Functional Dyspepsia Flashcards
What are the categories of functional gastrointestinal disorders?
-Functional dyspepsia (FD)
=(comprising postprandial distress syndrome
=[PDS] and epigastric pain syndrome [EPS]),
-Belching disorders
=(comprising excessive gastric and supragastric belching),
-Chronic nausea and vomiting disorders
=(comprising chronic nausea vomiting syndrome [CNVS], cyclic vomiting
=syndrome [CVS], and cannabinoid hyperemesis syndrome [CHS]),
-Rumination syndrome.
Describe uncomplicated dyspepsia
-Non alarm symptoms
-Prevalence 10-30% worldwide
-Post-prandial distress syndrome (PDS)
=Fullness and satiety but no pain
=Gastric dysmotility or abnormal accommodation
-Epigastric pain syndrome (EPS)
=Pain and burning- visceral hypersensitivity
What is the diagnostic criteria for functional dyspepsia?
Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.
1. One or more of the following:
a. Bothersome postprandial fullness
b. Bothersome early satiety (fullness after eating)
c. Bothersome epigastric pain or burning sensation
AND
2. No evidence of structural disease (often excluded by
upper endoscopy)
What is the pathophysiology of functional dyspepsia?
- CNS modulation (anxiety, stress)
- Visceral hypersensitivity (H+, wall distention)
- Gastroesophageal reflux (H+, bile acids)
- Gastric inflammation (bacteria H.pylori)
- Duodenal inflammation (H+, bacteria, viruses, allergy)
- Decreased fundic accommodation
- Abnormal distribution of gastric contents
- Delayed emptying
- Abnormal myoelectrical activity
- Overdistended antrum
- Intestinal dysmotility
- Impaired mucosal integrity
- Low-grade immune activation
- Dysregulation of gut-brain axis
What environmental exposures are linked to functional dyspepsia?
- Acute infection can trigger upper gastrointestinal symptoms in 10-20% of infected individuals
- Post-infectious dyspepsia can be short-lived compared with post-infection IBS
- Features of infective agents and genetic predisposition of infected individuals likely modulate the probability of developing post-infectious digestive syndromes
What drugs are used for delayed gastric emptying?
Antiemetic, prokinetic combinations
- erythromycin
- Domperidone
What drugs are used in increased fundic tone?
5HT agonist
What drugs are used in hypersensitivity?
Antidepressants
What drugs are used in duodenal mucosa inflammation/ permeability?
Montelukast, H1/H2 bladder combinations