Functional dyspepsia is a functional distress (does not have an organic substrate), characterized by symptomatology located in the upper abdomen, which has the manifestations of epigastric pain, fullness, bloating or discomfort. About 70% – 80% of patients that have seen a gastroenterologist doctor, have a symptomatology located in upper abdomen, but paraclinical explorations can not reveal the presence of organic lesions (peptic ulcer, gastric cancer, gallstones, chronic pancreatitis). These patients are classified as having functional dyspepsia. The remaining 20% – 30% of patients with upper abdominal symptomatology have an organic dyspepsia.
Functional dyspepsia etiopathogenesis:
Concerning on functional dyspepsia etiopathogenesis, there are many poorly understood aspects. Thus, for cases with ulcer-like symptoms may be incriminated the role of Helicobacter pylori or the hypersecretion status , while those with symptoms of bloating can criminalize a type of gastric emptying disorder or sensory perception digestive disorders (the patient perceives as abnormal a regular amount of gas which is located in the digestive tract).
Functional dyspepsia classification:
It is achieved after the dominant symptom:
- ulcer-like dyspesia, dominated by epigastric pain, discomfort, painful hunger, but the paraclinical examination reveal the absence of digestive ulcers;
- dismotility dyspepsia, the patient complains of fullness, epigastric heaviness, bloating, belching, but paraclinical explorations will reveal the absence of lesions;
- essential dyspepsia, which includes a mixture of symptoms belonging to the two types of functional dyspepsia described above.
Functional dyspepsia diagnosis:
Clinical diagnosis, consists of an epigastric symptomatology more or less noisy, but weight loss, digestive bleeding or anemia are missing, in the presence of these symptoms, attention should be directed to an organic distress. The type of symptoms that predominate will enable the hiring in one of the forms of functional dyspepsia.
Laboratory diagnosis will consist of a series of explorations that will demonstrate the absence of organic lesions:
- Abdominal ultrasound will demonstrate a gallbladder without stones, a normal looking pancreas, a liver without modification;
- Digestive endoscopy will show an normal esophagus, stomach and duodenum;
- Colonoscopy does not reveal changes in the mucosa of the colon.
So, the character of functional dyspepsia is shown by the absence of organic lesions.
Treatment of functional dyspepsia:
Regarding to functional dyspepsia treatment, it generally addresses to the symptoms and will be administered at their appearance.
- Treatment of ulcer-like dyspepsia is done with antisecretory drugs, like histamine H2 blockers(ranitidine, famotidine), administered in periods with symptoms or proton pump inhibitors (omeprazole, lansoprazole). There are discussions about the usefulness of eradication of Helicobater pylori infection, when is present in ulcer-like dyspesia patients and microbe can be found by direct or indirect tests. Half of patients in whom triple therapy works for the eradication of Helicobacter pylori, the symptoms disappear or are reduced, but at the rest of the patients symptoms remain;
- Treatment of dismotility functional dyspepsia is using prokinetic, like metoclopramide or domperidone. Also can be used digestive ferments, such as digestion or festive and sinks of intestinal gas, as dimethicone;
- Essential functional dyspepsia treatment will be done with medication which addresses to the dominant symptom, considering that in this form of functional dyspepsia symptoms include the first two entities.
In all cases of functional dyspepsia, if stress plays a role in symptoms, should be given a mild sedative or resorting to psychotherapy.