Functional Dyspepsia

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Transcript of Functional Dyspepsia

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    Functional Dyspepsia patient

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    Functional dyspepsia, sometimes referred to as non-ulcer dyspepsia, is a common functional disorder of the upper digestive tract (stomach and upper small intestine). Functional dyspepsia is characterised by chronic or recurrent upper abdominal pain or discomfort, often in conjunction with feelings of early satiety (fullness), pressure in the abdomen, burning, bloating, belching or nausea. Symptoms may occur after eating a meal, but can happen at any time. Similarly, certain foods or drinks may worsen symptoms for some people.

    As with other functional disorders, there is no evidence of organic disease or other structural abnormality in the gut (such as an ulcer or inflamed esophagus) that can account for the symptoms that are present.

    While the condition is uncomfortable and can be distressing, especially if symptoms are chronic, functional dyspepsia does not cause other, more serious conditions. The symptoms associated with functional dyspepsia can be addressed, as outlined further in this leaflet, and the prognosis for the condition is generally quite good.


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    The exact cause of functional dyspepsia is not known, however symptoms are thought to be linked to an increased sensitivity in the esophagus and upper gastrointestinal system, which can be triggered by a variety of factors.

    these may include: impaired peristalsis (contraction and relaxation of the intestinal muscles that move food through the upper digestive tract), acid secretion, diet, lifestyle, and psychological factors. Many people with functional dyspepsia have an increased awareness of their stomach and upper gut activity and can have impaired digestion or be sensitive to food intake. Many people with functional dyspepsia find that certain foods can make symptoms worse, however, food is not the cause of functional dyspepsia.

    Functional Dyspepsia is one of several conditions known as functional gastrointestinal disorders. The term functional disorder refers to the presence of symptoms with a normal clinical examination and normal investigations. In other words there is nothing visibly wrong with the body. In the case of functional dyspepsia, the lining of the gut is not inflamed and the amount of acid in the stomach is normal. This can be very frustrating for patient and clinicians especially when the symptoms are very severe. An organic disorder refers to conditions where symptoms are associated with findings on clinical examination and/or abnormal diagnostic tests which identify the source of symptoms and direct future treatment.


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    Biological factors

    Functional dyspepsia can be caused by a failure of the stomach or upper digestive system to move food through the body in a normal way. Typically, the body moves food through the digestive system by rhythmically contracting and relaxing the muscles of the digestive system. In this way, food moves from the stomach through the intestinal tract. however, in those with functional dyspepsia, this process is often disturbed and the stomach or small intestine may not relax, contract, or empty normally after a meal.

    Issues relating to the brain-gut axis

    The link between the brain and the gut has been well established. Research using MRI scans showed that certain areas in the gut and in the brain are more active in functional dyspepsia than in non-functional dyspepsia subjects. It is therefore believed that functional dyspepsia is related to excessive nerve transmission between the gut and the brain, which is mediated by nerve chemicals (neurotransmitters). In other words, a primary trigger driving functional dyspepsia symptoms is that the gut is hypersensitive to stimuli and that food does not pass through the digestive systems of people

    with functional dyspepsia properly. This is because the signals that travel back and forth from the brain to the gut, controlling the nerves, are disrupted in some way. because of this, food, drinks, and emotions may trigger pain. The sensitivity, as mentioned above, stems from hypersensitive gut nerves that send excess signals to the brain, particularly to the area that processes pain. The brain then sends abnormal signals back to the gut to alter its motility or relax muscles. This back and forth electrical communication between the brain and gut is represented by the brain-gut axis and understanding this interaction forms the basis of current treatment approaches to functional dyspepsia.

    Emotional factorsIt has recently become evident that stress and other psychological factors, such as anxiety and depression, can affect the gastrointestinal system. These psychological factors can make functional dyspepsia symptoms worse, and sufferers more sensitive and less tolerant of food. heightened emotional states can lead to chemical changes in the body that can hinder the process of digestion. This can be cyclical as well, as the uncomfortable nature of functional dyspepsia can lead to more stress, depression, anxiety or anger.

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    General SymptomsThe symptoms of functional dyspepsia vary between each individual, as does their severity. At times, symptoms and signs can be mild, and at other times they can be painful and debilitating. Symptoms are often worse after eating and tend to come and go in bouts.

    Core symptoms of functional dyspepsia often include the following:

    o pain or discomfort in your upper abdomen or chest

    o A feeling of fullness in your upper abdomen

    o A burning feeling in your neck or esophagus (heartburn)

    o loss of appetite

    o belching

    o bloating

    o Nausea

    o vomiting


    Stress/depression/anxietyThe symptoms of functional dyspepsia can mostly be managed at home and do not require urgent care. however, due to the discomfort, pain and/or distress of functional dyspepsia, the clinical picture may well be accompanied by feelings of depression, anxiety and/or stress. These psychological factors should be related to your doctor, who can help to manage or treat them, along with your physical symptoms.

    Alarm symptomsIt is important to see a doctor if you have:

    o a noticeable change in any of the general or associated symptoms of functional dyspepsia

    o difficulty swallowing

    o difficulty breathing

    o frequent vomiting or blood in your vomit

    o family history of stomach cancer

    o family history of gastric cancer

    o shortness of breath

    o unintentional weight loss

    o or if you are 55 or older

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    DIAGNOSISFunctional dyspepsia is a functional gastrointestinal disorder, with no obvious physical abnormalities of the digestive tract, and so there is no specific test that can determine if it is present. Therefore, functional dyspepsia is largely a diagnosis of exclusion. your doctor will need to ask you a series of health questions, take your medical history, and complete a physical exam in order to rule out other causes. A diagnosis is made based on the symptoms you describe and the exclusion of other causes.

    An international working group developed a list of diagnostic criteria for functional dyspepsia. These criteria were developed in Rome and are now at their third version hence they are being referred to as the Rome III criteria.

    In some cases, particularly if you have alarm symptoms (see previous heading), your doctor may want to carry out additional tests. This is to rule out the possibility of other, more serious conditions, or infection or inflammation or the upper GI tract.


    Symptoms must include one or more of the following:

    bothersome postprandial fullness

    Early satiation

    Epigastric pain

    Epigastric burning


    No evidence of structural disease (including at upper endoscopy) that is likely to explain symptoms






    These criteria need to be fulfilled for the last three months with symptom onset at least six months prior to diagnosis

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    In some cases, particularly if you have alarm symptoms (see previous heading), your doctor may want to carry out additional tests. This is to rule out the possibility of other, more serious conditions, or infection or inflammation or the upper GI tract.

    FURThER TESTSIf alarm symptoms are raised, further tests may be recommended in order to rule out other conditions. Further investigations may include the following, depending on your symptoms and concerns:

    Endoscopy This test is used to examine the oesophagus, stomach, and duodenum by inserting a thin, flexible tube down the oesophagus.

    Helicobacter pylori test A stool or breath test may be performed to rule out the presence of h. pylori, which is a type of infection sometimes associated with dyspeptic symptoms.

    Blood testsA blood sample may be required to rule out more serious conditions.

    Barium swallow and meal X-rayThis test involves ingesting a drink that contains barium prior to having an abdominal X-ray. barium is a substance that can be seen on X-ray images, enabling you