Update on the Evaluation and Management of Functional Dyspepsia
RYAN A. LOYD, MD, and DAVID A. McCLELLAN, MD, Texas A&M Health Science Center College of Medicine, Bryan, Texas
Am Fam Physician. 2011 Mar 1;83(5):547-552.
http://www.aafp.org/afp/2011/0301/p547.pdf
The ROME II criteria defines functional dyspepsia a having at least one of the following:
postprandial fullness
early satiety
epigastric pain
epigastric burning
no evidence of structural disease
Functional dyspepsia can be divided into two categories; epigastric pain syndromes and postprandial distress syndrome. Pathophysiology is unclear, but may be involved with gastric motility, low pH, and infection.
Whenever a patient is considered to have dyspepsia, a proper history and physical should be done to rule out other more common causes. There is a large differential and thus functional dyspepsia is a diagnosis of exclusion. If the patient has significant risk factors
(age greater than 55 years,
unintentional weight loss,
dysphagia,
persistent vomiting,
gastric bleeding, or
family history of cancer),
then an endoscopy should be done. Any results should be treated accordingly. If the patient has no risk factors or the endoscopy is negative, then the patient can be tested for H.pylori, or treated empirically for the infection. If symptoms resolve, then continue treatment and reevaluate as needed. If it does not resolve, then an endoscopy can be done. Due to cost and the sensitivity of endoscopy, it is better to start with empiric therapy before invasive testing. Cochrane recommends testing first and then treating (makes sense to me!) Testing for H. pylori includes serology, stool antigen, and urea breath testing. H2 blockers and PPIs appear to be the best medication. Prokinetics may have a benefit in treatment. Metoclopramide is a prokinetic that is associated with serious side effects, including tardive dyskinesia and parkinsonian symptoms. Erythromycin is another prokinetic (or irritant, depending on who you ask) which may have benefit. Antidepressants may assist with associated depression and actually improve the dyspepsia.
I had my first bout of functional dyspepsia about 4 years ago now (although at the time I did not know what it was). I went through two MRI's, multiple blood tests, two endoscopys and saw so many 'ologists' I've lost count. I spent two weeks in hospital before being discharged with no diagnosis and the doctors telling me there was nothing they could do. After about a year the whole thing calmed down. Then just over a month ago it came back, 100 times worse than the first time. I spent another weeks in hospital here I was on IV fluids (because I couldn't drink or eat without vomiting). I had another endoscopy, CT scan, more blood tests, biopsies of my stomach etc. All results were absolutely normal and I tested negative for H.pylori. I have now been diagnosed with functional dyspepsia. As soon as I eat or drink anything my stomach throws a fit. I am currently on so many pills that I don't know what half of them do but I know that none of them are working, While I was in hospital my son found at about dr George cure to functional dyspepsia so i email him and order for his product which i use for 3 weeks, now i can tell you am so happy with my life THANKS TO DR GEORGE. You can always contact the Doctor through his email for more information. (georgeadam65@gmail.com) His herbal is the only permanent cure to functional dyspepsia
ReplyDelete