Functional Dyspepsia

Question 1

What are the categories of functional gastrointestinal disorders?

Answer 1

-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.

Question 2

Describe uncomplicated dyspepsia

Answer 2

-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

Question 3

What is the diagnostic criteria for functional dyspepsia?

Answer 3

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)

Question 4

What is the pathophysiology of functional dyspepsia?

Answer 4

• 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

Question 5

What environmental exposures are linked to functional dyspepsia?

Answer 5

• 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

Question 6

What drugs are used for delayed gastric emptying?

Answer 6

Antiemetic, prokinetic combinations

• erythromycin
• Domperidone

Question 7

What drugs are used in increased fundic tone?

Answer 7

5HT agonist

Question 8

What drugs are used in hypersensitivity?

Answer 8

Antidepressants

Question 9

What drugs are used in duodenal mucosa inflammation/ permeability?

Answer 9

Montelukast, H1/H2 bladder combinations