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functional dyspepsia

At least 3 months of pain or discomfort centered in the upper abdomen, without clinical, endoscopic, or ultrasonographic evidence of known organic disease likely to explain the symptoms. Etiology: (differential diagnosis) 1) gastroesophageal reflux disease (GERD)* 2) irritable bowel syndrome (IBS)* 3) peptic ulcer disease (PUD) is an uncommon cause 4) gallstones * 75% of cases are due to GERD &/or IBS Pathology: 1) dysfunctional gastric acid secretion 2) gastrointestinal dysmotility -> gastroparesis* 3) psychosocial factors * essentially the same disorder as gastroparesis [4] Clinical manifestations: 1) ulcer-like dyspepsia - epigastric pain - relieved by food - relieved by antacids or H2 receptor antagonists - occurs before meals or when hungry - awakens patients from sleep - periodic: weeks to months with pain with intermittent remissions of weeks without pain 2) dysmotility-like dyspepsia - abdominal discomfort (pain is infrequent) - early satiety - postprandial fullness - nausea - recurrent wretching or vomiting - bloating in the upper abdomen, not accompanied by visible distension - upper abdominal discomfort often aggravated by food - gastroparesis* * essentially the same disorder as gastroparesis [4] Diagnostic criteria: - bothersome postprandial symptoms - early satiety - epigastric pain &/or burning - symptoms for past 3 months - symptom onset at least 6 months previously - no evidence of structural disease to explain symptoms [1] Laboratory: 1) endoscopy 2) 24 hours esophageal pH monitoring 3) serology for Helicobacter pylori Management: - diet & lifestyle modification [1] - benefit proton pump inhibitor short-lived - benefit at 4 weeks, but not at 8 weeks [2] - low-dose tricyclic antidepressant if poor response to once daily proton pump inhibitor [1] - cognitive behavioral therapy - probiotics Bacillus subtilis & Bacillus coagulans may be of benefit

Related

cholelithiasis (gallstones) gastroesophageal reflux disease (GERD) gastroparesis Helicobacter pylori irritable bowel syndrome (IBS) peptic ulcer disease (PUD)

General

dyspepsia (indigestion)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018
  2. van Zanten SV et al, Esomeprazole 40 mg once a day in patients with functional dyspepsia: The radomized, placebo-controlled 'ENTER' trial. Am J Gastroenterol 2006, 101:2096 PMID: 16817845
  3. Lacy BE, Talley NJ, Locke GR 3rd et al Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther. 2012 Jul;36(1):3-15. Epub 2012 May 16. PMID: 22591037
  4. Pasricha PJ et al. Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathologic features. Gastroenterology 2021 May; 160:2006. PMID: 33548234 https://www.gastrojournal.org/article/S0016-5085(21)00337-1/fulltext - Tack J et al. Gastroparesis: A dead-end street after all? Gastroenterology 2021 May; 160:1931. PMID: 33621562 https://www.gastrojournal.org/article/S0016-5085(21)00432-7/fulltext
  5. Hamza Z Probiotics Show Promise for Symptoms of Functional GI Disorders. Small pilot study suggested clinical benefit, acceptable safety profile. https://www.medpagetoday.com/gastroenterology/generalgastroenterology/93951 - Wauters L, Slaets H, De Paepe K et al Efficacy and safety of spore-forming probiotics in the treatment of functional dyspepsia: a pilot randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2021; Aug 3. PMID: 34358486 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00226-0/fulltext - Burns GL, Hoedt EC, Keely S Spore-forming probiotics for functional dyspepsia. Lancet Gastroenterol Hepatol 2021; Aug 3. PMID: 34358485 https://www.thelancet.com/journals/langas/article/PIIS2468-1253(21)00260-0/fulltext