2023-04-28 07:11:05
Definition: what is functional dyspepsia?
Dyspepsia is defined as a digestive disorder characterized by discomfort – even pain – chronic localized on the epigastric regionwhich results in a impression of bad digestion. Since these symptoms are quite common, in some cases they can be linked to an organic pathology, in which case dyspepsia is one of the symptoms. We only speak of functional dyspepsia when the dyspepsia is not attributable to any organic pathologyand no obvious cause is identified.
Dr Paul Benfredj, gastroenterologist: Functional dyspepsia is a rather vague and poorly understood concept. It is sometimes said to be the “high counterpart” of irritable bowel syndrome (IBS).
What are the possible causes of functional dyspepsia?
Although functional dyspepsia has no identifiable cause, there are a few risk factors for its occurrence.
- Treatment or infection : “It happens that a functional dyspepsia appears following a drug treatment, in particular a nonsteroidal anti-inflammatory drug (NSAID) or following certain infections, often of the gastroenteritis type”, indicates the gastroenterologist.
- Helicobacter pylori : If it is difficult to know if the bacterium can be responsible for dyspepsia in a carrier patient, it would seem that a small proportion of them see their symptoms disappear following its eradication. “The search for helicobacter pylori is therefore part of the examinations that can be done in the event of functional dyspepsia, although this is not a recognized major cause”, underlines the specialist.
- Diabetes “Diabetes may be responsible for a gastric emptying defect called gastroparesiswhich can be likened to severe dyspepsia,” explains Dr. Benfredj.
When do we speak of nervous dyspepsia?
As with many digestive disorders – including IBS (irritable bowel syndrome) – it is believed thatpsychological aspect (stress, anxiety, anxiety, nervousness, etc.) can play a role in the onset or aggravation of dyspepsia. “The term nervous dyspepsia is not patented or used medically. Rather, it is said that dyspepsia is often related to nervousness, ”says the gastroenterologist.
Nausea, bloating, stomach pain, burping, early satiety…: the many symptoms of dyspepsia
Dyspepsia is characterized by a difficulty in digestion associated with a feeling of rapid gastric fullness.
The patient feels full very quickly and may have difficulty finishing a normal-sized meal, translates the gastroenterologist.
This early satiety is often associated with belching and sometimes to pain and/or burning located in the epigastric or oesogastroduodenal region. It is therefore a disorder of the upper digestive tract, unlike IBS which concerns the lower digestive tract.
Does dyspepsia make you tired?
Fatigue is not a symptom of dyspepsia. “However, when dyspepsia is said to be nervous, fatigue can be linked to anxiety or stress,” says Dr. Benfredj.
What is the difference with gastritis?
“Very often patients suffering from dyspepsia use the term gastritis, but it is necessary to distinguish between the two pathologies”, insists Dr. Benfredj.
Dr. Benfredj: Gastritis is usually asymptomatic and discovered incidentally. Patients with gastritis tend to blame their dyspepsia symptoms on it even though they are two separate things.
Gastritis is characterized by inflammation stomach cells, which is not the case with dyspepsia.
Diagnostic: which test?
First, the doctor performs a history and a complete clinical examination of the patient, in order to determine whether the dyspepsia is functional or potentially linked to a digestive pathology.
If he is leaning towards functional dyspepsia, he may look for: a diabetes or the presence of helicobacter pylori. If he suspects a possible digestive pathology, he will prescribe additional examinations. This is usually the case if:
- the patient has over 45 years old : age from which the risk of cancer of the esophagus or stomach increases;
- if the subject is younger, in the presence of a significant weight loss or anemia;
- in case of’personal or family history digestive cancer.
The proposed examination is then the gastric fibroscopy – or gastroscopy – with biopsy, which makes it possible to check the state of the gastric and duodenal wall. “Gastroscopy and fibroscopy can also be offered as first-line treatment, without there necessarily being any suspicion of a more serious pathology”, specifies the specialist.
Treatment: how to treat dyspepsia?
The management of functional dyspepsia is considered, as soon as possible organic causes are ruled out. This care is often delicate and does not always give the expected results. It always begins with the implementation of a few simple lifestyle and dietary measuresand if they are not enough, a drug treatment can be proposed to relieve the symptoms.
Food and eating habits: what foods to avoid in case of dyspepsia?
The basic hygiene and dietary advice are:
- split meals and avoid overeating ;
- avoid carbonated drinks ;
- limit the intake of drinks during meals, and prefer drink between meals ;
- limit caffeine-rich drinks ;
- avoid wearing clothes that are tight around the waist ;
- limit as much as possiblealcohol and tobacco ;
- practice a regular physical activity ;
- regain a healthy weight in case of overweight or obesity.
And although the famous drink Pepsi-cola was named for its supposed benefits on dyspepsia, it has never been shown to be effective, quite the contrary, since it contains both gas and caffeine, two aggravating elements!
What drugs?
In first intention, when dyspepsia is accompanied by pain, patients are offered drugs that act on acidity, such as H2 blockers or proton pump inhibitors (PPI).
If there is little pain but mainly digestive discomfort, prokinétiques (domperidone or metoclopramide) may be offered. Whether Helicobacter pylori has been detected, a antibiotic treatment is set up to eradicate it.
“If none of this works, the options for treatment narrow. Numerous tests are in progress but none is giving very convincing results for the moment”, regrets the specialist.
Other approaches can then be considered:
- hypnosis might work for some patients,
- Antidepressants such as imipramine or Venlafaxine in small doses: which have an anxiolytic effect on the one hand, but which would also act on gastric motility.
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