Dyspepsia. Causes and types

The first sign of any disease digestive organ- dyspepsia. This is a specific set of symptoms (syndrome), which manifests itself in different ways, depending on the level of damage to the gastrointestinal tract.

Most often, the patient experiences nausea, abdominal pain and discomfort. In 60% of patients, this condition occurs without any obvious cause, which makes diagnosis extremely difficult and requires special approaches to treatment.

In the clinic, there are 2 main groups of the syndrome. The first is functional dyspepsia, which is an independent disease. The second is organic, accompanying any gastroenterological disease (rotovirus or bacterial infection, cholecystitis, toxic poisoning, etc.). They must be considered independently of each other, as they differ significantly in symptoms, causes of development and treatment.

What it is?

Dyspepsia is one of the main problems of gastroenterology, since up to 40% of the population of developed countries makes vague complaints of digestive discomfort, while only one in five visits doctors. Digestive disorders may have an organic or functional basis. Organic dyspepsia occurs against the background of various pathologies of the digestive organs (gastritis, peptic ulcer, inflammatory diseases hepatobiliary system, pancreas and various parts of the intestine, tumors of the gastrointestinal tract, etc.).

Functional dyspepsia is said to be in the case when, in the presence of symptoms of a violation of the activity of the stomach, no organic pathology is detected that could cause these complaints. Women suffer from functional dyspepsia 1.5 times more often than men; The main age group in which this disease is detected is 17-35 years old.

Classification

In medicine, there are two main forms of gastric dyspepsia:

1. functional. With this form of the course of the disease, there are no organic lesions of the digestive system, there are only functional disorders.
2. organic. Dyspepsia in this case will be associated with structural changes in the cells / tissues of the digestive system. It is with organic dyspepsia that the symptoms of the disease are pronounced.

The disease in question is classified and based on the reasons that provoked its development:

1) Alimentary dyspepsia - there is a direct connection between the appearance of symptoms of pathology and malnutrition. It is subdivided into:

• Fermentation - the patient consumes large quantities of foods high in carbohydrates (legumes, bread, pastries, cabbage) and drinks prepared by fermentation (kvass, beer).
• Putrefactive - more often diagnosed when eating a large amount of protein products, as well as not fresh meat.
• Soapy - occurs against the background of a large amount of fat in the diet. Especially often soapy (it is also called fatty) alimentary dyspepsia is inherent in people who eat pork and lamb.

2) Dyspepsia resulting from insufficient secretion of food enzymes. This makes it difficult for the stomach to digest food. This type of disease in question is divided into:

• enterogenic dyspepsia - the patient secretes too little gastric juice;
• gastrogenic - insufficient amount of stomach enzymes;
• hepatogenic - there are violations in the process of bile production by the liver;
• pancreatogenic - a small amount of enzymes secreted by the pancreas.

3) Dyspepsia, directly related to the violation of the process of intestinal absorption. Most often occurs against the background of malabsorption syndrome - this is congenital disease which is characterized by a violation of the absorption of nutrients into the blood.

4) Dyspepsia on the background of intestinal infections. In this case, the disease in question will be classified as secondary. May occur in the background:

• dysentery (shigellosis infection) - a pathology that affects colon. Most characteristic symptom disease is feces with impurities of blood and mucus;
• salmonellosis (acute intestinal infection of bacterial etiology) is a pathology that is diagnosed with vomiting, diarrhea, hyperthermia, dizziness.

5) Intoxication dyspepsia. It develops against the background of poisoning with the development of various pathologies - for example, with purulent infections, influenza, poisoning with toxic substances.

Reasons for development

There is a wide variety of causes that can cause dyspepsia. Very often, several causes and / or risk factors are simultaneously involved in the development of this syndrome. Modern concept about the causes of dyspepsia was actively developed in last years. Today scientists are possible causes, contributing to the development of dyspepsia, consider a number of factors, namely hypersecretion of hydrochloric acid, nutritional errors, bad habits, long term medicines, Helicobacter Pylori infection, neuropsychiatric and other factors.

The causes of dyspepsia are:

• bacteria;
• stress;
• genetic predisposition;
• pathology of the biliary (biliary) system;
• pathology of the gastrointestinal tract (GIT).

Stress as a cause of dyspepsia

In the development of dyspepsia, the initial state of the central nervous system. Recent studies in this area have revealed that patients with dyspepsia have disorders in the perception and processing of impulses from the gastrointestinal tract by the nervous system. Thanks to the method of functional magnetic resonance imaging, it was found that distension of the stomach causes the activation of certain areas of the brain.

Confirmation that the state of the nervous system plays an important role in the development of dyspepsia is the fact that stressful situations often provoke a deterioration in the condition of patients with this disease.

Helicobacter pylori and other bacteria in the development of dyspepsia

An important role in the development of dyspepsia is played by the microbial factor, namely Helicobacter Pylori. Many researchers confirm the etiological role of this microorganism in the formation of dyspepsia syndrome. They rely on data clinical picture dyspepsia in patients with Helicobacter pylori. They also believe that the severity of the syndrome is related to the degree of contamination of the gastric mucosa. The proof of this theory is the fact that after antibiotic therapy (against Helicobacter) the manifestations of dyspepsia are significantly reduced.

Also, with functional dyspepsia (as with many other functional diseases), a connection with previously transferred infectious diseases. These can be infections caused by Salmonella gastroenteritis or Giardia lamblia. It is assumed that after the infection, a sluggish inflammatory process, which may contribute to visceral hypersensitivity.

genetic predisposition

In recent years, research has been actively conducted to identify the genetic predisposition to dyspepsia. As a result of these studies, a gene was identified that is associated with the work of the digestive organs. Disruption of its expression may explain this pathology.

Pathology of the gastrointestinal tract in dyspepsia

Various diseases of the gastrointestinal tract can also be the cause of dyspeptic syndrome. It can be gastritis, peptic ulcer or pancreatitis. In this case, we are not talking about functional, but about organic dyspepsia.

The most common disease that manifests itself as symptoms of dyspepsia is gastritis. Chronic gastritis is a disease that affects more than 40 to 50 percent of the adult population. According to various sources, the frequency of this disease is approximately 50 percent of all diseases of the digestive system and 85 percent of all diseases of the stomach. The second most common is gastric ulcer. It is a chronic disease with periods of exacerbation and remission.

Pathology of the biliary system

In the hepatobiliary system of the body, the formation of bile occurs continuously. It serves as a reservoir gallbladder. In it, bile accumulates until it enters the duodenum. From the gallbladder during digestion, bile enters the intestines, where it participates in the digestion process. Bile demulsifies (breaks down into small particles) fats, facilitating their absorption. Thus, the biliary system takes an important part in digestion, and therefore the slightest dysfunction can provoke the development of dyspepsia.

The most common functional disorders of the biliary system, namely various dyskinesias (motor disorders). The prevalence of these disorders ranges from 12.5 to 58.2 percent. In persons over 60 years of age, functional disorders of the biliary system are observed in 25 to 30 percent of cases. It is important to note that dyskinesia predominantly affects women. Functional disorders of the biliary system include functional disorder of the gallbladder, functional disorder of the sphincter of Oddi, and functional pancreatic disorder.

Symptoms and first signs

In case of indigestion, patients present various complaints, which are united by the general term "dyspepsia". In adults, these symptoms are:

• dysphagia (difficulty swallowing);
• pain, discomfort in the epigastric region;
• belching;
• nausea, vomiting;
• heartburn;
• rumbling in the stomach;
• flatulence;
• diarrhea, constipation.

Esophageal dyspepsia is manifested by dysphagia. Patients complain of difficulty swallowing, inability to swallow liquid (with spasm of the esophagus) or solid food. There is a sensation of a lump in the throat, pain when swallowing, food getting into other organs. Dysphagia occurs with all diseases of the esophagus, for example:

• esophagitis;
• gastroesophageal reflux disease;
• esophageal ulcer;
• stenosis;
• benign tumors of the esophagus;
• periesophagitis;
• diverticulum of the esophagus;
• scleroderma.

In addition, dysphagia may indicate other diseases not associated with an organic lesion of the esophagus:

1. Diseases of the central, peripheral nervous and muscular systems. Patients with esophagospasm, atony of the esophagus and achalasia of the cardia complain of esophageal dyspepsia.
2. Pathologies of neighboring organs. Dysphagia occurs when narrowing of the esophagus caused by a tumor or mediastinal cysts, central cancer lung, mitral defect, aortic aneurysm, vascular anomalies, hyperplasia thyroid gland and etc.

With dyspepsia caused by diseases of the stomach and duodenum patients complain about:

1. Pain in the epigastric region. It can be intense, or patients feel discomfort in the epigastric region.
2. Rapid satiety, feeling full, nausea.
3. Belching. With hypersecretion of gastric juice, patients complain of belching sour, heartburn. Belching of air and food occurs with achlorhydria.

Gastric dyspepsia occurs when:

• peptic ulcer;
• gastritis;
• benign tumors;
• stomach cancer.

Alarming symptoms accompanying gastric dyspepsia are loss of appetite, sudden, for no good reason, weight loss.

With intestinal dyspepsia, patients complain of:

• rumbling in the lower and middle part of the abdomen;
• flatulence (increased gas separation);
• flatulence;
• diarrhea
• constipation.

Digestive disorders in the intestines signal such pathologies:

• diverticular disease;
• dysbacteriosis;
• intestinal tumors;
• enzymopathies;
• infectious diseases of the intestine (dysentery, salmonellosis, intestinal tuberculosis, cholera, typhoid and paratyphoid diseases);
• irritable bowel syndrome;
• enteritis;
• colitis;
• Crohn's disease;
• ischemic colitis;
• stomach diseases (dumping syndrome, gastritis, cancer);
• pathology of the pancreas;
• diseases of the endocrine system;
• gynecological diseases;
• metabolic pathology.

In patients with functional dyspepsia, various symptoms predominate. Depending on this, there are such options clinical course diseases:

1. Ulcerative. Patients complain of hungry and nocturnal pain in the epigastric region. They are aggravated by nervous tension, anxiety, fear.
2. Dyskinetic. Characterized by rapid saturation, a feeling of fullness in the stomach, bloating, rarely accompanied by nausea and vomiting.
3. Non-specific. A combination of signs of ulcer-like and dyskinetic variant of the course of the disease. Often, symptoms of gastrointestinal pathologies are added to them (abdominal pain that disappears after defecation, constipation).

Only a doctor can determine what exactly caused dyspepsia by conducting an examination. Special attention should be given to the "symptoms of anxiety":

• weight loss for no reason;
• night pains in the abdomen;
• abdominal pain is the only sign of illness;
• fever;
• enlargement of the liver, spleen;
• leukocytosis;
• anemia;
• high ESR;
• deviation from the norms in the biochemical analysis of blood.

For an accurate diagnosis, in addition to a thorough examination and questioning of the patient, it is necessary:

• general and biochemical analysis blood and urine;
• general analysis stool and occult blood test;
• Ultrasound of organs abdominal cavity;
• EGDS;
• determination of the acidity of gastric juice;
• assessment of the motor-evacuation function of the stomach (X-ray, electrogastroenterography, probe food test, etc.);
• determination of H. Pylori infection.

Often the patient is referred for additional consultations to an endocrinologist, cardiologist, neuropathologist, psychiatrist. And only after an accurate diagnosis is established, treatment begins. It depends on the cause of the illness.

Diagnostics

Diagnosis of functional dyspepsia primarily involves the exclusion of organic diseases that occur with similar symptoms, and includes research methods:

1. Esophagogastroduodenoscopy - allows you to detect reflux esophagitis, stomach ulcers, stomach tumors and other organic diseases.
2. Ultrasound examination - makes it possible to identify chronic pancreatitis, cholelithiasis.
3. Clinical blood test.
4. Blood chemistry.
5. General analysis of feces, analysis of feces for occult blood.
6. X-ray examination.
7. Electrogastroenterography - allows you to identify violations of gastroduodenal motility.
8. Stomach scintigraphy - helps to identify gastroparesis.
9. Daily pH-metry - allows you to exclude gastroesophageal reflux disease.
10. Determination of infection of the gastric mucosa with the bacterium Helicobacter pylori.
11. Esophagomanometry - which allows you to assess the contractile activity of the esophagus, the coordination of its peristalsis with the work of the lower and upper esophageal sphincters (LES and UES)
12. Antroduodenal manometry - allows you to explore the motility of the stomach and duodenum.

How to treat dyspepsia?

Therapy depends on the form of the syndrome and is aimed at reducing the intensity of symptoms and preventing relapses.

Patients who are faced with the first symptoms of dyspepsia are advised to adjust their lifestyle. It is necessary to adhere to such non-drug methods of treatment:

1. Hiking. After eating, it is strictly forbidden to lie down. It is not recommended to even sit. It is best to take a short walk after eating, for 30-60 minutes. Such actions activate intestinal motility.
2. Proper charging. In the case of dyspepsia, it is necessary to limit exercises that develop the abdominal muscles.
3. Choice of clothes and accessories. It is necessary to select things of the appropriate size. Do not tighten the stomach with a belt. Women are advised to give up corsets and bras that tighten the chest.
4. Dinner. The last meal should take place 3 hours before bedtime.
5. High pillow. The head during sleep should be significantly higher than the body. This will prevent reflux of gastric contents into the esophagus.

Medical treatment

Unfortunately, many patients go to the doctor when the pathology is already progressing. In such situations, it is impossible to do without medical assistance.

Drug therapy usually includes the following drugs:

1. Prokinetics. To reduce nausea and protect against vomiting, the patient is prescribed: Motilium, Metoclopramide, Cerucal, Cisapride, Coordinax, Prepulsid, Cysap.
2. Drugs that improve the functioning of the digestive tract. Therapy sometimes includes the defoamer Simethicone and activated charcoal. This combination improves digestion and facilitates the access of enzymatic substances to digested food, by reducing foam and absorption of harmful components.
3. Antibiotics. These drugs are prescribed for intestinal infections. If the unpleasant condition is caused by the penetration of bacteria into the digestive system, the doctor will recommend the patient to resort to antibiotic therapy. One of effective drugs is Alpha Normix.
4. Painkillers. They are designed to reduce pain in the abdomen. Such medicines are in demand: Drotaverin, No-Shpa.
5. Hydrogen pump blockers. Means can reduce the acidity of the stomach. These medicines are useful for sour belching and heartburn. Usually prescribed: Omeprazole, Ultop, Omez, Lanzoptol, Losec Maps, Rabeprazole, Pariet, Sanpraz, Esomeprazole, Pantoprazole, Nexium.
6. H2-histamine blockers. This group of drugs is also aimed at reducing the acidity of the stomach. It differs from the above drugs in a weaker effect. May be recommended: Famotidine, Gastrosidin, Ranitidine, Kvamatel, Ranisan.
7. Antacids. Preparations that neutralize hydrochloric acid. Therapy may include: Maalox, Phosphalugel, Gastal, Actal, Protab.
8. enzyme preparations. They restore the lack of enzymes and help digest food. Such medicines are effective: Mezim, Pancreatin, Festal, Pancreazin.

If dyspepsia is provoked by stress, then antidepressants are recommended to the patient.

Nutrition and diet

With fermentative, putrefactive and fatty and organic form of dyspepsia, nutritional correction is indicated. The following categories of foods are eliminated from the diet:

• fried and fatty foods;
• sweet;
• flour baking;
• spicy seasonings;
• salinity;
• carbonated drinks;
• legumes;
• white cabbage;
• grape;
• garlic;

Consumed dishes must be stewed or steamed. The diet should include dairy products, cottage cheese, cheese, cereals, chicken and vegetables without a large amount of complex carbohydrates (beets, carrots, etc.).

Eating should be frequent, but in small portions. Overeating should not be allowed and long intervals between doses should not be allowed. After eating, the patient should actively move.

Prevention

The course of the disease is favorable, and it will not be difficult to defeat dyspepsia if all the recommendations of a specialist are followed. But, like any other pathology, it is easier to prevent. For this it is recommended:

• lead healthy lifestyle life;
• eat properly;
• avoid stress;
• there are only fresh and high-quality products;
• follow the daily routine;
• observe the rules of personal hygiene;
• give up cigarettes and alcohol.

People with a predisposition to the development of gastrointestinal diseases should be regularly examined by a gastroenterologist.

Dyspepsia is a term, in the broad sense of the word, that includes most of the subjective manifestations of diseases of the gastrointestinal tract, caused by a violation of the digestive processes. The term dyspepsia is of Greek origin and means "indigestion".

Dyspepsia in the broadest sense is pain of a dull, boring or burning nature localized in the epigastric region closer to midline and feelings of discomfort (heaviness, fullness, bloating, nausea, heartburn, belching). Dyspepsia can manifest itself as a violation of digestion.

functional dyspepsia- a symptom complex of functional disorders, including pain or discomfort in the epigastric region, heaviness, a feeling of fullness after eating, early satiety, bloating, nausea, vomiting, belching, heartburn and other signs in which organic diseases cannot be detected (i.e. dyspepsia without a definite biochemical or morphological cause).

• Epidemiology of dyspepsia

  Dyspeptic disorders are among the most common gastroenterological complaints. Literature data on the prevalence of functional dyspepsia syndrome among the population range from 5 to 70%. In the developed countries of Western Europe, they occur in about 30-40% of the population and cause 4-5% of all visits to doctors. general practice. In some African countries, the frequency of dyspepsia syndrome in the population reaches 61%.

  The presence of dyspeptic symptoms significantly reduces the quality of life of patients. However, only 20-25% of patients go to the doctor. At the same time, studies have shown that a smaller part (35-40%) falls on the share of diseases included in the group of organic dyspepsia, and most (60-65%) - on the share of functional dyspepsia.

  The high prevalence of dyspepsia syndrome among the population determines the huge costs incurred by health care for the examination and treatment of such patients.

  In women, functional dyspepsia occurs 1.5 times more often than in men.

  The most common functional dyspepsia at the age of 20-40 years. At an older age, functional dyspepsia is less common, since other chronic diseases of the digestive tract that cause clinical manifestations are more common.

• Classification of dyspepsia

  All patients with dyspepsia are divided into 2 parts:

  • Dyspepsia with an established cause (organic).

    It can be observed with peptic ulcer, diseases of the pancreas, gallbladder and other organic diseases. Organic causes of dyspepsia are found in 40% of patients.

  • Dyspepsia without an established cause (functional dyspepsia).

    According to the Rome criteria-2 (1999), functional dyspepsia includes clinical manifestations that have developed as a result of disorders of gastric motility and 12 PCs, not associated with any organic pathology and observed for more than 12 weeks (at least 12 weeks for 12 months ). With functional dyspepsia, there is no association of pain and discomfort with impaired bowel function.

  By clinical manifestations functional dyspepsia is divided into 3 forms:

  • Ulcer-like form of functional dyspepsia. The main symptom is epigastric pain.
  • Dyskinetic form of functional dyspepsia. The main symptoms are abdominal discomfort without pain.
  • Nonspecific functional dyspepsia. There are mixed symptoms (nausea, bloating, hiccups, belching, heartburn).

• ICD-10 code

  K30 - Dyspepsia.

Diagnostics

The diagnosis of functional dyspepsia is suggested when symptoms of dyspepsia occur in the absence of causes that could cause them.

• Rome II criteria (1999) for functional dyspepsia According to the Rome II criteria (1999), the diagnosis of functional dyspepsia is based on the presence of 3 main criteria:
  • Persistent or recurrent dyspepsia (pain or discomfort localized in the epigastric region in the midline), the duration of which is at least 12 weeks in the last year.
  • Lack of evidence of an organic disease, confirmed by anamnesis, endoscopic examinations and ultrasound of the abdominal organs, as well as clinical and biochemical studies.
  • No evidence that dyspepsia is relieved by defecation or is associated with a change in stool frequency or consistency (which is characteristic of irritable bowel syndrome).

• Diagnostic methods

  Application various methods research is aimed at excluding organic diseases that may be accompanied by symptoms of dyspepsia.

  • Anamnesis

    When collecting an anamnesis, the doctor should find out if the patient has diseases that cause dyspeptic symptoms. Determine the nature and dynamics of complaints (pain, distension, belching, heartburn), their relationship with the season and food intake.

    It is also necessary to find out the nature of the patient's diet.

    It is important to find out if the treatment was carried out earlier and by what methods.

  • Physical examination

    It is carried out to exclude physical signs of diseases of the gastrointestinal tract, respiratory and cardiovascular systems.

• Diagnostic plan
  • Routine diagnostic methods include clinical analysis blood and fecal examination for the presence of occult blood (to exclude gastrointestinal bleeding), as well as a biochemical blood test.
  • In the presence of deviations in routine diagnostic methods, it is indicated to carry out additional methods diagnostics (eg, imaging studies and endoscopy).
  • Patients over the age of 45, as well as patients with warning symptoms! (dysphagia, vomiting with blood, melena, hematochezia - scarlet blood in the feces, fever, unmotivated weight loss, leukocytosis, anemia, increased ESR), due to the risk of malignancy, an immediate endoscopic examination of the stomach is indicated.
  • For patients younger than 45 years of age (in the absence of warning signs), some clinicians recommend empiric therapy with antisecretory or prokinetic drugs. If there is no effect from the treatment, diagnostic endoscopic intervention is performed. The main danger of empiric therapy for diagnostic purposes is that even a short course of conservative therapy can give a good subjective effect in many cases. serious illnesses(including, for example, the primary ulcerative form of gastric cancer), which can lead to their belated diagnosis.
  • Some authors recommend screening tests to rule out H. pylori infection (eg, urease breath test, fecal PCR).
  • If symptoms of gastroesophageal reflux persist after endoscopy and 2-4 weeks of inhibitors proton pump patients may be prescribed esophageal manometry and pH-metry.

• Differential diagnosis in functional dyspepsia

  The first stage of the differential diagnosis- exclusion of organic pathology.

  After performing examinations aimed at excluding organic causes, and determining the functional nature of dyspepsia, it is necessary to conduct a differential diagnosis with other functional disorders.

  Functional dyspepsia often has to be differentiated from irritable bowel syndrome - a disease also of a functional nature, manifested by abdominal pain that disappears after defecation, flatulence, diarrhea, constipation or their alternation, sensation incomplete emptying intestines, imperative urge to defecate. At the same time, however, it is often necessary to keep in mind that functional dyspepsia can often be combined with irritable bowel syndrome, since in the pathogenesis of both syndromes an important place belongs to similar disorders of the motor function of the digestive tract.

  In some cases, the syndrome of functional dyspepsia has to be differentiated from other functional disorders of the stomach - aerophagia and functional vomiting.

  In accordance with the recommendations of the aforementioned conciliation meeting (Rome, 1999), aerophagia is defined as repeated belching due to swallowing air, which causes anxiety to the patient and is noted by him for at least 12 weeks during the year. The diagnosis is usually based on the history and objective evidence of increased air swallowing. Patients suffering from aerophagia require a mandatory consultation with a psychiatrist to rule out depression and increased anxiety.

  The diagnosis of functional vomiting is made when the patient vomits for at least 12 weeks during the year and at least 3 days a week, and a thorough examination does not reveal other reasons explaining the presence of given symptom(no self-induced or drug-induced vomiting, no organic damage bowel or central nervous system, metabolic disorders, and serious mental illness). The diagnosis of rare functional vomiting is difficult and is made only after a thorough examination of the patient, including gastroduodenoscopy, X-ray examination of the small intestine and computed tomography, determination of the content of electrolytes, assessment of the evacuation function of the stomach, a thorough study of the state of the central nervous system.

  With the persistent nature of dyspeptic symptoms, it may be useful to consult a psychiatrist to rule out depression and somatoform disorders.

The first sign of any disease of the digestive organ is dyspepsia. This is a specific set of symptoms (syndrome), which manifests itself in different ways, depending on the level of damage to the gastrointestinal tract. Most often, the patient experiences nausea, abdominal pain and discomfort. In 60% of patients, this condition occurs without any obvious cause, which makes diagnosis extremely difficult and requires special approaches to treatment.

In the clinic, there are 2 main groups of the syndrome. The first is functional dyspepsia, which is an independent disease. The second is organic, accompanying any gastroenterological disease (rotovirus or bacterial infection, toxic poisoning, etc.). They must be considered independently of each other, as they differ significantly in symptoms, causes of development and treatment.

organic dyspepsia

Thanks to the dyspepsia syndrome, it is possible to approximately determine which organ is affected, since the symptoms of the gastric and intestinal forms differ significantly. Having studied them in a patient, one can also assume the cause of the disease, which greatly facilitates the choice of additional diagnostic methods.

Digestive tract.

To understand the syndrome of dyspepsia, it is necessary to represent the course of the digestive tract. After passing through the mouth and esophagus, the chyme (a piece of food processed by enzymes) enters the stomach, where it is affected by hydrochloric acid. After 30-60 minutes, food moves into the duodenum, where the pancreas and common bile duct. Completely digested food is absorbed in the small intestine. In the large intestine, feces are formed, water with microelements is absorbed. Through the final section (rectum), feces are excreted into the environment.

gastric dyspepsia

The stomach is an organ where a very high acidity is constantly maintained, which most microorganisms cannot tolerate. Toxins also pass through it, due to the well-protected mucosa. Therefore, gastric dyspepsia, as a rule, does not occur due to poisoning and infections (rotovirus, escherichiosis, etc.).

The main reason for the appearance of this unpleasant syndrome is the destruction or damage to the gastric mucosa. This condition may occur when:

• . Helicobacter pylori (Helicobacter pylori) is one of the few bacteria that can live in conditions of high acidity. Aggressive drugs can also lead to gastritis. chemical substances that irritate the stomach lining (alcohol, acetic acid, energetic drinks);
• peptic ulcer;
• Acute/chronic ulcer;
• or 12 duodenal ulcer.

The above diseases can reduce / increase the acidity in the stomach, as they have an effect on the cells that form hydrochloric acid. Symptoms of dyspepsia in this case will be different:

Gastric dyspepsia in endocrine diseases.

Some hormonal disorders can lead to dyspepsia, as they indirectly affect the gastric mucosa:

• Itsenko-Cushing syndrome- the protective properties of the mucous membrane decrease, due to the increased content of the hormone Cortisol;
• Ellison-Solinger syndrome, hyperthyroidism- Significantly increases the secretion of hydrochloric acid in the stomach.

In these diseases, conventional treatment has no effect. Therefore, it is important to identify these violations in a timely manner.

As a rule, when the stomach is affected, a person suffers from chronic dyspepsia. To clarify the cause and determine the tactics of treatment, an adequate diagnosis should be carried out.

Diagnosis of gastric dyspepsia

Laboratory methods, such as urine (OAM) and feces, do not have a high diagnostic value. As a rule, changes in them are not noted or they are nonspecific. The following deviations are possible:

• An increased number of leukocytes (WBC) in the KLA - more than 9.1 * 10 9 / l;
• Positive fecal occult blood test.

More informative are instrumental methods. To diagnose dyspepsia, you should use:

1. FGDS with biopsy - fibrogastroduodenoscopy allows you to assess the condition of the inner surface of the stomach, the presence of ulcerative defects, tumors or signs of gastritis, take small "pieces" of the mucosa for examination under a microscope and "seeding" on the Helicobacter microbiological medium;

How to prepare for FGDs? During this study, the patient is administered through oral cavity endoscopic probe - a small rubber tube with a camera and a flashlight at the end. 12 hours before fibrogastroduodenoscopy, you should not eat. Other preparatory procedures, such as gastric lavage, drinking plenty of water, dieting, etc., are not indicated. FGDS takes about 10 minutes. This is a rather unpleasant method of examination, so if the patient has a gag reflex, the oral cavity is sprayed with a spray of Lidocaine (anesthetic).

1. pH-metry - at present, it is rarely used, since the procedure is quite unpleasant for the patient. With it, you can accurately determine the change in acidity in the stomach, which is a reliable sign of gastric dyspepsia.

How pH is measured? There are 2 versions of this method: short-term (measuring acidity within 2 hours) and extended (24 hours). To diagnose gastric dyspepsia, a thin probe is inserted through the patient's nose, which reaches the stomach at one end, and connects the other to a special pH-meter device. This device captures changes in acidity every hour and writes it to a memory card. It should be noted that the patient does not have to be in the hospital - he can follow his usual regimen.

If the doctor suspects the endocrine nature of dyspepsia, the examination must be supplemented by the study of certain hormones.

Treatment of gastric dyspepsia

To eliminate this syndrome, therapy of the underlying disease should be carried out. Depending on this, medical tactics will change. If the cause of dyspepsia is gastritis or peptic ulcer, the following therapeutic measures are recommended:

• A diet that excludes fatty, salty and spicy foods. Also avoid eating fiber-rich foods. Rye bread, fruits, vegetables, juices, etc.), as they can increase pain;
• If the role of Helicobacter is proven, the doctor prescribes complex antimicrobial therapy, which necessarily includes 2 antibiotics;
• Acidity should be normalized to treat dyspepsia. Increased release of hydrochloric acid can be eliminated by "H + pump inhibitors" (, Rabeprazole, Lansoprazole) and antacids (Gaviscon, Almagel). With low acidity, acid-forming cells can be stimulated with Pentaglucid or juice;
• It is possible to prescribe drugs that create a protective shell for the gastric mucosa (, Sucralfate, etc.).

The discovery of an open ulcer or tumor is often an indication for surgery. If a hormonal disease is determined in a patient, only an endocrinologist can determine the treatment.

Dyspepsia due to NSAIDs

Due to the widespread distribution of anti-inflammatory non-hormonal drugs and their uncontrolled intake, patients often experience adverse reactions, in the form of a lesion of the stomach. NSAID dyspepsia is a form of gastric dyspepsia that most often occurs after therapy with the following medications:

• Indomethacin;
• Piroxicam;
• Long course or Ketorolac.

As a rule, the symptoms are limited to heartburn, discomfort and pulling pain in the upper abdomen. To get rid of dyspepsia, you should stop taking NSAIDs or use more modern drugs(Nimesulide or Nise). "H + pump inhibitors" and antacids are also prescribed.

Intestinal dyspepsia

This syndrome is rarely chronic. Most often, it occurs acutely due to an infection or poisoning. Also, the causes of intestinal dyspepsia can be:

• Insufficiency of secretion of enzymes or bile (with cholelithiasis, hepatitis);
• - an autoimmune disease in which any part of the digestive tract can be damaged;
• Damage to the intestinal mucosa with chemically active substances (toxic dyspepsia);
• Intestinal dyskinesia is a violation of the contraction of this organ, due to which food stagnates in the intestinal cavity. It is a common cause of dyspepsia in pregnancy.

Currently, it is customary to distinguish two additional forms of intestinal dyspepsia: putrefactive and fermentative. Each of them occurs with a lack of enzymes, the first - with damage to the pancreas (acute / chronic pancreatitis, pancreatic necrosis, removal of the pancreas). The second - in the absence of lactase (a substance that digests dairy products). They should be considered independently of the usual syndrome.

Simple dyspepsia, which is not accompanied by enzyme deficiency, may manifest itself:

• Paroxysmal pain throughout the abdomen, moderate intensity;
• bloating;
• Constant "rumbling" of the intestine;
• Violation of the stool (most often patients are disturbed by diarrhea).

The cause of classical intestinal dyspepsia can be determined using laboratory methods. As a rule, the following studies are sufficient for this:

Instrumental diagnostics is not carried out with intestinal dyspepsia. The exception is autoimmune pathologies (Crohn's disease).

How to treat dyspepsia in these conditions? First of all, it is necessary to treat the underlying disease:

• Intestinal infections - antibiotics;
• Food toxins - elimination of general intoxication and the use of local local detoxicants (Enterodez,);
• Crohn's disease - the appointment of hormone therapy.

For any of these conditions, foods high in fiber should not be consumed. It is important to take sorbents (, Smectin, Activated carbon etc.), which are effective enough to eliminate the syndrome. To reduce pain, it is possible to prescribe antispasmodics (Drotaverine, Kellin, etc.).

Fermentative dyspepsia

This is one of the varieties of intestinal dyspepsia, in which there is a deficiency of the enzyme "lactase". It is necessary for the digestion of a number of products: sour-milk and flour products, chocolate, most sausages, etc. Most common causes occurrence of fermentative dyspepsia:

• Acute/chronic pancreatitis;
• Pronounced;
• Congenital deficiency of the lactase enzyme;
• celiac disease.

Symptoms in this case will be somewhat different from the usual intestinal form. Patients may complain of:

• Severe bloating of the entire abdomen;
• Severe pain that decreases/disappears after passing gas
• Abundant and frequent diarrhea (perhaps up to 10 times a day). Feces during defecation with an unpleasant odor, has a light yellow color, a liquid consistency, often foams;
• Audible "rumbling" of the intestines, sounds of fluid transfusion in the abdomen;
• Headache, irritability and general weakness (due to the action of toxic substances absorbed in the intestines on the nervous system).

The main method for determining fermentative dyspepsia remains laboratory coprological analysis, that is, the study of feces in the laboratory. It determines the acid reaction of feces, an increased amount of undigested fiber, starch grains, fermentative intestinal microflora.

Treatment should begin with a diet of reduced content carbohydrate food. It is allowed to eat high-protein dishes (boiled meat, meat broth, butter, steamed chicken), it is necessary to reduce the amount of bread, potatoes, vegetables and fruits, pastries, cereals.

Adsorbent substances are used (Smecta, Polysorb, Neosmectin), (, Laktofiltrum, Bifikol) and enzyme preparations for dyspepsia (Creon, Pancreatin). As you recover, carbohydrate-containing foods are gradually introduced into the diet, but in limited quantities. Menus and allowed dishes are determined, depending on the cause of the development of this syndrome.

Fermentative dyspepsia in children

It is this dyspepsia in children that is more common than others. In a child, the disease, as a rule, develops against the background of excessive feeding with special mixtures, as well as mashed potatoes based on fruits and vegetables. The cause is often a congenital lack of the enzyme lactase.

What will be the syndrome? The child's stool is characterized by rapidity, the color is greenish, with an admixture of mucus and lumps of a white tint. Due to the accumulation of gases in the intestinal lumen, the baby is naughty, he is tormented by pain in the abdomen, constantly crying. After the passage of gases, the child usually immediately calms down and falls asleep.

Adequate treatment can only be prescribed by a neonatologist or a qualified pediatrician. If you have one of the symptoms, you should immediately contact these specialists.

Putrid dyspepsia

Another type of syndrome that occurs when there is a violation of the digestion of proteins in the small intestine. The causes of putrefactive dyspepsia can be diseases of the pancreas, damage to the intestinal mucosa (by toxins or microbes), or duodenal ulcers.

Symptoms that will be observed in patients have characteristic features. These include:

• The feces are dark brown in color with a "putrid" or sour smell;
• Mushy, foamy stool. As a rule, during a bowel movement, the patient feels a burning sensation in the anus;
• Passing flatus with a fetid odor;
• Can be severe pain over the entire surface of the abdomen, which weaken after defecation.

The therapy is carried out similarly to the fermentation form. First of all, the patient is recommended a diet that excludes protein (any kind of meat and fish, dairy products, eggs, etc.). You should also use sorbents and probiotics. As a rule, enzyme preparations are not used in the treatment process. The need for antibiotic therapy is determined by the doctor.

functional dyspepsia

This is the second large group of digestive disorders that occur without any apparent cause. In patients with this syndrome, violations of the enzymes and organs of the gastrointestinal tract are not detected, even with careful examination.

Currently, the causes of functional dyspepsia are not fully understood. Doctors believe that the psychosocial factor (constant stress, emotional instability) and heredity play the greatest role. To provoke an exacerbation of the disease can:

• Smoking and drinking alcohol (even in small amounts);
• Certain medicines (theophylline, digitalis preparations, NSAIDs);
• Stress.

This form of dyspepsia in adults is observed much more often than in children. Symptoms of the disease can manifest themselves in different ways. There are three main forms of functional dyspepsia:

1. Ulcerative - it is characterized by "hungry" pains in the upper part abdominal wall, which weaken after eating;
2. Dyskinetic - the patient is worried about heaviness in the abdomen that occurs after eating (especially fatty foods). May be accompanied by nausea;
3. Mixed - symptoms can be combined between ulcerative and dyskinetic forms.

It should be noted that stool disorders (diarrhea, discoloration / consistency, fetid odor, blood impurities) do not occur with this disease. Otherwise, it is necessary to re-examine due to the suspicion of another pathology.

In order to exclude organic dyspepsia, the following diagnostics are recommended:

1. General analysis of blood and feces;
2. Blood biochemistry (ALT, AST, alpha-amylase, C-reactive protein);
3. Microbiological study of feces;
   FGDS with biopsy.

If the above examinations showed the norm, and the patient has these symptoms, a diagnosis is made.

• Antacids (Gaviscon, Almagel);
• H + -pump inhibitors (Omeprazole, Rabeprazole, Lansoprazole);
• Sedatives (Phenazepam, Adaptol, Grandaxin).

It should be noted that only the attending physician can select the necessary medicines for treatment.

The most common syndrome of impaired digestion is dyspepsia. It manifests itself in different ways, depending on the nature of the disease (organic or functional) and the affected section of the digestive tract. Currently, there are simple examination methods that can be used to make a diagnosis within 1 day. After that, therapy and diet are prescribed, which allows you to quickly restore the patient's former quality of life.