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Dyspepsia
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INTRODUCTION
Functional dyspepsia, sometimes referred
to as non-ulcer dyspepsia, is a common
functional disorder of the upper digestive
tract (stomach and upper small intestine).
Functional dyspepsia is characterised by
chronic or recurrent upper abdominal pain
or discomfort, often in conjunction with
feelings of early satiety (fullness), pressure in
the abdomen, burning, bloating, belching or
nausea. Symptoms may occur after eating a
meal, but can happen at any time. Similarly,
certain foods or drinks may worsen symptoms
for some people.
As with other functional disorders, there
is no evidence of organic disease or other
structural abnormality in the gut (such as
an ulcer or inflamed esophagus) that can
account for the symptoms that are present.
While the condition is uncomfortable and can
be distressing, especially if symptoms are
chronic, functional dyspepsia does not cause
other, more serious conditions. The symptoms
associated with functional dyspepsia can
be addressed, as outlined further in this
leaflet, and the prognosis for the condition is
generally quite good.
CAUSES
The exact cause of functional dyspepsia is not known, however symptoms are
thought to be linked to an increased sensitivity in the esophagus and upper
gastrointestinal system, which can be triggered by a variety of factors.
These may include: impaired peristalsis (contraction and
relaxation of the intestinal muscles that move food
through the upper digestive tract), acid secretion, diet,
lifestyle, and psychological factors. Many people with
functional dyspepsia have an increased awareness of their
stomach and upper gut activity and can have impaired
digestion or be sensitive to food intake. Many people with
functional dyspepsia find that certain foods can make
symptoms worse, however, food is not the cause of
functional dyspepsia.
Emotional factors
It has recently become evident that stress and other
psychological factors, such as anxiety and depression,
can affect the gastrointestinal system. These
psychological factors can make functional dyspepsia
symptoms worse, and sufferers more sensitive and less
tolerant of food. Heightened emotional states can lead
to chemical changes in the body that can hinder the
process of digestion. This can be cyclical as well, as the
uncomfortable nature of functional dyspepsia can lead
to more stress, depression, anxiety or anger.
symptoms
General Symptoms
The symptoms of functional dyspepsia vary between each individual, as does their
severity. At times, symptoms and signs can be mild, and at other times they can be
painful and debilitating. Symptoms are often worse after eating and tend to come and
go in bouts.
oo
oo
oo
Loss of appetite
oo
Belching
oo
Bloating
oo
Nausea
oo
Vomiting
Stress/depression/anxiety
Alarm symptoms
oo
difficulty swallowing
oo
difficulty breathing
oo
oo
oo
oo
shortness of breath
oo
oo
DIAGNOSIS
Functional dyspepsia is a functional gastrointestinal
disorder, with no obvious physical abnormalities of the
digestive tract, and so there is no specific test that can
determine if it is present. Therefore, functional dyspepsia
is largely a diagnosis of exclusion. Your doctor will need
to ask you a series of health questions, take your medical
history, and complete a physical exam in order to rule out
other causes. A diagnosis is made based on the symptoms
you describe and the exclusion of other causes.
Early satiation
Epigastric pain
Epigastric burning
and
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In some cases, particularly if you have alarm symptoms (see previous heading), your
doctor may want to carry out additional tests. This is to rule out the possibility of
other, more serious conditions, or infection or inflammation or the upper GI tract.
Further Tests
If alarm symptoms are raised, further tests may be recommended in order to rule
out other conditions. Further investigations may include the following, depending on
your symptoms and concerns:
Endoscopy
Blood tests
A blood sample may be required to rule out more serious
conditions.
TREATMENT
Once diagnosed with functional dyspepsia, there are a
number of treatment options that can help you alleviate
your symptoms. Sometimes, with mild to moderate cases
of functional dyspepsia, symptoms can be managed at
home by changing elements of your diet and lifestyle.
When symptoms are more severe, or if your functional
dyspepsia has become chronic, medication and
psychological treatments can also be useful. The different
psychological treatments for functional dyspepsia are
cognitive behavioural therapy (CBT), psychodynamic
psychotherapy and hypnotherapy.
Eat regularly
Diet
Identify problem foods
In many cases, certain foods and drinks can exacerbate
the symptoms of functional dyspepsia. Foods with a
high fat or sugar content, for example, can slow down
the passage of food through the gut and break down
producing gas and liquid, which may make dyspeptic
symptoms worse. While these foods are not the cause
of functional dyspepsia, your gut may not tolerate them
well. Identifying and limiting your intake of certain types
of foods, in conjunction with a healthy, balanced diet, may
improve your symptoms.
Consider the following list of foods and drinks that are
sometimes associated with functional dyspepsia and
consider limiting your intake if you are finding any of these
make your symptoms worse:
oo
oo
oo
spicy foods
oo
alcohol
oo
oo
carbonated beverages
oo
lactose
oo
chocolate
Lifestyle
Smoking
Therapeutic Interventions
If more conservative treatment, such as changes to diet
and exercise routines do not help relieve your symptoms,
or if functional dyspepsia is having a significant impact on
your daily activities and quality of life, a talking therapy
or counseling can often be helpful. This is particularly true
for those who experience high levels of stress, or who
feel stress worsens their symptoms. Reducing the amount
of tension you experience or learning tools to manage
stress and anxiety can often reduce the severity and
frequency of functional dyspepsia symptoms and improve
Medication
If other more conservative treatments do not have an
effect on your functional dyspepsia, medication can
sometimes be prescribed to reduce the severity of
symptoms. For further more specialised medications
consult your gastroenterologist.
Acid-suppressing medications
There are a range of over-the-counter medications from
your pharmacist that may help reduce the amount of acid
in the stomach. If your stomach is sensitive to acid, these
antacid medications may reduce dyspeptic symptoms,
such as bloating or upper abdominal discomfort. Acidsuppressing medications are not a long-term solution
however, and should only be used as needed and in the
short-term.
Prescription-only medications
If other means of controlling symptoms do not work,
your GP or gastroenterologist may try another type of
prescription medication, such as a prokinetic drug, to
address your symptoms.
Anti-depressant medications
If you are experiencing high levels of stress and/
or depression, your doctor may recommend an
antidepressant medication in addition to diet and exercise,
or in conjunction with psychotherapy treatment. These
medications can help with symptoms of depression and
via the brain-gut axis can inhibit the activity of neurons
that control the intestines. Sometimes antidepressant
medications are prescribed at a very low dose in the
absence of depression as these have been shown to
reduce the pain signals that eminate from the gut in
functional bowel disorders.
Hypnotherapy
Hypnotherapy has been shown to help some people with
functional disorders reduce their symptoms of pain and
discomfort. Hypnosisis used to change your unconscious
minds attitude towardsyour symptoms. You can have
hypnotherapy as an outpatient, oryou can learn selfhypnosis techniques to practice at home.
COMPLICATIONS
While functional dyspepsia is not linked to any life-threatening
condition or illness, there can often be an impact on day-to-day
activities and quality of life. For some people, the difficulties of coping
with the symptoms of functional dyspepsia (ie frequently belching
or experiencing discomfort in the abdomen) may limit their ability or
desire to make plans, maintain social commitments and recreational
activities. The pain and discomfort of functional dyspepsia, combined
with the effect it can have on ones social, work, or personal
activities can be very taxing. Over time, this may lead to feelings of
discouragement, stress, depression, and anxiety.
If you are experiencing any of these symptoms, or if you feel
functional dyspepsia is limiting your activities or negatively affecting
your quality of life, it is recommended that you visit your GP, who
will be able to help identify an appropriate and effective treatment
for you.
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SUPPORT AND
FURTHER RESOURCES
Living with functional dyspepsia can be uncomfortable
and challenging and it can be difficult to know where
to turn for help. While your first point of contact should
always be your GP or gastroenterologist, educational
and community resources may help you to cope more
effectively with functional dyspepsia and improve your
quality of life.
The Core Charity (www.corecharity.org.uk) is such a
non-profit organisation that raises awareness and funds
research on gut and liver disease, promotes education
on gut function, and provides contacts for patient
organisations and support groups.
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