Functional Dyspepsia - University of .Functional DyspepsiaFunctional Dyspepsia Fx Gastro-intstinal

download Functional Dyspepsia - University of .Functional DyspepsiaFunctional Dyspepsia Fx Gastro-intstinal

of 13

  • date post

    07-Jul-2019
  • Category

    Documents

  • view

    215
  • download

    0

Embed Size (px)

Transcript of Functional Dyspepsia - University of .Functional DyspepsiaFunctional Dyspepsia Fx Gastro-intstinal

  • Functional DyspepsiaFunctional Dyspepsia

    Norbert WelkovicsNorbert WelkovicsHeine van der WaltHeine van der Walt

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    DefinitionDefinitionCharacteristics: Central abdomen Pain or discomfort Not associated with bowel movements

    No structural or biochemical abnormalty

    Part of Gastroduodenal disorders (Rome II)

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Fx GastroFx Gastro--intstinal disordersintstinal disordersRome II (1999)Rome II (1999)

    A. Esophagial disorders E. Billiary disordersA1. Globus E1. Gallbladder dysfunction

    A2. Rumination Syndrome E2. Sphincter of Odi dysfunctionA3. Functional chest pain of presumed oesophageal originA4. Functional heartburnA5. Functional dysphagiaA6. Unspecified oesophageal disorder

    B. Gastroduodenal disorders F. Anorectal disordersB1. Functional dyspepsia F1. Functional faecal incontinence

    B1a. Ulcer like dyspepsia F2. Functional anorectal painB1b. Dysmotility like dyspepsia F2a. Levator ani syndromeB1c. Non-specific dyspepsia F2b. Proctalgia fugax

    B2. AerophagiaB3. Functional vomiting

    C. Bowel disordersC1. Irritable bowel syndromeC2. Functional abdominal bloatingC3. Functional constipationC4. Functional diarrhoeaC5. Unspecified functional bowel disorder

    D. Functional abdominal painD1. Functional abdominal pain syndromeD2. Unspecified functional abdominal pain

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    ClassificationClassificationOrganic dyspepsia PUD, GERD, Pancreatico-billiry disease Functional dyspepsia Ulcer-like dyspepsiea

    Pain

    Dysmotility-like dyspepsia Discomort; nausea, vomiting, postprandial fullness and upper

    abdominal bloating

    Reflux-like dyspepsia Heartburn but not the predominant symptom

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    EpidemiologyEpidemiologyCommon complaint (15 25%)On upper GIT endoscopy: Peptic ulcer disease 22% Esophagitis 10% Cancer 1% Functional dyspepsia 67%

    Comparable to asymptomatics

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    AetiologyAetiologyCause and effect difficult to establish1. Symptoms experienced are intermittent and

    changing2. High placebo response rate (30%)3. No specific findings in all patients present4. Findings present in asymptomatic patients as well5. Symptoms and findings often do not correlate6. There is no universal effective treatment7. The response to treatment is difficult to predict

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology PostulatesPostulatesUlcerUlcer--likelikeDyspepsiaDyspepsia

    Helicobacter pylori Gastritis / Duodenitis Missed PUD Acid sensitivity Occult GERD

    DysmotilityDysmotility--likelikeDyspepsiaDyspepsia

    Gastroparesis Abnormal relaxation Visceral hypersensitivity Brain-gut disorder Psychological disorder

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology Helicobacter pyloriHelicobacter pyloriControversial: Background infection rates increase with age H.pylori gastritis equal in asymptomatics

    Possible CagA+ strain

    For treatment WHO declared HP carcinogen Response to treatment 20% at 1 year

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology Helicobacter pyloriHelicobacter pyloriAgainst treatment Response to PPI not to antibiotics Low background infection rate in 1st world countries

    MAASTRICHT CONSENSUSMAASTRICHT CONSENSUSTest and treat approach in uninvestigated dyspepsia in

    patients younger than 45 in the absence of:1. Alarm symptoms

    2. NSAID use

    3. Predominant reflux symptoms

    4. Family history of gastric carcinoma

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology GastritisGastritisNSAID gastropathy and functional dyspepsia can occur simultaniously Stop NSAID If symptoms dont improve, treat as functional

    dyspepsia

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology DuodenitisDuodenitisPresence of past PUD diagnosis Manage as PUD even if endoscopy normal Missed PUD?

    Absence of past history Treat as functional dyspepsia

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology Acid sensitivityAcid sensitivityNormal acid secretion

    Acid sensitivity increased 20% incidence in functional dyspepsia Decreased acid clearance by duodenum

    ? H2 treatment response 20% above placebo rate

  • Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia

    Aetiology Aetiology Occult GERDOccult GERDReflux s a normal phenominon

    High positive predictive value If dominant symptom = GERD Might form part of functional dyspepsia