Dyspepsia – the digestion violation caused by the reasons of organic and functional character. Symptoms of dyspepsia are pains in the top part of a stomach of not clear localization, nausea, heartburn, feeling of overpopulation of a stomach, bystry saturation after food, etc. The diagnosis of dyspepsia is established only in case of an exception of other pathology of a GIT, fundamental value at the same time has endoscopic inspection of the top departments of a digestive tract. Treatment of dyspepsia symptomatic: fermental medicines, means for improvement of motility of a GIT etc. The psychotherapy has huge value – after classes with the psychologist most of patients note decrease in intensity of complaints.
Dyspepsia – one of the main problems of gastroenterology as shows uncertain complaints to discomfort of digestion to 40% of the population of the developed countries, at the same time doctors only every fifth. Disorders of digestion can have an organic or functional basis. Organic dyspepsia arises against the background of various pathology of digestive organs (gastritises, stomach ulcer, inflammatory diseases of gepatobiliarny system, a pancreas and different departments of intestines, a GIT tumor, etc.). Speak about functional dyspepsia in that case when in the presence of symptoms of violation of activity of a stomach no organic pathology which could cause these complaints comes to light. Women have functional dyspepsia 1,5 times more often than men; the main age contingent at which this disease comes to light is made by persons of 17-35 years.
Today dyspepsia is considered to be a psychosocial disease at which as a result of various stressful factors regulation of functions of a stomach and initial departments of intestines is broken. Except an emotional overstrain, violations of food, reception of some medicines, increase in secretion of hydrochloric acid, a helikobakterny obsemeneniye of a mucous membrane of a stomach, dyskinesia of initial departments of a digestive tract, violation of digestion of complex sugars, etc. can be the reasons of development of functional dyspepsia. It is known that hypovitaminoses (a vitamin deficiency With and groups B) can also promote development of dyspepsia.
As a result of impact of the listed factors on a wall of a stomach sensitivity of visceral receptors increases, there is a diskoordination of motility of a stomach and small intestine, normal secretion of digestive juice is broken. As manifestations of these frustration serve (is followed by weight in an epigastriya, nausea and vomiting), the raised visceral susceptibility to stretching (feeling of overpopulation of a stomach, hungry pains in subspoon area), incomplete relaxation of a muscular layer of body (feeling of early saturation), delay of advance of food masses from a stomach in intestines.
With a dispepsichesky syndrome also such diseases as food allergy, a gastroezofagealny reflux disease, diafragmalny hernia with the shift of belly department of a gullet in a chest cavity, gastritis, an akhlorgidriya, stomach ulcer of a stomach and duodenum, cholelithiasis, cholecystitis, a state after a holetsistektomiya, pancreatitis, , GIT tumors, various infections of a digestive tract proceed. Food toksikoinfektion, in this case into the forefront, along with dispepsichesky are the most frequent reason of dyspepsia at children, there is a syndrome of a toksiko-eksikoz. As symptoms of organic dyspepsia are considered in sections on the corresponding gastrointestinal diseases, in this article it will be a question mainly of functional dyspepsia.
Classification of dyspepsia
On the basis of the pathogenetic principle distinguish functional and organic dyspepsia. Organic dyspepsia usually accompanies various diseases of a digestive tract, and functional proceeds against the background of lack of organic damage of a GIT.
On a causal factor allocate the following options of dyspepsia:
- Alimentary – is usually connected with violation of a ratio of the main nutrients in a diet. Fermentative dyspepsia develops at prevalence in the menu of carbohydrates, putrefactive – proteins and stale meat, soap – at a surplus of refractory fats.
- Enzymatic – is connected with insufficient production of digestive enzymes. Depending on in what body fermental insufficiency developed, allocate gastrogenny, pankreatogenny, hepatogenous and enterogenny dyspepsia.
- Dyspepsia at a malabsorption syndrome - is connected with violation of absorption of nutrients in intestines.
- Infectious - develops at various intestinal infections, most often at dysentery and salmonellosis.
- Intoksikatsionny – arises at sharp poisonings, heavy general infections, extensive injuries.
Also allocate four clinical forms of functional dyspepsia: yazvennopodobny, diskinetichesky, reflyuksopodobny and uncertain.
The diagnosis of functional dyspepsia is established with three obligatory criteria. The first of them – complaints to pains and discomfort in the top half of a stomach on the median line within one week monthly, or 12 weeks in a year. The second - lack of organic changes of a GIT at fizikalny, endoscopic and ultrasonic inspection of the top departments of a digestive tract. The third criterion is lack of signs of a syndrome of the angry intestines (relief of symptoms after defecation or change of character and frequency of a chair).
There is a number of signs in the presence of which the diagnosis of functional dyspepsia is excluded: it is a dysphagy, temperature increase of a body, emergence of blood in a chair, inflammatory changes in clinical analyses, causeless loss of weight, anemia. In the presence of the listed symptoms deeper inspection of the patient for statement of the right diagnosis is required.
Distinguish four options of a course of functional dyspepsia, each of which has the clinical and fizikalny signs. So, the yazvennopodobny option is shown by rather severe night or hungry pains in epigastralny area which are often arising after an emotional overstrain. The pain syndrome is stopped meal, introduction of antatsid. A characteristic sign is sensation of fear during an attack, the notions of compulsion about existence of an incurable disease.
The Diskinetichesky option of dyspepsia is expressed by feeling of overpopulation of a stomach after food, weight in an epigastriya, nausea, an abdominal distension. The vomiting giving relief is possible. Patients note that after food there occurs bystry saturation. Reflyuksopodobny dyspepsia is shown by heartburn, feeling of the burning-down pain behind a breast, an eructation and vomiting by acid. The last form of a disease – uncertain, or nonspecific – is characterized by polymorphism of symptoms, at the same time one leader is not possible to allocate. The long current, lack of progressing of symptoms is characteristic of functional dyspepsia.
Diagnosis of dyspepsia
Consultation of the gastroenterologist will allow to reveal the leading complaints, to decide on the necessary volume of researches. The diagnosis of functional dyspepsia is established only after full inspection of the patient and an exception of other pathology of a GIT. The next researches are obligatory: consultation of the endoscopist for carrying out an ezofagogastroduodenoskopiya, ultrasonography of abdominal organs, blood tests (all-clinical and biochemical blood tests), a research a calla for assessment of digestive activity, identification of the hidden blood. At functional dyspepsia during EGDS changes of mucous are not visualized. On ultrasonography of abdominal organs chronic pancreatitis, cholelithiasis can be found. Deviations in analyses at this diagnosis usually do not happen.
For differential diagnosis of functional dyspepsia with other gastrointestinal diseases additional researches can be required. At a X-ray analysis of a stomach expansion of a cavity of body, delay of evacuation of food can come to light. On an elektrogastrografiya violation of a vermicular movement of a stomach is registered (most often urezheny its rhythm). For definition of acidity the research of gastric juice, an intragastric rn-metriya is conducted (both increase, and decrease is possible). For assessment of extent of relaxation of a stomach the antroduodenalny manometriya during which the special sensor transferring pressure indicators is entered into a cavity of body is used. At functional dyspepsia the manometriya can indicate insufficient relaxation or, on the contrary, a relaxation of walls of a stomach.
In a situation when symptoms of functional dyspepsia progress, or regress against the background of treatment insufficiently, carrying out two various researches for detection of a helikobakterny infection is required. Use of methods with different mechanisms of diagnostics (definition a helikobakter in Calais by IFA method, PTsR-diagnostics a helikobakter, definition in blood of antibodies to a helikobakter by IFA method, the respiratory test on a helikobakter) will allow to avoid a mistake.
Repeated consultation of the gastroenterologist after obtaining results of all researches gives the chance to exclude organic pathology, to establish the diagnosis of functional dyspepsia and to appoint the correct treatment. It is known that the organic reasons of dyspepsia are found in 40% of patients with complaints, characteristic of this disease, therefore diagnostic search first of all has to be directed to detection of the specified diseases. Functional dyspepsia should be differentiated with a syndrome of the angry intestines, functional vomiting, an aerofagiya.
Treatment of dyspepsia
Main aims which are pursued by the doctor at purpose of treatment of functional dyspepsia, – reduction of intensity of symptoms, the prevention of a recurrence of a disease. Hospitalization in office of gastroenterology is usually shown only for carrying out difficult researches, at difficulties of differential diagnostics. Main directions of therapy of functional dyspepsia: correction of a way of life and food, medicamentous and psychotherapeutic actions.
For normalization of a day regimen it is necessary to exclude the situations provoking stresses and experiences, physical and emotional overworks. It is recommended to refuse alcohol intake, smoking. It is necessary to allocate time for daily occupations with physical culture – they improve both the general condition of the patient, and function of digestive organs. It is also necessary to pay much attention to a diet. Fried, extractive and spicy food, carbonated drinks, coffee is excluded from a diet. Is it is necessary small portions, carefully to chew food, not to allow an overeating and long breaks between meals. After food it is necessary to move actively, you should not lay down to have a rest. In the presence of symptoms of dyspepsia the refusal of use of nonsteroid resolvents as they negatively influence a condition of a mucous membrane of a stomach is recommended. These actions are leaders in treatment of functional dyspepsia.
If the patient is not able to normalize independently a diet, the help of the nutritionist can be necessary for it. The expert will explain need of observance of frequency and volume of each meal, harm of an overeating and long breaks for food. Also the nutritionist will control qualitative structure of food – existence of enough protein and vitamins, food fibers.
Treatment from functional dyspepsia is impossible without deep psycho-emotional reorganization. For this purpose it is necessary not only to reduce quantity of stresses to a minimum, but also to change the patient's relation to negative situations. It can be promoted by sport, water procedures, occupations yoga. The attending physician has to maintain the confidential relations with the patient, in detail it is possible explain the reasons and mechanisms of development of a disease – only in this case obtaining desirable effect of treatment. Bigger efficiency of therapy can be reached at purpose of sedative medicines (a grass of a valerian, a motherwort), antidepressants (, fluoxetine).
Drug treatment is appointed depending on a dyspepsia form. At yazvennopodobny option the main group of medicines – antatsida and antisekretorny means: aluminum hydroxide in combination with magnesium hydroxide, inhibitors of a proton pomp, blockers of H2 receptors and others. At a diskinetichesky form of dyspepsia use pro-kinetics: or . Other options of functional dyspepsia assume application of various combinations of antatsid and prokinetik.
In case symptoms of dyspepsia do not regress against the background of the carried-out treatment, it is necessary to use other medicines from the specified groups, or to change a combination of medicines. Also it is recommended to conduct a research on H.pylori (if still it was not conducted), at positive result – to carry out a microorganism eradikation antibacterial means. Antikhelikobakterny therapy in 25% of cases considerably facilitates the course of dyspepsia.
It is worth to remember about disturbing symptoms which can appear at the patient with dyspepsia: a dysphagy, bleeding from different departments of a GIT, unmotivated weight loss. If the patient shows the listed complaints, it is necessary to repeat endoscopic and other researches for timely detection of dangerous pathology of a GIT (cancer of a stomach, cancer of a small intestine, etc.).
Forecast and prevention of dyspepsia
Functional dyspepsia worsens a tide of life of the patient, however the forecast of this disease favorable. In the absence of the disturbing symptoms which are listed above existence of serious pathology of a GIT is improbable. However, the wavy current therefore after the conducted course of therapy the high probability of a recurrence of symptoms remains is characteristic of dyspepsia. Specific measures of prevention of dyspepsia it is not developed, but maintaining a healthy lifestyle, a balanced diet and an exception of stressful situations considerably reduce probability of development of this disease.