant of non-ulcer dyspepsia, the following symptoms are most typical: especially when bending forward and in a horizontal position, after eating; chest pain with short-term relief after drinking soda; , dull pain and a feeling of heaviness in the epigastric region. Gastric secretion is usually increased. There is a connection between the appearance of these symptoms or their severity and the intake of spicy and sour foods (marinades, mustard, pepper), and alcoholic beverages. This option often occurs cyclically: periods of exacerbations of different durations are replaced by the spontaneous disappearance of all symptoms.

The dyskinetic variant of non-ulcer dyspepsia is associated mainly with motor disorders of the stomach and intestines and resembles the picture of chronic gastritis. This is manifested by a feeling of heaviness and fullness in the epigastric region, rapid satiety during meals, intolerance to various types of food, pain spread with varying intensity throughout the abdomen, and nausea.

Sometimes, in a small number of patients with non-ulcer dyspepsia, the main complaint is frequent painful belching of air (aerophagia). Its distinctive features are that it is loud, occurs regardless of food intake, more often with nervous excitement. This belching does not bring relief; it intensifies when eating, especially quickly. can be combined with cardialgia and heart rhythm disturbances in the form of a feeling of heaviness in the epigastric region.

In half of the patients, non-ulcer dyspepsia can transform into an organic pathology: peptic ulcer.

Causes:

The term “non-ulcer dyspepsia” refers to digestive disorders associated with diseases of the esophagus, stomach and intestines, of non-ulcer, often of functional origin.

Treatment:

For treatment the following is prescribed:

Treatment of non-ulcer dyspepsia is based on the characteristics of the variant of manifestation and is essentially symptomatic.

To reduce the secretory function of the stomach or neutralize it in case of “acidism syndrome” - i.e. heartburn, sour belching, pain in the epigastric region, relieved after taking alkalis, occurring against the background of increased gastric secretion, the use of pirenzepine is also indicated. The prescription of the drug is due to the peculiarities of its pharmacodynamics, in particular, relatively low bioavailability, insignificant penetration through the blood-brain barrier, the absence of pronounced interindividual fluctuations in absorption, distribution and elimination of the drug, and low level of metabolism in the liver.

Pirenzepine slows down the evacuation of contents from the stomach, however, unlike other atropine-like drugs, it does not affect the tone of the lower esophageal sphincter, which thus eliminates the risk of occurrence or intensification of gastroesophageal reflux.
The duration of treatment for non-ulcer dyspepsia is short - from 10 days to 3-4 weeks.

What is dyspepsia?

Dyspepsia is a disease characterized by indigestion.

Causes of dyspepsia

Among the main factors causing dyspepsia is a lack of special digestive enzymes, which causes malabsorption syndrome. Dyspepsia is often caused by significant dietary errors. In this case we are talking about nutritional dyspepsia.

Symptoms of this disease can be caused by both a lack of nutritional regimen and an unbalanced diet.

Thus, dysfunction of the gastrointestinal tract without organic damage to organs leads to the occurrence of so-called functional, or nutritional, dyspepsia. In this case, an insufficient amount of digestive enzymes is a consequence of damage to organs related to the gastrointestinal tract. In this case, dyspepsia acts only as a symptom of another disease.

As for children, dyspepsia occurs when the quantity or composition of food does not correspond to the capabilities of the children's gastrointestinal tract. Dyspepsia in infants less than one year old occurs due to overfeeding, as well as untimely introduction of new foods into the child’s diet.

There is also the concept of physiological dyspepsia, which occurs in children at birth and in the first weeks of life. This manifestation of the disease cannot be treated, as it goes away after the gastrointestinal tract matures.

Older children may experience dyspepsia during a period when the body is growing rapidly. Thus, in adolescence, dyspepsia can also occur due to hormonal imbalance. This time is called the critical period of development. In this state, the gastrointestinal tract becomes too susceptible to any, even the slightest, errors in nutrition.

Unfortunately, teenagers often develop dyspepsia because they eat fast food, drink carbonated sweet drinks, and also foods that contain easily digestible carbohydrates.

Symptoms of dyspepsia

Symptoms of dyspepsia can manifest themselves in different ways, depending on the specific type of disorder, but there are signs that are simultaneously characteristic of all types of the disease.

Different types of dyspepsia have the following common symptoms:

the appearance of unpleasant sensations in the so-called epigastric region, that is, in the upper abdomen. The patient experiences feelings of fullness and heaviness, sometimes pain of varying intensity occurs;

belching. Rare isolated cases of belching are not signs of the disease. Dyspepsia is indicated only by constant frequent belching;

Dyspepsia refers to a complex of symptoms related to diseases of the upper gastrointestinal tract: pain, discomfort in the abdominal area, heaviness after eating, increased gas formation, nausea, vomiting. Dyspepsia can be paroxysmal, occur sporadically, the symptoms of the disease can torment the patient constantly, intensifying after eating. In 40% of cases, the causes of dyspepsia are organic; the pathology accompanies ulcerative lesions of the stomach and duodenum, reflux esophagitis, and stomach cancer. In half of the cases, the causes of dyspepsia remain unknown; this type of disease is called “non-ulcer dyspepsia.” In medicine, unfortunately, at present there are no reliable methods that make it possible to confidently make a diagnosis, distinguishing organic dyspepsia from the second form of the disease - non-ulcer.

Causes of non-ulcer dyspepsia

There are several hypotheses that describe the causes of non-ulcer dyspepsia. According to the first assumption (acid hypothesis), the symptoms of the disease are directly related to increased secretion of gastric juice or increased sensitivity of the stomach walls to hydrochloric acid. According to the dyskinetic hypothesis, the cause of the disease is impaired motility of the upper gastrointestinal tract. The psychiatric hypothesis explains the occurrence of symptoms of the disease by the patient’s anxiety-depressive disorder. Another hypothesis - enhanced visceral perception - suggests that the development of non-ulcer dyspepsia occurs due to an increased reaction of the gastrointestinal tract to the action of physical factors: pressure on the walls of organs, stretching of the walls, changes in temperature. According to a hypothesis called the food intolerance hypothesis, dyspepsia occurs due to certain types of foods that cause a secretory, motor or allergic reaction.

Regarding the treatment of non-ulcer dyspepsia, today there is no clear opinion; the data are extensive and contradictory. Antisecretory agents, prokinetics and drugs that affect H. Pylory have been studied in most detail. However, there are general provisions that are recommended to be followed when treating non-ulcer dyspepsia.

In the treatment of the disease, it is recommended to use drugs that reduce the level of acidity of gastric juice. According to researchers, the effectiveness of drugs in this series is considered moderate. According to experts, treatment of non-ulcer dyspepsia with prokinetics turned out to be much more effective.

Much controversy in medicine is associated with the question of the advisability of using drugs that suppress the activity of H. Pylory in the complex treatment of the pathological process. Most experts agree that eradication of H. Pylory is quite justified, even if it does not have the desired effect for dyspepsia resulting from peptic ulcer disease.

Among psychotropic drugs in the treatment of non-ulcer dyspepsia, antidepressants, anxiolytics, drugs that block serotonin receptors and serotonin reuptake are used.

Small doses of antidepressants, k-opioid receptor agonists, serotonin receptor blockers, and drugs from the group of somatostatin analogues are used as medications to reduce pain sensitivity. In modern treatment regimens for the disease, much attention is paid to visceral nociception, since, according to recent studies, visceral sensitivity increases in non-ulcer dyspepsia.

Every person at least several times in his life has experienced discomfort in the abdomen after a festive meal, during study sessions or during prolonged emotional stress. Usually these are a variety of symptoms that indicate the presence of dyspeptic disorders; they can occur for no apparent reason, disappear and return on their own. Dyspepsia requires qualified treatment and is the first sign of diseases of the digestive tract.

The term comes from the ancient Greek language and means “digestion” with a prefix indicating an unfavorable effect - “dis”. Sometimes in everyday life it is pronounced incorrectly – “dyspeptic symptoms”. This is not true, the word dyspepsia does not exist.

Dyspepsia concept

The first thing you need to figure out is what it is, the term is a little confusing. Dyspepsia is a nonspecific complex syndrome consisting of a number of symptoms, the severity of which depends on the degree of damage to the digestive tract, most often vague pain and discomfort in the stomach. In practice, this means indigestion of various etiologies with similar symptoms. There is functional dyspepsia (non-ulcer) and organic.

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A syndrome is a complex of symptoms of a disease that have a common cause. A set of symptoms with a common nature.

A feature of functional dyspepsia is that a thorough examination does not diagnose any lesions of the gastrointestinal tract; the cause often remains unclear. It has been proven that psychosocial factors, genetic predisposition, weakened motor skills, and problems with the neuromuscular system play an important role in this. In half of the cases it is accompanied by chronic gastritis.

If the study reveals obvious disorders in the gastrointestinal tract, such as stomach ulcers, gastritis, inflammation of the pancreas, gallbladder disease, electrolyte changes, gastroesophageal reflux disease, then organic dyspepsia is diagnosed, otherwise functional dyspepsia is diagnosed, this is the main difference.

A striking example of organic dyspepsia is a disorder of the biliary system (cholecystitis, cholelithiasis). If bile loses its activity or is supplied in insufficient quantities, serious disruptions in digestion occur, since it is responsible for the effective digestion of fats, proteins and carbohydrates. Spasms, pain, bloating and other characteristic symptoms appear.

In chronic gastritis, in most cases, most of the signs of dyspepsia are observed.

Diagnostics

An important step in diagnosing dyspepsia is diagnosis by a gastroenterologist. Key points: medical history (according to the patient), examination results and laboratory tests. The primary goal is to identify or exclude organic character. I use various methods:

• Gastroduodenoscopy.
• Ultrasound of the abdominal organs.
• X-ray of the stomach.
• Stool analysis.
• Detection of H. Pylori.
• Monitoring the level of acidity and motor functions of the stomach and intestines.

According to ICD-10, the disease code corresponds to “K30 - Functional dyspepsia”.

Varieties

There are several types of dyspepsia divided by type:

1. Fat. This type of dyspepsia occurs when enzymes do not have time to cope with large amounts of fat. It can occur due to their insufficient lipolytic activity or excessive consumption of fatty foods. Specific symptoms include frequent loose stools, diarrhea and bloating.
2. Fermentation. Appears after eating food containing a lot of carbohydrates and gas-forming products (peas, beans, cabbage, honey). Abdominal pain is cramping or absent. Accompanied by the release of gases and profuse diarrhea. Easily treatable with dietary adjustments.
3. Putrid. It develops when the body is unable to break down difficult-to-digest protein foods, usually meat products. The symptoms are aggravated by the reduced secretory function of the stomach, in which there is insufficient production of pepsin, which breaks down the peptide bonds of proteins to form simpler compounds. Putrefactive dyspepsia is more difficult to tolerate than fatty or fermentative dyspepsia. Accompanied by frequent diarrhea, often with pieces of poorly digested food and a pungent odor. Transition to a chronic form is possible.
4. Toxic. It can occur with general poisoning of the body, with extensive surgical interventions, or serious viral diseases. It is strongly manifested in infectious diseases such as salmonellosis and dysentery, but then they rarely talk about dyspepsia; therapy is aimed at harmful microorganisms.

There is a mixed type, as well as a chronic form.

Risks and causes of the disease

If with the organic type the cause is clear, then with functional dyspepsia it is worth considering a number of factors that can cause the development of pathology:

• Poor nutrition, overeating.
• It may occur in people with weak gastric motility, when its contents do not enter the duodenum in time for subsequent digestion.
• Increased sensitivity of the stomach walls to stretching due to impaired receptor perception.
• Taking certain medications: non-steroidal anti-inflammatory drugs, antibiotics, iron.
• Bad habits, bad environment.
• Hazardous production factors encountered at work: constant vibrations and loud sounds, chemical fumes and more.
• With emotional instability and stress factors, dyspepsia of neurotic origin may occur.

Symptoms

The large number of different symptoms of dyspepsia causes confusion. Abdominal pain has been described as both a burning sensation and cramping, and the burning sensation has been confused with heartburn. Some symptoms may be more severe than others. What complicates the situation is that, according to research by doctors, less than 1% of those who apply complain of only one of the symptoms. To varying degrees, the following are observed:

• Epigastric pain.
• Spasms.
• Flatulence, bloating.
• Abnormal stool, diarrhea, constipation.
• Heartburn.
• Burning in the epigastrium.
• Rumbling in the stomach.
• Nausea, vomiting.
• Belching.
• Salivation.
• Feeling of early satiety.
• Feeling full after eating.

Treatment

Treatment of any dyspepsia must necessarily have an integrated approach, consisting of drug therapy, normalization of nutrition and lifestyle, cessation of tobacco and alcohol, healthy sleep, and elimination of psycho-emotional stress. The organic species, in addition to symptomatic therapy, requires treatment directly aimed at the identified disease.

The main goal is to improve the quality of life, eliminate pain symptoms and other dyspeptic disorders.

Functional gastric dyspepsia is very often accompanied by a chronic inflammatory process of the mucous membrane. Today, doctors are arguing whether this diagnosis is a replacement for a similar one - chronic gastritis. After all, gastritis is something specific, and dyspepsia with unknown causes is much more “inconvenient” for treatment.

Nutrition

For dyspeptic symptoms, split meals are recommended, in small portions 5–6 times a day. Limiting foods that can irritate the mucous membrane: spicy, fatty, salty, smoked, cold, hot. Avoid preservatives, dyes and carcinogens whenever possible.

The diet includes porridge, stewed vegetables, broths, dietary meat and fish, weak tea, and low-fat dairy products. It is preferable to steam all dishes. Adequate fluid and electrolyte intake is essential.

Patients show a clear connection between unpleasant symptoms and nutrition.

The diet is selected depending on the expected type of disease. After all the tests and studies, the doctor, in addition to the general diet, may recommend limiting certain foods. So, with fatty dyspepsia, it is necessary to exclude fatty foods, including those with hidden fats. During fermentation, the amount of carbohydrates consumed is reduced, and it is recommended, on the contrary, to increase protein in the diet. With the putrefactive type, the tactics will be the opposite, with a decrease in protein levels, replacing meat products with cereals.

Walking in the afternoon and before bed will be useful.

Medicines

Medicines for functional dyspepsia are prescribed depending on the severity of the accompanying symptoms; there is no standard treatment for this pathology.

• If a violation of enzyme activity is detected, replacement therapy is prescribed: Creon, Mezim, Festal, Pancreatin.
• Stimulate bile flow: Chofitol, Karsil, Allohol. They have choleretic and hepatoprotective effects.
• For spasms, antispasmodics are prescribed: Duspatalin (Mebeverine), No-shpa, Papaverine.
• In case of insufficient motor function of the stomach and intestines - means that normalize gastrointestinal motility, prokinetics: Motilium, Ganaton (Itopride).
• For increased acidity, proton pump inhibitors or antacids: Nolpaza, Omeprazole, Gastal and others. For ulcer-like dyspepsia, their prescription is mandatory.
• In the case of fermentative dyspepsia, carminatives are used: Espumisan, Meteospasmil. Prevents the formation of gas bubbles.
• In case of severe diarrhea, means are prescribed to rehydrate the body: mineral waters, Regidron, Gidrovit. Aimed at diarrhea itself: Imodium, Loperamide, Enterol.
• Means that normalize the microflora of the small and large intestines: Linex, Hilak, Acipol. Helps overcome pathogenic flora.
• Antidepressants and sedatives for neurotic dyspepsia.
• A course of antibiotics if H. pylori is detected.
• Vitamin preparations are recommended for general strengthening of the body.

It is rare that a single medication is prescribed for treatment; more often, it is a whole series of medications to eliminate possible causes. For example, an adult may be given a prescription:

1. Nolpaza 40 mg once a day for a month. If heartburn or burning is present, to heal possible erosive damage to the esophagus due to GERD.
2. Ganaton, three tablets per day before meals, for a course of 2 months. Starts the normal passage of food through the gastrointestinal tract. Tablets of this group are almost always included in the treatment course.
3. Meteospasmil 2-3 (as needed) capsules before meals. Eliminates bloating, eliminates increased gas formation and relieves smooth muscle spasms.
4. Hofitol up to 9–10 tablets per day, divided into several doses. Stimulates bile production, relieves inflammation.

Taking any medications without a doctor's prescription can be harmful to health.

Prevention

First of all, preventive measures aimed at preventing pathology include maintaining a healthy lifestyle and adequate sleep, limiting caffeine and alcohol. Moderate physical activity is advisable. Walking, swimming, yoga have a positive effect not only on your figure, but also on your digestion.

Functional dyspepsia is not a dangerous disease and, if the appropriate rules are followed, the prognosis for full recovery is favorable.

Version: MedElement Disease Directory

general information

Short description

Classification

Etiology and pathogenesis

The etiology and pathogenesis of SFD is currently poorly understood and controversial.

Among the possible reasons The following factors contribute to the development of FD:

Epidemiology

Sign of prevalence: Common

Sex ratio(m/f): 0.5

Clinical picture

Clinical diagnostic criteria

Symptoms, course

The clinical picture of FD is characterized by instability and rapid dynamics of complaints: patients have fluctuations in the intensity of symptoms during the day. In some patients, the disease has a clearly defined seasonal or phasic character.

When studying the history of the disease, it is possible to see that symptomatic treatment usually does not lead to a stable improvement in the patient’s condition, and taking medications has an unstable effect. Sometimes the effect of symptom escape is observed: after successful completion of treatment for dyspepsia, patients begin to complain of pain in the lower abdomen, palpitations, problems with stool, etc.
At the beginning of treatment, there is often a rapid improvement in well-being, but on the eve of completion of the course of therapy or discharge from the hospital, symptoms

Diagnostics

Postprandial distress syndrome

Diagnostic criteria (may include one or both of the following symptoms):

Laboratory diagnostics

Differential diagnosis

- Symptoms appear for the first time after the age of 40 years.

Most often there is a need to differentiate FD from other functional disorders, in particular from irritable bowel syndrome. Symptoms of dyspepsia in SFD should not be associated with the act of defecation, a violation of the frequency and nature of stool. However, it should be kept in mind that the two disorders often co-occur.

In general, the differential diagnosis of functional dyspepsia syndrome involves, first of all, the exclusion of organic diseases that occur with similar symptoms, and includes the following research methods:

— Ultrasonography- makes it possible to detect chronic pancreatitis and cholelithiasis.

— X-ray examination.

— Electrogastroenterography - detects gastroduodenal motility disorders.

— Scintigraphy of the stomach- used to detect gastroparesis.

— Daily pH monitoring — allows to exclude gastroesophageal reflux disease.

— Determination of infection of the gastric mucosa Helicobacter pylori.

— Esophagomanometry - used to assess the contractile activity of the esophagus, the coordination of its peristalsis with the work of the lower and upper esophageal sphincters (LES and UES).

— Antroduodenal manometry- allows you to study the motility of the stomach and duodenum.

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Treatment

Drug therapy

Prescribed taking into account the clinical variant of FD and focusing on the leading clinical symptoms.

The effectiveness of placebo is high (13-73% of patients with SFD).

The use of PPIs allows achieving results in 30-55% of patients with epigastric pain syndrome. However, they are only effective in people with GERD.
Prokinetics are used in the treatment of postprandial distress syndrome.

Currently, antisecretory drugs and prokinetics are considered “first-line” drugs, with the prescription of which it is recommended to begin therapy for SFD.

If therapy with first-line drugs is ineffective, psychotropic drugs may be prescribed. An indication for their use may be the patient’s presence of signs of a mental disorder such as depression or anxiety disorder, which in themselves require treatment. In these situations, the use of psychotropic drugs is also indicated if there is no effect from symptomatic therapy.
There is evidence of the successful use of tricyclic antidepressants and serotonin reuptake inhibitors. Anxiolytics are used in patients with high levels of anxiety. Some researchers report the successful use of psychotherapeutic techniques (autogenic training, relaxation training, hypnosis, etc.) to treat patients with SFD.

Medical tactics in accordance with the “Rome III Criteria” are as follows:

Currently, in foreign gastroenterology much attention is paid to the problem of the so-called. non-ulcer dyspepsia. We are talking about a condition (disease?) that is unfamiliar (and poorly understood from a terminological point of view) to domestic doctors and requires special explanation.

The term non-ulcer dyspepsia is given slightly different definitions by different authors. Most foreign experts define non-ulcer dyspepsia as a symptom complex that includes pain or a feeling of fullness in the epigastric region, associated or unrelated to eating or exercise, early satiety, bloating, nausea, heartburn, belching, regurgitation, intolerance to fatty foods, etc. ., in which a thorough examination of the patient fails to identify any organic disease.

A number of foreign authors call this condition “essential nonulcer dyspepsia” (“essential non-ulcer dyspepsia”), and non-ulcer dyspepsia in the broad sense of the word also means gastritis, esophagitis, reflux disease, irritable bowel syndrome. A.A. Sheptulin points out the inappropriateness of including chronic gastritis in non-ulcer dyspepsia from the point of view of its definition as a functional disease, since chronic gastritis is a disease with already developed structural changes. From this point of view, it is incorrect to include both esophagitis and reflux disease in non-ulcer dyspepsia. With irritable bowel syndrome, functional changes are also observed in the lower gastrointestinal tract, which also makes it possible to exclude this disease from non-ulcer dyspepsia.

The following terms are also found in the literature as synonyms for the concept of non-ulcer dyspepsia: functional dyspepsia, essential dyspepsia, idiopathic dyspepsia, inorganic dyspepsia, "epigastric distress syndrome".

Clinical manifestations of nonulcer dyspepsia are very diverse and nonspecific. The complaints made can be divided into the following groups:

1. Localized pain in the epigastrium, hunger pain, or after sleep, which goes away after eating and (or) antacids. Remissions and relapses may occur.
2. High intensity heartburn, belching, regurgitation, acid regurgitation.
3. Early satiety, feeling of heaviness after eating, nausea, vomiting, intolerance to fatty foods, upper abdominal discomfort, increasing with food intake.
4. A variety of difficult-to-classify complaints.

Based on this division of complaints, most authors distinguish 4 types of non-ulcer dyspepsia: ulcer-like, reflux-like, dyskinetic, nonspecific.

It should be noted that this classification is conditional, since complaints in rare cases are stable (according to Johannessen T. et al., only 10% of patients have stable symptoms). When assessing the intensity of symptoms, patients often note that the symptoms are not intense, with the exception of heartburn in the reflux-like type and pain in the ulcer-like type.

Speaking about the etiopathogenesis of non-ulcer dyspepsia, currently most authors devote significant attention to impaired motility of the upper gastrointestinal tract, against the background of changes in their myoelectric activity, and the associated delay in gastric emptying and numerous GER and DGR. However, Bost R. et al. in their work they suggest that DGRs do not play a primary role in the etiopathogenesis of non-ulcer dyspepsia. X Lin. et al. note that changes in gastric myoelectric activity occur in response to food intake.

It was previously assumed that HP plays a significant role in the etiopathogenesis of non-ulcer dyspepsia. It has now been established that this microorganism does not cause non-ulcer dyspepsia, although eradication of HP has been shown to improve the condition of patients with non-ulcer dyspepsia.

The leading role of the peptic factor in the pathogenesis of non-ulcer dyspepsia has not been confirmed. Studies have shown that there are no significant differences in the level of hydrochloric acid secretion in patients with non-ulcer dyspepsia and healthy ones.

In patients with non-ulcer dyspepsia, there was no greater prevalence of smoking, drinking alcohol, tea and coffee, or taking non-steroidal anti-inflammatory drugs compared to patients suffering from other gastroenterological diseases.

It should be noted that these patients are significantly more prone to depression and have a negative perception of major life events. This indicates that psychological factors play a significant role in the pathogenesis of non-ulcer dyspepsia. Therefore, in the treatment of non-ulcer dyspepsia, both physical and mental factors must be taken into account.

Work on studying the pathogenesis of non-ulcer dyspepsia continues to be carried out. Kaneko H. et al found in their study that the concentration of somatostatin in the gastric mucosa in patients with ulcer-like type of non-ulcer dyspepsia is significantly higher than in other groups of non-ulcer dyspepsia, as well as in comparison with patients with peptic ulcer and the control group. Also in this group the concentration of substance P was increased compared to the group of patients with peptic ulcers. Minocha A et al. conducted a study to study the effect of gas formation on the formation of symptoms in HP+ and HP- patients with non-ulcer dyspepsia. Interesting data was obtained by Matter S.E. et al., who found that patients with nonulcer dyspepsia, who have an increased number of mast cells in the antrum of the stomach, respond well to therapy with H1-antagonists, in contrast to standard antiulcer therapy.

In a study of gastric hypersensitivity in patients with non-ulcer dyspepsia, Klatt S. et al. found that on average their sensitivity threshold was higher than that of the control group, but in 50% of patients with non-ulcer dipepsia the sensitivity threshold was within normal limits.

Nevertheless, until now the concept of implicit dyspepsia remains largely clinical without a clear understanding of the pathogenesis. To some extent, it can be considered synonymous with functional gastrointestinal disorders or gastrointestinal dyskinesia. In further study of non-ulcer dyspepsia, it is necessary to pay great attention to clarifying the etiopathogenesis and improving the classification.