FUNCTIONAL DYSPEPSIA (FD)

BACKGROUND

Functional dyspepsia, also called indigestion or an upset stomach — is a general term that describes discomfort in upper abdomen. Indigestion is not a disease, but rather some symptoms you experience, including abdominal pain and a feeling of fullness soon after you start eating. Symptoms of indigestion may be felt occasionally or as often as daily.

Indigestion can be a symptom of another digestive disease. Indigestion that isn't caused by an underlying disease may be eased with lifestyle changes and medication.

DISEASE OCCURRENCE IN POPULATION:

Globally, the prevalence of uninvestigated dyspepsia varies between 7% - 45%, depending on definition used and geographical location, whilst the prevalence of functional dyspepsia has been noted to vary between 11% - 29.2%.

There is a lack of data regarding occurrence of dyspepsia in Pakistan.

RISK FACTORS:

Risk factors include the following:

• Overeating or eating foods that are difficult to digest;
• Stomach or duodenal ulcers;
• Stomach irritation (gastritis);
• Inflammation of the gallbladder (cholecystitis);
• Lactose intolerance (inability to digest lactose, a milk sugar, and dairy products);
• Irritable bowel syndrome and other disorders affecting intestinal motility;
• Swallowing air (aerophagia);
• Anxiety or depression;
• Medications that irritate the stomach lining;
• Smoking;
• Drinking too much alcohol.

SIGN AND SYMPTOMS:

People with dyspepsia may have one or more of the following symptoms:

• Early fullness during a meal: You haven't eaten much of your meal, but you already feel full and may not be able to finish eating.
• Uncomfortable fullness after a meal: Fullness lasts longer than it should.
• Discomfort in the upper abdomen: You feel a mild to severe pain in the area between the bottom of your breastbone and your navel.
• Burning in the upper abdomen: You feel an uncomfortable heat or burning sensation between the bottom of your breastbone and your navel.
• Bloating in the upper abdomen: You feel an uncomfortable sensation of tightness.
• Nausea: You feel as though you want to vomit.

Less frequent symptoms include vomiting and belching.

DIAGNOSTIC TEST:

Your doctor is likely to start with a health history and a thorough physical exam. Those evaluations may be sufficient if your indigestion is mild and you're not experiencing certain symptoms, such as weight loss and repeated vomiting.

But if your indigestion began suddenly, and you are experiencing severe symptoms, your doctor may recommend:

• Laboratory tests: To check for thyroid problems or other metabolic disorders.
• Breath and stool tests: To check for Helicobacter pylori (H. pylori), the bacterium associated with peptic ulcers, which can cause indigestion. H. pylori testing is controversial because studies suggest limited benefit from treating the bacterium.
• Endoscopy: To check for abnormalities in your upper digestive tract. A tissue sample (biopsy) may be taken for analysis.
• Imaging tests (X-ray or CT scan): To check for intestinal obstruction.

TREATMENT OPTIONS:

Many people find that their symptoms ease with antacids raising the concern about conditions like gastritis and peptic ulcers that also ease with antacids. However, in functional dyspepsia it is believed that the stomach lining is hypersensitive to the presence of acid without the inflammation seen in gastritis or open sores (ulcers) seen in peptic ulcer disease.

Medication for functional dyspepsia includes:

• Antacids that neutralize the stomach acid.
• Proton pump inhibitors and H-2 receptor blockers to reduce gastric acid production.
• Simethicone to relieve gas in the digestive tract.
• Prokinetic agents like metoclopramide to speed up gastric emptying.
• Tricyclic antidepressants to ease pain associated with increased nerve activity.

PRECAUTIONS:

CHANGE CHILD EATING HABITS:

• It's best to feed several small meals instead of two or three large meals to your child. Do not skip meal of your child.
• Instruct child to eat slowly and chew food thoroughly. This will prevent excessive air swallowing (aerophagia) and pronounced distension of the stomach.
• After taking meal, allow child to wait for 2 to 3 hours before child lie down. Late-night snacks aren't a good idea.
• Avoid chocolate, mint, and alcohol, they can make dyspepsia worse.
• Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make dyspepsia worse in some children. If child symptoms are worse after he/she eat a certain food, stop giving that food and check if child symptoms get better.
• Keep a food diary to identify trigger foods which can make your child dyspepsia worse. These trigger foods should then be avoided or minimized.
• Make a habit of your child to walk after eating. This can assist with gastric emptying and may also help with symptoms of reflux.

Protect from your child from second hand smoke.

If child get dyspepsia at night, raise the head of bed 6 to 8 inches by putting the frame on blocks or placing a foam wedge under the head of mattress. (Adding extra pillows does not work.)

Do not dress tight clothing around child abdomen.

Losing weight can help if your child is overweight. It's important to lose weight safely and steadily through regular exercise and by eating a healthy, balanced diet.

Manage stress effectively with relaxation techniques that prove to be helpful. Physical activity like sports may have multiple benefits when it comes to functional dyspepsia.

REFERENCES:

• jnmjournal.org/journal/view.html?uid=107&vmd=Full
• ncbi.nlm.nih.gov/pmc/articles/PMC4130971/
• rightdiagnosis.com/symptoms/dyspepsia/tests.htm
• mayoclinic.org/diseases-conditions/stomach-pain/basics/definition/con-20027306
• www.medscape.com/viewarticle/444547