FUNCTIONAL (NON-ULCER) DYSPEPSIATUCOMInternal Medicine 4th class Dr. Hasan. I. Sultan
Learning objectives• Define functional dyspepsia.
• List the causes of functional dyspepsia.
• Review the clinical features of functional dyspepsia.
• List the important investigations of functional dyspepsia.
• Outline the management of functional dyspepsia.
FUNCTIONAL (NON-ULCER )DYSPEPSIA
Dyspepsia; is a collective symptoms thought to be originate from the upper gastrointestinal tract, that may include pain or discomfort, bloating, feeling of fullness with very little intake of food , feeling of early satiety, nausea, loss of appetite or heartburn.Functional dyspepsia; chronic dyspepsia (more than 3 months) in the absence of organic disease.
Aetiology; The pathophysiology of functional dyspepsia is unclear but probably due to mucosal, motility, psychiatric disorders or H. pylori infection.
Clinical features ;
Usually young (< 40 years) women.Abdominal pain associated with a variable 'dyspeptic' symptoms( nausea and bloating after meals).
Morning symptoms are characteristic.
A drug history, pregnancy, and alcohol misuse should be ruled out.
Examination;
Usually negative apart from inappropriate tenderness on abdominal palpation, no weight loss, patients may be anxious.
Symptoms may appear disproportionate to clinical well-being.
Investigations;
• Endoscopy is necessary to exclude mucosal disease.
• Testing for H. pylori infection.
• Ultrasound scan may detect gall stones.
Management;
Explanation of symptoms and reassurance that the risk of cancer is very low in absence of alarm features.
Possible psychological factors should be explored.
Give dietary advice; stop smoking, take regular meals, limit spicy, acidic and fatty foods may be helpful.
Review medications that may aggravating symptoms.
Drug treatment;
1-Antacids and alginates are sometimes helpful.2-Prokinetic drugs such as metoclopramide or domperidone -- if nausea, vomiting or bloating is prominent.
3-H2-receptor antagonists or PPI -- if night pain or heartburn is troublesome.
4-The role of H. pylori eradication remains controversial. Indicated in those who are positive results. (Testing and treating for H. pylori) used as a role.
5-Low-dose amitriptyline is sometimes of value.
6-Some patients need behavioral or other formal psychotherapy.