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Do you know what dyspepsia is?

Functional gastrointestinal disorders are common chronic disorders that are characterized by the manifestation of symptoms, without evidence of structural, organic or metabolic disease. The Rome consensus subdivided patients with functional gastrointestinal disorders according to symptom patterns and other characteristics. 

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Among them, functional dyspepsia is one of the most frequent functional disorders, and it would be localized at the gastroduodenal level, with manifestations of early satiety, postprandial fullness, epigastric pain and heartburn. Criteria Rome III and IV consider that this condition has heterogeneous characteristics, so it was divided into postprandial malaise syndrome and epigastric syndrome.

What is your Epidemiology?

The prevalence of functional dyspepsia according to the Rome IV consensus is between 8% and 12%, where 61% of people suffer from postprandial discomfort syndrome; 18%, epigastralgia syndrome, and 21% have overlap of both syndromes.

According to the findings, functional disorders tend to overlap, and both the impact of this overlap and its correct diagnosis, the physiopathological mechanism and the therapeutic options, among others, are still under study. These disorders are associated with effects on quality of life, health costs and daily activities, including work.

Does it have overlap with other disorders?

Patients with functional dyspepsia often have symptoms coexisting with other gastrointestinal or functional disorders.

The most common overlap condition is gastroesophageal reflux disease (GERD), with a prevalence greater than 50% in patients with functional dyspepsia, while in the rest of the population, GERD represents between 15% and 25%. %.

A study conducted in Korea, using Rome III criteria, found a significant overlap between irritable bowel syndrome and functional dyspepsia; however, the study did not distinguish the postprandial malaise of the epigastric syndrome.

How is your Diagnosis?

The diagnostic approach should start with a detailed clinical history that identifies the presentation of the predominant symptoms, such as early satiety and postprandial fullness, among others.

It is important to evaluate the presence of warning signs that may motivate more extensive studies in search of some organic disease, such as weight loss without apparent cause, dysphagia and gastrointestinal hemorrhages, among others.

The diagnosis of functional dyspepsia is made in the presence of a negative upper gastrointestinal endoscopy.

In primary care, endoscopy is not usually performed and it is referred to patients under the diagnosis of undisclosed dyspepsia. In the presence of chronic symptoms, the specialist can perform an endoscopy and arrive at the diagnosis because it is negative. The latest guidelines recommend obtaining routine gastric biopsies, depending on detecting the presence of Helicobacter pylori.

Physiopathological mechanisms

A variety of pathophysiological mechanisms have been implicated in the pathogenesis of functional dyspepsia, including alterations in gastric and sensory gastric function, changes in the mucosa and, in addition, changes in the processing of different afferent signals at the stomach level. This number of mechanisms would reflect the heterogeneity of this disorder.

How is your treatment?

The symptoms of functional dyspepsia, and especially those of postprandial discomfort, are usually triggered by the ingestion of a meal, so it would be logical to consider a dietary adjustment to address the symptoms.

It is usually recommended to make meals in smaller portions and avoid fats.

Some guidelines recommend the eradication of H. pylori in patients with gastrointestinal symptoms and negative endoscopy. 

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Acid suppression with proton pump inhibitors is the therapy of first choice in patients with functional dyspepsia. Prokinetics would be less effective for functional dyspepsia than proton pump inhibitors.

Some meta-analyzes confirm the efficacy of prokinetics as a pharmacological group, but few agents are available, and the studies have an extremely heterogeneous quality.

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This article was published on Thursday 11 July, 2019.

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