Functional dyspepsia

Functional dyspepsia: when and how to treat?

What is the relationship between these two diseases?

Treatment of PD is always complex

Functional dyspepsia: when and how to treat?

According to world statistics, the overall prevalence of dyspepsia symptoms is on average 25%. These numbers include both organic and functional dyspepsia.

Functional dyspepsia (PD) is characterized by the presence of symptoms such as pain, burning, early satiety, a feeling of fullness in the epigastrium after eating. Moreover, there are signs of PD in the absence of an organic lesion of the gastrointestinal tract.   The mechanism of occurrence of PD is not fully understood, but a violation of gastrointestinal motility, visceral sensitivity and increased secretion of hydrochloric acid is expected.

Despite the high prevalence of PD, such a diagnosis almost does not figure in Russian practice. Doctors prefer to use the term “chronic gastritis.”

What is the relationship between these two diseases?

Chronic gastritis – morphological diagnosis, characterizes the degree of damage to the gastric mucosa and is not necessarily accompanied by clinical manifestations. Functional dyspepsia – a diagnosis reflecting the presence of symptoms in a patient. At the same time, the clinical picture may not be combined with inflammatory changes in the mucous membrane.

According to the Rome criteria, PD diagnosis is made under the following conditions:

1. The patient experiences persistent or intermittent recurrent symptoms of dyspepsia ( epigastric pain, discomfort, etc.) for a total duration of at least 3 months in the last 6 months.

2. During examination of the patient (including the instrumental one), no organic disorders were detected, which could be the source of these symptoms.

Treatment of PD is always complex.

The main objectives of drug treatment of patients with PD are the elimination of the clinical symptoms of pathological changes in the gastric mucosa, reduction of the risk of recurrence of the disease, improving the quality of life of patients.

1. Pharmacotherapy is selected depending on the type of PD. If a patient suffers from an ulcer-like PD, he is primarily shown to receive acid-suppressant drugs and antacids. In the treatment of non-ulcer PD, the picture is different – even high doses of antacid drugs improve well-being in 35-80% of patients, which looks quite modest against the background of placebo intake (30-60% of improvements). However, due to the safety of the intake, antacids retain their popularity in the treatment of PD. Acid – suppressive drugs, unlike neutralizing acids that have already been released by the chemical reaction of antacids, directly affect the process of acid production. Histamine H2 receptor antagonists are more commonly used in the treatment of PD, although their effectiveness is lower than that of few inhibitors used in the treatment of PD proton pumps. Last recommendations of the Russian Gastroenterological Association indicate the feasibility of receiving rabeprazole in the treatment of PD

2. With dyskinetic PD, prokinetics reception comes to the fore. Products- prokinetiki most studies show a significantly higher efficacy than placebo (by an average of 40-45%) prokinetic increase the intensity of peristaltic contractions of the esophagus, stomach, duodenum. Reductions are synchronized, thereby reducing the amount of reflux from the stomach into the esophagus, accelerating gastric emptying and the passage of food masses through the duodenum.

3. If a patient has been diagnosed with H. pylori, he is shown anti-helicobacter therapy in addition to other methods of treating PD. More recently, there was no consensus about the feasibility of H. pylori eradication in PD. Recommendations from the National Institutes of Health of the USA from 1994 indicated that anti-Helicobacter therapy in patients with PD leads to the elimination of dyspeptic phenomena only in 25% of cases, and therefore there is no need for it. At the moment, it is known that H. pylori has a inhibitory effect on gastric motility due to the action of cytokines IL-1b, IL-6, IL-8 and tumor necrosis factor TNF-alpha. Considering these data, in 2005 the III Maastricht consensus was developed , according to which patients with FD are subject to mandatory testing for H. pylori and, if it is revealed, they need eradication therapy.

4. In the treatment of PD for the relief of postprandial distress syndrome, antiemetic agents are prescribed, which are based on blocking central dopamine receptors. So, as a result of taking the drug Motilak patient can get rid of nausea, belching, heartburn. Blocking the dopamine receptors in the antrum of the stomach improves its peristalsis, which helps with early satiety and heaviness in the stomach. Taking the drug reduces the time of contact of the mucous membrane of the esophagus with the contents of the stomach, increases the pressure of the lower esophageal sphincter and accelerates gastric emptying. Stimulation of dopaminereceptors in the duodenum increases its peristalsis, which helps with bloating. A significant advantage is that domperidone – the active ingredient of the drug Motilak – the safest prokinetic with a wide evidence base . Unlike metoclopramide, known for its relatively frequent side effects in the form of extrapyramidal effects, domperidone provokes such phenomena extremely rarely – in no more than 0.05% of cases. Prolactinemia is one of the side effects of domperidone , manifests itself in no more than 1.3% of patients when prescribing the drug in the maximum daily dosage. Other adverse reactions (dry mouth, diarrhea, headache, skin rashes) when taking Motilaka rarely occur.

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5. In the presence of refractoriness to the therapy being conducted, borderline mental disorders require antidepressants, which can improve the quality of life of patients by analogy with the treatment of patients with ulcerative colitis and other serious chronic diseases of the gastrointestinal tract. For the successful treatment of PD, the patient must be configured for long-term therapy, the course of which is usually 6-8 weeks.

6. In some cases, enzyme preparations that stimulate digestion and improve the quality of life of the patient are used as an auxiliary treatment of PD. The researchers note that the combined enzyme preparations, which include sorbents, eliminate flatulence, which often worries patients with FD, are more effective .

The causes of functional dyspepsia, issues of its diagnosis and treatment, possible complications and prognosis continue to be studied. But already now in the arsenal of doctors there are enough funds to significantly improve the quality of life of patients with FD.

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