| ID | 11 |
|---|---|
| Name | FUNCTIONAL DYSPEPSIA or NON ORGANIC DYSPEPSIA or NON ULCER DYSPEPSIA |
| Cause | Being female. Using certain pain relievers that are available without a prescription. These include aspirin and ibuprofen, which can cause stomach problems. Smoking. Anxiety or depression. History of childhood physical or sexual abuse. Helicobacter pylori infection. |
| Signs Symptoms | Pain or burning in the stomach, bloating, excessive belching, or nausea after eating. An early feeling of fullness when eating. |
| Diagnosis | Dyspepsia is another word for indigestion. People with chronic indigestion often report feelings of stomach pain, over-fullness and bloating during and after eating. Other common symptoms include acid reflux, heartburn and excessive burping. |
| Investigations | 1. The history will often suggest the diagnosis. 2. To exclude organic causes relevant investigations should be performed such as- i. Endoscopy- in elderly subject, ii. Ultrasonogram of abdominal organs to exclude gall stone etc. 3. Other routine tests may also be done. |
| Management | 1. Patient should be explained the condition and reassurance. 2. Relevant psychological factors should be explored & explained. 3. Social factors (if any) should be resolved with appropriate counselling. 4. Smoking and alcohol abuse should be discouraged & sensible dietary advice may be given. 5. Drug treatment is not beneficial, but may try the following: a. Antacids may sometimes be helpful, b. Prokinetic drugs such as- Metoclopramide 10mg 8 hourly. Or, Domperidone 10-20mg 8 hourly may be given before meals if nausea, vomiting or bloating are present, c. H2-receptor antagonist drugs or proton pump inhibitors may be given if there are complaints of night pain &/or heartburn. d. Low dose amitriptyline may be helpful.2 6. In many patients, however symptoms may persist or recur over a lifetime, so that formal psychotherapy should be considered if major psychological difficulties are identified. 7. Majority of the patients may derive relief from placebo therapy |
| Introduction | Persistant dyspepsia, in the absence of relevant alimentary disease or any history of peptic ulcer disease is called functional or non organic or non ulcer dyspepsia. About to two-thirds of patients belong to this group & found no obvious organic cause for their symptoms after investigation. Symptoms may be due to a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying or impaired accommodation to food, or psychosocial stressors1. |
| History | |
| Etiology | Gastric motility disorders, visceral hypersensitivity, psychological factors, Helicobacter pylori infection, and excessive gastric acid secretion. The present article provides an overview of pathogenetic factors and pathophysiologic mechanisms. |
| Clinical Features | 1. Patients are usually young (<40 years). 2. Women are affected twice as commonly as men. 3. Abdominal pain is associated with other symptoms, such as nausea & bloating after meals. 4. Morning symptoms are characteristic & pain or nausea may occur on waking. 5. Colonic dysmotility such as pellet-like stools or a sense of incomplete rectal evacuation on defecation. 6. Patients may appear anxious & distraught. 7. Many patients are self-admitted ‘worriers’ concerned about finance, employment or family appears. NB. Difference between Functional dyspepsia & Peptic ulcer |
| Preventions | Avoid Factors |
| Treatment | DIETARY MODIFICATION. A low-risk intervention for patients is to encourage dietary modifications to limit foods associated with functional dyspepsia. ... H. PYLORI ERADICATION. ... ACID SUPPRESSION. ... PSYCHOTROPIC MEDICATIONS. ... PROKINETICS. ... NONPHARMACOLOGIC THERAPY. ... COMPLEMENTARY AND ALTERNATIVE MEDICINE. |
| Complications | The disturbed motility present in functional dyspepsia leads to amplified sensation in the upper gut (visceral hyperalgesia). This is due to uncoordinated and even ineffectual emptying of the upper digestive tract, with resulting symptoms of pain, fullness and bloating, and an inability to finish meals. |
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