Mkb simple dyspepsia. Functional dyspepsia in adults. Dyskinetic type of dyspepsia is accompanied by

Functional dyspepsia syndrome (SFD)

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Dyspepsia (K30)

Gastroenterology

general information

Short description

functional dyspepsia(non-ulcerative, idiopathic, essential) is a disease characterized by unpleasant sensations (pain, burning, bloating, a feeling of fullness after eating, a feeling of rapid satiety), localized in the epigastric region, in which it is not possible to identify any organic or metabolic changes that can cause these symptoms.

Classification

Classification of functional dyspepsia syndrome (SFD) in accordance with the "Rome III criteria" (developed by the Committee for the Study of Functional Disorders of the Gastrointestinal Tract in 2006):

- IN 1 - functional dyspepsia:

- B1a - postprandial distress syndrome;

- B1b- epigastric pain syndrome;

- AT 2 - functional burp:

- B2a - aerophagia;

- B2b - nonspecific excessive belching;

- AT 3 - functional nausea and vomiting syndrome:

- VZA - chronic idiopathic nausea;

- VZB - functional vomiting;

- VZs - cyclic vomiting syndrome;

- AT 4 - regurgitation syndrome in adults.

Etiology and pathogenesis

The etiology and pathogenesis of SFD are currently poorly understood and controversial.

Among the possible reasons contributing to the development of FD, consider the following factors:

Errors in nutrition;

Hypersecretion of hydrochloric acid;

Bad habits;

Taking medications;

H. pylori infection Helicobacter pylori (traditional transcription - Helicobacter pylori) is a spiral gram-negative bacterium that infects various areas of the stomach and duodenum.
;

Motility disorders of the stomach and duodenum;

Mental disorders.

Recently, the question of the significance that pathological GER has has been considered. GER - gastroesophageal reflux
in the pathogenesis of dyspepsia. According to some reports, such reflux occurs in a third of patients with SFD. In this case, reflux may be accompanied by the appearance or intensification of pain in the epigastric region. In connection with this fact, some researchers even raise the question of the impossibility of clearly differentiating SFD and endoscopically negative GERD. Gastroesophageal reflux disease (GERD) is a chronic relapsing disease caused by spontaneous, regularly repeated reflux of gastric and / or duodenal contents into the esophagus, which leads to damage to the lower esophagus. Often accompanied by the development of inflammation of the mucosa of the distal esophagus - reflux esophagitis, and / or the formation of peptic ulcer and peptic stricture of the esophagus, esophageal-gastric bleeding and other complications
.

Chronic gastritis is currently considered as an independent disease that can occur in combination with or without dyspepsia syndrome.

Epidemiology

Age: adult

Prevalence sign: Common

Sex ratio (m/f): 0.5

According to various authors, 30-40% of the population of Europe and North America suffer from dyspepsia.
The annual incidence of dyspepsia syndrome is about 1%. At the same time, from 50 to 70% of cases fall to the share of functional dyspepsia.
In women, functional dyspepsia is twice as common as in men.

Clinical picture

Clinical Criteria for Diagnosis

Abdominal pain, bloating, hunger pains, night pains, nausea, discomfort after eating

Symptoms, course

Clinical features of various variants of functional dyspepsia (in accordance with the "Rome II criteria").

Ulcerative variant. Symptoms:

Pain is localized in the epigastric region;

Pain disappears after taking antacids;

hungry pains;

Night pains;

Periodic pain.

Dyskinetic variant. Symptoms:

Feeling of rapid satiety;

Feeling of fullness in the epigastrium Epigastrium - the region of the abdomen, bounded from above by the diaphragm, from below by a horizontal plane passing through a straight line connecting the lowest points of the tenth ribs.
;
- nausea;

Feeling of bloating in the upper abdomen;

Feeling of discomfort, aggravated after eating;

Note. According to the new classification, nausea is not considered a symptom of FD. Patients in whom nausea is the dominant symptom are considered to be suffering from functional nausea and vomiting syndrome.

Patients with FD often present with symptoms of functional disorders of other organs and systems. The combination of FD with irritable bowel syndrome is especially common. Due to the polymorphism of symptoms, patients are often seen by doctors of different specialties at the same time.

A significant part of the patients expressed such asthenic complaints as increased fatigue, general weakness, weakness.

The clinical picture of FD is characterized by instability and rapid dynamics of complaints: patients have fluctuations in the intensity of symptoms during the day. In some patients, the disease has a distinct seasonal or phasic character.

When studying the history of the disease, it is possible to trace that symptomatic treatment usually does not lead to a stable improvement in the patient's condition, and taking drugs has an unstable effect. Sometimes there is an effect of symptom escape: after the successful completion of the treatment of dyspepsia, patients begin to complain of pain in the lower abdomen, palpitations, problems with stools, etc.
At the beginning of treatment, there is often a rapid improvement in well-being, but on the eve of completing the course of therapy or discharge from the hospital, the symptoms

They return with renewed vigor.

Diagnostics

Diagnosis according to "Rome criteria III".

Diagnosis of functional dyspepsia (FD) can be installed under the following conditions:

1. Duration of symptoms for at least the last three months, despite the fact that the onset of the disease occurred at least six months ago.

2. Symptoms may not disappear after a bowel movement or occur in combination with a change in the frequency or consistency of the stool (a sign of irritable bowel syndrome).
3. Heartburn should not be the dominant symptom (a sign of gastroesophageal reflux disease).

4. Nausea cannot be considered as a symptom of dyspepsia, since this sensation has a central origin and does not occur in the epigastrium.

According to the "Rome III criteria", SFD includes postprandial Postprandial - occurring after eating.
distress syndrome and epigastric pain syndrome.

Postprandial distress syndrome

Diagnostic criteria (may include one or both of the following symptoms):

Feeling of fullness in the epigastrium after taking the usual amount of food, which occurs at least several times a week;

Feeling of rapid satiety, which does not make it possible to complete a meal that occurs at least several times a week.

Additional criteria:

There may be swelling in the epigastric region, postprandial nausea and belching;

May be associated with epigastric pain syndrome.

epigastric pain syndrome

Diagnostic criteria (should include all of the symptoms listed):

Pain or burning in the epigastrium of moderate or high intensity, occurring at least once a week;

The pain is intermittent Intermittent - intermittent, characterized by periodic ups and downs.
character;

The pain does not spread to other parts of the abdomen and chest;

Defecation and flatulence do not relieve pain;

The symptoms do not meet the criteria for dysfunction of the gallbladder and sphincter of Oddi.

Additional criteria:

The pain may be burning in nature, but should not be localized behind the sternum;

The pain is usually associated with eating, but can also occur on an empty stomach;

May occur in combination with postprandial distress syndrome.

In the case when it is not possible to clearly identify the prevailing symptoms, it is possible to make a diagnosis without specifying the variant of the course of the disease.

To exclude organic diseases that can cause dyspepsia, esophagogastroduodenoscopy and ultrasound of the abdominal organs are used. According to the indications, other instrumental studies can be prescribed.

Laboratory diagnostics

Laboratory diagnostics is performed for the purpose of differential diagnosis and includes a clinical and biochemical blood test (in particular, the content of erythrocytes, leukocytes, ESR, AST, ALT, GGT, alkaline phosphatase, glucose, creatinine), general fecal analysis and fecal occult blood analysis .
There are no pathognomonic laboratory signs of dyspepsia.

Differential Diagnosis

When conducting differential diagnosis, timely detection of the so-called "anxiety symptoms" is important. The detection of at least one of these symptoms requires careful exclusion of severe organic diseases.

"Symptoms of anxiety" in dyspepsia syndrome:

Dysphagia;

Vomiting blood, melena, scarlet blood in stools;

Fever;

Unmotivated weight loss;

Anemia;

Leukocytosis;

ESR increase;

Onset of symptoms for the first time over the age of 40.

Most often there is a need to differentiate FD with other functional disorders, in particular with irritable bowel syndrome. Symptoms of dyspepsia in SFD should not be associated with the act of defecation, a violation of the frequency and nature of the stool. However, it should be kept in mind that these two disorders often coexist.

SFD is also differentiated from such functional diseases of the stomach as aerophagia And functional nausea and vomiting. The diagnosis of aerophagia is made on the basis of complaints of belching, which is observed in the patient for at least three months during the year, and objective confirmation of the presence of increased swallowing of air.
The diagnosis of functional nausea or vomiting is made if the patient has nausea or vomiting at least once a week for a year. At the same time, a thorough examination does not reveal other reasons explaining the presence of this symptom.

In general, the differential diagnosis of functional dyspepsia syndrome primarily involves the exclusion of organic diseases that occur with similar symptoms, and includes the following research methods:

- Esophagogastroduodenoscopy - allows you to identify reflux esophagitis, gastric ulcer, stomach tumors and other organic diseases.

- Ultrasonography- makes it possible to detect chronic pancreatitis, cholelithiasis.

-X-ray examination.

- Electrogastroenterography - reveals violations of gastroduodenal motility.

- Stomach scintigraphy- used to detect gastroparesis.

- Daily pH monitoring - allows to exclude gastroesophageal reflux disease.

Determination of infection of the gastric mucosa Helicobacter pylori.

- Esophagomanometry - used 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).

- Antroduodenal manometry- allows you to explore the motility of the stomach and duodenum.

Treatment

Medical therapy

Assign taking into account the clinical variant of FD and focus on the leading clinical symptoms.

High placebo efficacy (13-73% of patients with SFD).

With epigastric pain syndrome, antacids and antisecretory drugs are widely used.
Antacids have traditionally been used to treat dyspepsia, but there are no clear data to support their effectiveness in SFD.
H2 receptor blockers are slightly superior to placebo in their effectiveness (by about 20%), and inferior to PPIs.

The use of PPIs can achieve results in 30-55% of patients with epigastric pain syndrome. However, they are only effective in people with GERD.
In the treatment of postprandial distress syndrome, prokinetics are used.

Currently, antisecretory drugs and prokinetics are considered the first-line drugs, with the appointment of which it is recommended to start SFD therapy.

The question of the need for anti-Helicobacter therapy remains controversial. This is due to the fact that the role of this infection in the development of the disease has not yet been proven. Nevertheless, many leading gastroenterologists consider it necessary to conduct anti-Helicobacter therapy in individuals who do not respond to other drugs. In patients with SFD, the use of standard eradication regimens, which are used in the treatment of patients with chronic lesions of the stomach and duodenum, proved to be effective.

If therapy with "first line" drugs was ineffective, it is possible to prescribe psychotropic drugs. An indication for their appointment may be the presence in the patient of such signs of a mental disorder as depression, anxiety disorder, which themselves require treatment. In these situations, the use of psychotropic drugs is also indicated in the absence of the effect of symptomatic therapy.
There is evidence of the successful use of tricyclic antidepressants and serotonin reuptake inhibitors. Anxiolytics are used in patients with high levels of anxiety. Some researchers report the successful use of psychotherapeutic methods (autogenic training, relaxation training, hypnosis, etc.) for the treatment of patients with SFD.

Medical tactics in accordance with the "Rome III criteria" is as follows:

First stage of treatment
The appointment of symptomatic drug therapy, as well as the establishment of a trusting relationship between the doctor and the patient, explaining to the patient in an accessible form the features of his disease.

Second stage of treatment
It is carried out with insufficient effectiveness of the first stage of treatment and in the case when it is not possible to stop the existing symptoms or new ones have appeared in their place.
There are two main treatment options in the second stage:

1. The appointment of psychotropic drugs: tricyclic antidepressants or serotonin reuptake inhibitors in a standard dose, with an assessment of the effect after 4-6 weeks. Such treatment, a gastroenterologist, with certain skills, can be carried out independently.

2. Referral of the patient for a consultation with a psychotherapist, followed by the use of psychotherapeutic techniques.

The prognosis for recovery in SFD is unfavorable, since, like all functional disorders, the disease is of a chronic relapsing nature. Patients are shown long-term observation of a gastroenterologist, in many cases together with a psychiatrist.

Hospitalization

Not required.

Information

Sources and literature

1. Ivashkin V.T., Lapina T.L. Gastroenterology. National leadership. Scientific and practical publication, 2008
   1. pp 412-423
2. wikipedia.org (Wikipedia)
   1. http://ru.wikipedia.org/wiki/Dyspepsia

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functional dyspepsia(Roman criteria II, 1999) - a syndrome that includes pain and discomfort (heaviness, feeling of fullness, early satiety, bloating, nausea), localized in the epigastric region closer to the midline, observed for more than 12 weeks and not associated with any - or organic pathology. Prevalence: 20-25% of the total population.

Code according to the international classification of diseases ICD-10:

Causes

Etiology and pathogenesis. Dysmotility of the stomach and duodenum is the only factor of pathogenesis, the significance of which in the development of functional dyspepsia has been firmly proven; manifested by a violation of the accommodation of the stomach, a violation of the rhythm of the peristalsis of the stomach, a violation of the antroduodenal coordination (duodenogastric reflux, a decrease in the tone and evacuation activity of the stomach), increased sensitivity of the stomach wall to stretching (visceral hypersensitivity). Possible reasons for the development of functional dyspepsia include hypersecretion of hydrochloric acid, alimentary errors (tea, coffee), bad habits (smoking, drinking alcohol), taking NSAIDs, neuropsychic factors (depressions, neurotic and hypochondriacal reactions are often observed); Helicobacter pylori infection.

Diagnostics

Diagnostics. The diagnosis of functional dyspepsia is made in the presence of the following conditions: The presence of relevant clinical symptoms for at least 12 weeks during the year. Exclusion of organic pathology occurring with similar symptoms. In the presence of "symptoms of anxiety" (dysphagia, melena, hematemesis, hematochezia, fever, weight loss, anemia, increased ESR, leukocytosis, the onset of symptoms of dyspepsia for the first time over the age of 45), an additional examination is performed to exclude an organic disease. To exclude organic pathology of the gastrointestinal tract:. FEGDS - to exclude esophagitis, peptic ulcer, pancreatitis, etc. General analysis of feces and analysis of feces for occult blood - to exclude bleeding from the organs of the tumor; . Ultrasound of the abdominal organs - to exclude cholelithiasis, chronic gastrointestinal tract. Daily monitoring of intraesophageal pH - in order to exclude gastroesophageal reflux disease. If necessary, x-ray examination of the esophagus and stomach, diagnosis of Helicobacter pylori, esophageal manometry, electrogastrography, scintigraphy (in order to detect gastroparesis)

Clinical variants of the course. Ulcerative. Dyskinetic. Non-specific.

Symptoms (signs)

clinical picture. The ulcer-like variant is manifested by pain in the epigastrium on an empty stomach, at night, which stops after eating and antisecretory drugs. The dyskinetic variant is characterized by a feeling of early satiety, fullness, bloating, heaviness after eating, nausea, and a feeling of discomfort that increases after eating. The nonspecific variant has mixed symptoms, often the leading symptom cannot be identified.

Differential diagnosis. Gastroesophageal reflux disease. Peptic ulcer of the stomach and duodenum. Stomach cancer. Diseases of the gallbladder. Chronic pancreatitis. Diffuse esophagospasm. Malabsorption syndrome. Functional diseases of the gastrointestinal tract: aerophagia, functional vomiting. ischemic heart disease. Secondary changes in the gastrointestinal tract in diabetes, systemic scleroderma, etc.

Treatment

TREATMENT

Lead tactics. With an ulcer-like variant, antacids and antisecretory drugs (histamine H 2 receptor blockers: ranitidine 150 mg 2 r / day, famotidine 20 mg 2 r / day, proton pump inhibitors - omeprazole, rabeprazole 20 mg 2 r / day, lansoprazole 30 mg 2 r / day In the dyskinetic variant - prokinetics: domperidone, metoclopramide In the non-specific variant: combination therapy with prokinetics and antisecretory drugs, if it is not possible to isolate the leading symptom. If Helicobacter pylori is detected - conducting eradication therapy. In the presence of depressive or hypochondriacal reactions - rational psychotherapy possible prescription of antidepressants

Diet. Exclusion from the diet of indigestible and rough food. Frequent and small meals. Cessation of smoking and abuse of alcohol, coffee, NSAIDs.

Synonyms. Non-ulcer dyspepsia. Idiopathic dyspepsia. inorganic dyspepsia. Essential dyspepsia

ICD-10. K30 Dyspepsia

DYSPEPSIA FUNCTIONAL honey.
Functional dyspepsia is a digestive disorder caused by functional disorders of the gastrointestinal tract. It is characterized by chronic discomfort in the epigastric region (most often pain and a feeling of heaviness), rapid satiety, nausea and / or vomiting, belching without signs of structural changes in the gastrointestinal tract. The frequency is 15-21% of patients who turn to therapists with complaints from the gastrointestinal tract.
Clinical variants of the course
ulcerative
Reflux-like
Dyskinetic
Non-specific. Etiology and pathogenesis
Violation of the motility of the upper gastrointestinal tract (decreased tone of the lower esophageal sphincter, duodenogastric reflux, decreased tone and evacuation activity of the stomach)
Neuropsychiatric factors - depression, neurotic and hypochondriacal reactions are often observed
Assume the etiological role of Helicobacter pylori, although there is no consensus on this issue.

Clinical picture

Differential Diagnosis

Treatment:

Diet

Contraindications

Precautionary measures

drug interaction

Synonyms

Disease Handbook. 2012 .

See what "FUNCTIONAL DYSPEPSIA" is in other dictionaries:

Dyspepsia- ICD 10 K30.30. Dyspepsia (from other Greek. δυσ prefix that denies the positive meaning of the word and ... Wikipedia

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Honey. Irritable bowel syndrome is a violation of the motor activity of the gastrointestinal tract, manifested by damage to its lower sections; the main symptoms of varying intensity of abdominal pain, constipation, diarrhea. The clinic almost always arises in a state of ... ... Disease Handbook

Gastritis- ICD 10 K29.029.0 K29.7 ICD 9 535.0535.0 535.5535.5 ... Wikipedia

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Kvamatel- Active ingredient ›› Famotidine* (Famotidine*) Latin name Quamatel ATX: ›› A02BA03 Famotidine Pharmacological group: H2 antihistamines Nosological classification (ICD 10) ›› J95.4 Mendelssohn's syndrome ›› K20 Esophagitis ›› K21 ...

Penzital- Active ingredient ›› Pancreatin (Pancreatin) Latin name Penzital ATX: ›› A09AA02 Polyenzyme preparations (lipase + protease, etc.) Pharmacological group: Enzymes and antienzymes Nosological classification (ICD 10) ›› E84.1 ... ... Medicine Dictionary

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Activated carbon FAS-E- Active ingredient ›› Activated charcoal Latin name Carbo activatus FAS E ATX: ›› A07BA01 Activated charcoal Pharmacological groups: Detoxifying agents, including antidotes ›› Adsorbents Nosological ... ... Medicine Dictionary

INFORMATION MAIL

FUNCTIONAL DISORDERS,

MANIFESTED IN ABDOMINAL PAIN SYNDROME

functional dyspepsia

functional dyspepsia is a symptom complex that includes pain, discomfort or fullness in the epigastric region, associated or not associated with eating or physical exercise, early satiety, belching, regurgitation, nausea, bloating (but not heartburn) and other manifestations not associated with defecation. At the same time, during the examination it is not possible to identify any organic disease.

Synonyms: gastric dyskinesia, irritable stomach, gastric neurosis, non-ulcer dyspepsia, pseudo-ulcer syndrome, essential dyspepsia, idiopathic dyspepsia, epigastric distress syndrome.

Code in ICD-10: KZO Dyspepsia

Epidemiology. The frequency of functional dyspepsia in children 4-18 years old varies from 3.5 to 27% depending on the country where the epidemiological studies were conducted. Among the adult population of Europe and North America, functional dyspepsia occurs in 30-40% of cases in women - 2 times more often than in men.

According to the Rome III criteria (2006), functional dyspepsia is classified as postprandial distress syndrome And abdominal pain syndrome. In the first case, dyspeptic phenomena predominate, in the second - abdominal pain. At the same time, the diagnosis of variants of functional dyspepsia in children is difficult and therefore not recommended due to the fact that in childhood it is often impossible to distinguish between the concepts of "discomfort" and "pain". The predominant localization of pain in children is the umbilical region or a triangle, which has the base of the right costal arch, and the apex is the umbilical ring.

Diagnostic criteria(Rome III criteria, 2006) should include All from the following:

Persistent or recurrent pain or discomfort in the upper abdomen (above the navel or around the umbilicus);

Symptoms not associated with bowel movements and with a change in the frequency and / or shape of the stool;

There are no inflammatory, metabolic, anatomical, or neoplastic changes that could explain the presenting symptoms; at the same time, the presence of minimal signs of chronic inflammation according to the results of histological examination of biopsy specimens of the gastric mucosa does not prevent the diagnosis of functional dyspepsia;

Symptoms occur at least once a week for 2 months. and more with a total duration of observation of the patient for at least 6 months.

clinical picture. Patients with functional dyspepsia are characterized by the same clinical features that are observed in all types of functional disorders: polymorphism of complaints, a variety of vegetative and neurological disorders, high referral to doctors of different specialties, a discrepancy between the duration of the disease, the variety of complaints and the satisfactory appearance and physical development of patients , lack of progression of symptoms, association with food intake, dietary error and / or with a traumatic situation, no clinical manifestations at night, no anxiety symptoms. In fact, functional dyspepsia is one of the variants of psychosomatic pathology, the somatization of a psychological (emotional) conflict. The main clinical manifestations: pain or discomfort in the epigastric region, occurring on an empty stomach or at night, stopped by eating or antacids; discomfort in the upper abdomen, early satiety, feeling of fullness and heaviness in the epigastrium, nausea, vomiting, loss of appetite.

Diagnostics. Functional dyspepsia is diagnosis is excludednia, which is possible only after the exclusion of organic pathology, for which they use a complex of laboratory and instrumental techniques used in the study of the gastrointestinal tract in accordance with the ongoing differential diagnosis, as well as a neurological examination and study of the psychological status of the patient.

Instrumental diagnostics. Required Research: EGDS and ultrasound of the abdominal organs. Examination for infection H. pylori(two methods) can be considered appropriate only in cases where eradication therapy is regulated by current standards (Maastricht III, 2000).

Additional research: electrogastrography, various modifications of pH-metry, gastric impedansometry, radiopaque techniques (contrast passage), etc.

Mandatory are the consultation of a neuropathologist, assessment of the vegetative status, consultation of a psychologist (in some cases - a psychiatrist).

An instrumental examination reveals motor disorders of the gastroduodenal zone and signs of visceral hypersensitivity of the gastric mucosa. Considering the significantly lower probability of serious organic diseases of the gastroduodenal zone, manifested by symptoms of functional dyspepsia, in children compared with adult patients, the Committee of Experts on the Study of Functional Diseases excluded endoscopy from the mandatory examination methods for the primary diagnosis of functional dyspepsia in childhood. Endoscopic examination is indicated if symptoms persist, persistent dysphagia, no effect of the prescribed therapy for a year or if symptoms recur after discontinuation of therapy, as well as when symptoms of anxiety aggravated by peptic ulcer and gastric oncopathology of heredity appear. On the other hand, the higher incidence of organic gastroduodenal pathology in children, especially adolescents, in Russia makes it advisable to keep endoscopy in the section of mandatory research methods, especially with a positive result of the examination for the presence of infection. N.pylori according to non-invasive tests (helic breathing test).

differential diagnosis. Differential diagnosis is carried out with all forms of organic dyspepsia: GERD, chronic gastroduodenitis, peptic ulcer, cholelithiasis, chronic pancreatitis, tumors of the gastrointestinal tract, Crohn's disease, as well as with IBS. anxiety symptoms, or “red flags” excluding functional dyspepsia and indicating a high probability of organic pathology: persistence of symptoms at night, growth retardation, unmotivated weight loss, fever and joint pain, lymphadenopathy, frequent epigastric pains of the same type, irradiation of pain, aggravated heredity according to peptic ulcer, repeated vomiting, vomiting with blood or melena, dysphagia, hepatosplenomegaly, any changes in the general and / or biochemical blood test.

Treatment. non-drug treatment: elimination of provoking factors, changing the patient's lifestyle including daily routine, physical activity, eating behavior, dietary addictions; using different options psychotherapy with the possible correction of traumatic situations in the family and children's team. It is necessary to develop an individualized diets with the exclusion of intolerable foods based on the analysis of the food diary in accordance with the patient's food stereotype and the leading clinical syndrome, physiotherapeutic methods of treatment. Frequent (up to 5-6 times a day) meals in small portions are shown with the exception of fatty foods, carbonated drinks, smoked meats and hot spices, fish and mushroom broths, rye bread, fresh pastries, coffee, limiting sweets.

If the above measures are ineffective, copper stone treatment. With proven hyperacidity, non-absorbable antacids are used (Maalox, Phosphalugel, Rutacid, Gastal, and others, less often - selective M-anticholinergics. In exceptional cases, in the absence of the effect of ongoing therapy, it is possible to prescribe a short course of antisecretory drugs: blockers of H2-histamine receptors of the famotidine group (Kvamatel, Famosan , ulfamide) or ranitidine (Zantak, Ranisan, etc.), as well as H +, K> ATPase inhibitors: omeprazole, rabeprazole and their derivatives. With the prevalence of dyspeptic phenomena, prokinetics are prescribed - domperidone (Motilium), antispasmodics of various groups, including cholinolytics (Buscopan, belladonna preparations).Consultation of a psychotherapist is indicated.Question about the expediency of eradication N.pylori decide individually.

The appointment of vasotropic drugs (Vinpocetine), nootropics (Phenibut, Nootropil, Pantogam), drugs of complex action (Instenon, Glycine, Mexidol), sedative drugs of plant origin (Novopassit, motherwort, valerian, peony tincture, etc.) is pathogenetically justified. If necessary, depending on the affective disorders identified in the patient, psychopharmacotherapy is prescribed together with a neuropsychiatrist.

Patients with functional dyspepsia are observed by a gastroenterologist and a neuropsychiatrist with periodic re-examination of the existing symptoms.

irritable bowel syndrome- a complex of functional intestinal disorders, which includes pain or discomfort in the abdomen associated with the act of defecation, a change in the frequency of bowel movements or changes in the nature of the stool, usually in combination with flatulence, in the absence of morphological changes that could explain the existing symptoms.

Synonyms: mucous colitis, spastic colitis, colon neurosis, spastic constipation, functional colopathy, spastic colon, mucous colic, nervous diarrhea, etc.

Code in ICD-10:

K58 Irritable bowel syndrome

K58.0 Irritable bowel syndrome with diarrhea

K58.9 Irritable bowel syndrome without diarrhea

Epidemiology. The frequency of IBS varies in the population from 9 to 48% depending on the geographic location, nutritional stereotype and sanitary culture of the population. The ratio of the frequency of IBS in girls and boys is 2-3:1. In Western European countries, IBS is diagnosed in 6% of elementary school students and 14% of high school students.

In accordance with the Rome III criteria (2006), depending on the nature of the stool, there are: IBS with constipation, IBS with diarrhea, mixed IBS and non-specific IBS.

Etiology and pathogenesis. IBS is fully characterized by all those etiological factors and pathogenetic mechanisms that are characteristic of functional disorders. The main etiopathogenetic (provoking) factors of IBS can be infectious agents, intolerance to certain types of food, eating disorders, psychotraumatic situations. IBS is defined as a biopsychosocial functional pathology. IBS is a violation of the regulation of the act of defecation and the motor function of the intestine, which in patients with visceral hypersensitivity and certain personality traits becomes a critical organ of mental maladaptation. In patients with IBS, a change in the content of neurotransmitters along the path of the pain impulse was found, as well as an increase in the frequency of signals coming from the periphery, which increases the intensity of pain sensations. In patients with a diarrheal variant of the disease, an increase in the number of enterochromaffin cells in the intestinal wall was found, including within a year after an intestinal infection, which may be associated with the formation of post-infectious IBS. A number of studies have shown that patients with IBS may have a genetically determined cytokine imbalance towards an increase in the production of pro-inflammatory and a decrease in the production of anti-inflammatory cytokines, and therefore an excessively strong and prolonged inflammatory response to an infectious agent is formed. With IBS, there is a violation of the transport of gas through the intestine; the delay in gas evacuation against the background of visceral hypersensitivity leads to the development of flatulence. The pathogenesis of these disorders has not yet been elucidated.

Diagnostic criteria for IBS for children (Rome III criteria, 2006) should include All from the following:

Appeared in the last 6 months or earlier and recur at least 1 time per week for 2 months. or more prior to diagnosis recurrent abdominal pain or discomfort associated with two or more of the following conditions:

I. Presence for at least 2 months. in the previous 6 months of abdominal discomfort (unpleasant sensations not described as pain) or pain associated with two or more of the following symptoms for at least 25% of the time:

Relief after stool;

Onset is associated with a change in stool frequency;

The beginning is associated with a change in the nature of st, 5, 6, 7).

II. There are no signs of inflammation, anatomical, metabolic or neoplastic changes that could explain the present symptoms. This allows the presence of minimal signs of chronic inflammation according to the results of endoscopic (or histological) examination of the colon, especially after an acute intestinal infection (post-infectious IBS). Symptoms cumulatively confirming the diagnosis of IBS:

Abnormal stool frequency: 4 times a day or more and 2 times a week or less;

Pathological form of feces: lumpy / dense or liquid / watery;

Pathological passage of feces: excessive straining, tenesmus, imperative urges, feeling of incomplete emptying;

Excessive mucus secretion;

Bloating and a feeling of fullness.

clinical picture. Patients with IBS also have extraintestinal manifestations. The main clinical manifestations of the disease - abdominal pain, flatulence and intestinal dysfunction, which are also characteristic of the organic pathology of the gastrointestinal tract, have certain features in IBS.

Abdominal pain variable in intensity and localization, has a continuously relapsing character, is combined with flatulence and flatulence, decreases after defecation or passing gases. Meteorism it is not expressed in the morning hours, increases during the day, is unstable and is usually associated with an error in the diet. Intestinal dysfunction in IBS is unstable, more often manifested by alternating constipation and diarrhea, there is no polyfecal matter (defecation is more frequent, but the volume of one-time defecation is small, stool liquefaction occurs due to a decrease in water reabsorption during accelerated passage, and therefore a patient with IBS does not lose body weight). Peculiarities diarrhea with IBS: loose stools 2-4 times only in the morning, after breakfast, against the background of a traumatic situation, imperative urges, a feeling of incomplete emptying of the intestine. At constipation usually observed "sheep" feces, stools in the form of a "pencil", as well as corky stools (discharge of dense, formed feces at the beginning of defecation, followed by the separation of mushy or watery stools without pathological impurities). Such violations of defecation are associated with the peculiarities of changes in the motility of the colon in IBS by the type of segmental hyperkinesis with a predominance of the spastic component and secondary disorders of microbiocenosis. Characterized by a significant amount slime in feces.

IBS is often combined with organic or functional diseases of other parts of the gastrointestinal tract; symptoms of IBS can be observed in gynecological pathology in girls, endocrine pathology, pathology of the spine. Non-gastroenterological manifestations of IBS: headache, a feeling of internal trembling, back pain, a feeling of lack of air - correspond to the symptoms of neurocirculatory dysfunction and can come to the fore, causing a significant decrease in the quality of life.

Diagnostics. IBS is diagnosis of exclusion which is put only after a barely comprehensive examination of the patient and the exclusion of organic pathology, for which they use a complex of laboratory and instrumental techniques used in the study of the gastrointestinal tract in accordance with the scope of the differential diagnosis. Careful analysis of anamnestic data with the identification of a traumatic factor is necessary. At the same time, in children with functional disorders, especially those with IBS, it is recommended to avoid invasive examination methods as much as possible. The diagnosis of IBS can be made subject to the compliance of clinical symptoms with the Rome criteria, the absence of anxiety symptoms, signs of organic pathology according to the physical examination, age-appropriate physical development of the child, the presence of trigger factors according to the anamnesis, as well as certain features of the psychological status and anamnestic indications of psychotrauma .

Additional research: determination of elastase-1 in feces, fecal calprotectin, immunological markers of CVD (antibodies to the cytoplasm of neutrophils - ANCA, characteristic of NUC, and antibodies to fungi Sacchawmyces cerevisiae - ASCA, characteristic of Crohn's disease), general and specific IgE on the spectrum of food allergens, VIP level, immunogram.

Instrumental diagnostics . Required Research: EGDS, ultrasound of the abdominal organs, rectosigmoscopy or colonoscopy.

Additional research: assessment of the state of the central and autonomic nervous system, ultrasound of the kidneys and small pelvis, colodynamic study, endosonography of the internal sphincter, X-ray contrast examination of the intestine (irrigography, passage of contrast according to indications), Doppler examination and angiography of the abdominal vessels (to exclude intestinal ischemia, stenosis of the celiac trunk) , sphincterometry, electromyography, scintigraphy, etc.

Expert advice. Mandatory consultations of a neurologist, psychologist (in some cases - a psychiatrist), proctologist. Additionally, the patient can be examined by a gynecologist (for girls), endocrinologist, orthopedist.

Treatment. Inpatient or outpatient treatment. The basis of therapy is non-drug treatment, similar to that in functional dyspepsia. It is necessary to reassure the child and parents, explain the features of the disease and the possible causes of its formation, identify and eliminate the possible causes of intestinal symptoms. It is important to change the patient's lifestyle (daily routine, eating behavior, physical activity, dietary addictions), normalize the psycho-emotional state, eliminate psycho-traumatic situations, limit school and extracurricular activities, apply various options for psychotherapeutic correction, create comfortable conditions for defecation, etc. diagnosis and therapy of concomitant pathology.

diet they are formed individually, based on the results of the analysis of the patient's food diary, individual food tolerance and the family's dietary stereotype, since significant dietary restrictions can be an additional psycho-traumatic factor. Exclude spicy seasonings, foods rich in essential oils, coffee, raw vegetables and fruits, carbonated drinks, legumes, citrus fruits, chocolate, foods that cause flatulence (legumes, white cabbage, garlic, grapes, raisins, kvass), limit milk. In IBS with a predominance of diarrhea, mechanically and chemically sparing diets are recommended, foods containing little connective tissue: boiled meat, lean fish, jelly, dairy-free cereals, boiled vegetables, pasta, cottage cheese, steam omelettes, mild cheese. The diet for IBS with constipation is similar to that for functional constipation, but limits the intake of foods containing coarse fiber.

Among non-drug methods, massage, exercise therapy, physiotherapeutic methods of treatment, phyto-, balneo- and reflexotherapy with a sedative effect are used. If the above measures are ineffective, depending on the leading IBS syndrome, they are prescribed medicamental treatment.

At painful syndrome and for the correction of motor disorders (taking into account the predominance of spasm and hyperkinesis), myotropic antispasmodics (drotaverine, papaverine), anticholinergics (Riabal, Buscopan, Meteospasmil, belladonna preparations), selective calcium channel blockers of smooth intestinal muscles - topical intestinal normalizers (Dicetel, mebeverine - Duspatalin, Spazmomen), enkephalin receptor stimulants - trimebutin (Trimedat). When diayards enterosorbents, astringents and enveloping agents are used (Smecta, Filtrum, Polyphepan, Lignosorb and other lignin derivatives, attapulgite (Neointestopan), Enterosgel, cholesterolamine, oak bark, tannin, blueberries, bird cherry). In addition, correction is carried out for changes in the intestinal microbiocenosis secondary to IBS with the staged use of intestinal antiseptics (Intetrix, Ercefuril, furazolidone, Enterosediv, nifuratel - Macmiror), pre- and probiotics (Enterol, Baktisubtil, Hilak forte, Bifiform, Linex, Biovestin, Laktoflor, Primadophilus, etc.), functional food products based on pre- and probiotics. It is also advisable to prescribe pancreatic enzyme preparations (Creon, Mezim forte, Pantsitrat, etc.). Antidiarrheals (loperamide) may be recommended in exceptional cases for a short course in patients aged 6 years or older. For cupping flatulence Simethicone derivatives are used (Espumizan, Sab Simplex, Disflatil), as well as combined preparations with complex action (Meteospasmyl - antispasmodic + simethicone, Unienzyme with MPS - enzyme + sorbent + simethicone, Pancreoflat - enzyme + simethicone).

It is advisable to prescribe vasotropic drugs, nootropics, drugs of complex action, sedatives of plant origin. The nature of psychopharmacotherapy, carried out, if necessary, together with a neuropsychiatrist, depends on the affective disorders identified in the patient.

Patients with IBS are observed by a gastroenterologist and a neuropsychiatrist with periodic re-examination of the existing symptoms.

Abdominal migraine

Abdominal migraine- paroxysmal intense diffuse pain (mainly in the umbilical region), accompanied by nausea, vomiting, diarrhea, anorexia in combination with headache, photophobia, blanching and coldness of the extremities and other vegetative manifestations lasting from several hours to several days, alternating with light intervals lasting from several days to several months.

Code in ICD10:

Abdominal migraine is observed in 1-4% of children, more often in girls the ratio of girls to boys is 3:2). Most often, the disease manifests itself at the age of 7, the peak incidence is at 10-12 years.

Diagnostic criteria should include All from the following:

paroxysmal episodes of intense pain in the umbilical region lasting about 1 hour or more;

light intervals of complete health, lasting from several weeks to several months;

Pain interferes with normal daily activities

pain associated with two or more of the following: anorexia, nausea, vomiting, headache, photophobia, pallor;

· there is no evidence of anatomical, metabolic or neoplastic changes that could explain the observed symptoms.

With abdominal migraine within 1 year should be at least 2 seizures. Additional criteria are aggravated heredity for migraine and poor transport tolerance.

Diagnostics. Abdominal migraine - exclusion diagnosis. A comprehensive examination is carried out to exclude organic diseases of the central nervous system (primarily epilepsy), mental illness, organic pathology of the gastrointestinal tract, acute surgical pathology, pathology of the urinary system, systemic diseases of the connective tissue, food allergies. The examination complex should include all methods of endoscopic examination, ultrasound of the abdominal organs, kidneys, small pelvis, EEG, Doppler examination of the vessels of the head, neck and abdominal cavity, an overview radiograph of the abdominal cavity and radiopaque techniques (irrigography, contrast passage), additionally in case of unclear diagnosis using spiral CT or MRI of the head and abdomen, laparoscopic diagnosis. The provoking and accompanying factors characteristic of migraine, young age, the therapeutic effect of anti-migraine drugs, and an increase in the rate of linear blood flow in the abdominal aorta during Doppler examination (especially during paroxysm) can help in the diagnosis. The psychological status of patients is dominated by anxiety, depression and somatization of psychological problems.

Treatment. The use of biopsychological correction techniques, normalization of the daily routine, sufficient sleep, limitation of stress, travel, prolonged fasting, exclusion of psycho-traumatic factors, limitation of bright and flickering light (watching TV programs, working at a computer) are recommended. Regular meals are needed with the exclusion from the diet of chocolate, nuts, cocoa, citrus fruits, celery tomato, cheeses, beer (products containing tyramine). Recommended rational physical activity, skiing, swimming, gymnastics. If an attack occurs, the child should be examined by a surgeon. After exclusion of acute surgical pathology in children over 14 years of age, anti-migraine drugs (Migrenop Imigran, Zomig, Relax), NSAIDs (ibuprofen - 10-15 mg / kg / day in 3 doses, paracetamol), combined drugs (Baralgin, Spazgan) can be used . They also recommend the appointment of prokinetics (domperidone), dihydroergotamine in the form of a nasal spray (1 dose in each nostril), 0.2% solution (5-20 drops each) or retard tablets (1 tab. - 2.5 mg) inside, 0.1% solution in / m or s / c (0.25-0.5 ml).

Functional abdominal pain

Functional abdominal pain (H2 d) - Abdominal pain, which is in the nature of colic, indefinite diffuse character, there are no objective causes of pain. Often associated with anxiety, depression, somatization.

Code in ICD-10: R10 Pain in the abdomen and pelvis

The frequency of functional abdominal pain in children aged 4-18 years (according to the data of gastroenterological departments) is 0-7.5%, more often observed in girls.

The etiopathogenesis is unclear, the formation of visceral intestinal hypersensitivity in patients with functional abdominal pain has not been proven. Assume the presence of inadequate perception of pain impulses and insufficiency of antinociceptive regulation. The immediate triggering factor is usually psychotrauma.

Diagnostic criteria should include All from the following:

episodic or prolonged abdominal pain;

There are no signs of other functional disorders;

There is no connection of pain with eating, defecation, etc., there are no stool disorders;

The examination does not reveal signs of organic pathology;

At least 25% of the time of an attack of pain, a combination of pain with a decrease in daily activity, other somatic manifestations (headache, pain in the extremities, sleep disturbance) is observed;

The severity of symptoms decreases when the patient is distracted, increases during the examination;

The subjective assessment of symptoms and the emotional description of pain do not match the objective data;

Requirement of many diagnostic procedures, search for a “good doctor”;

symptoms appear at least once a week for at least 2 months preceding the diagnosis. Pain is usually associated with anxiety, depression and somatization of psychological problems.

Diagnostics. The volume of laboratory and instrumental studies depends on the characteristics of the pain syndrome and corresponds to that of IBS. Consultations of a psychologist (psychiatrist), neurologist, surgeon, gynecologist are necessary.

Treatment. The basis of therapy is psychological correction, various options for psychotherapy, identification and elimination of causative factors. In terms of drug therapy, it is sometimes possible to use tricyclic antidepressants, the use of alternating courses of topical intestinal antispasmodics and eukinetics (Dicetel, Trimedat, Duspatalin).

Chief Freelance Children's

ministry gastroenterologist

health care of the Krasnodar Territory

Dyspepsia is a cumulative syndrome. It combines a number of dysfunctions of the digestive system, in which there is poor absorption of nutrients, difficult digestion of food, as well as the presence of intoxication of the body.

In the presence of dyspepsia, the general condition of a person worsens, painful symptoms in the abdomen and chest are noted. It is also possible the development of dysbacteriosis.

Causes of the syndrome

The occurrence of dyspepsia in many cases is unpredictable. This disorder can appear for a number of reasons, which, at first glance, seem harmless enough.

Dyspepsia occurs with equal frequency in men and women. It is also observed and, but much less frequently.

The main factors that provoke the development of dyspepsia include:

• A number of diseases of the gastrointestinal tract -, gastritis, and;
• Stress and psycho-emotional instability - provokes an undermining of the body, there is also a stretching of the stomach and intestines due to the ingestion of large portions of air;
• Improper nutrition - leads to difficulties in the digestion and assimilation of food, provokes the development of a number of gastrointestinal ailments;
• Violation of enzymatic activity - leads to uncontrolled release of toxins and poisoning of the body;
• Monotonous nutrition - damages the entire digestive system, provoking the appearance of fermentation and putrefactive processes;
• - an inflammatory process in the stomach, accompanied by an increased release of hydrochloric acid;
• Taking certain medications - antibiotics, special hormonal drugs, drugs against tuberculosis and cancer;
• Allergic reaction and intolerance - a special sensitivity of human immunity to certain products;
• - partial or complete blockage of the patency of the contents of the stomach through the intestines.
• Group A hepatitis is an infectious liver disease characterized by nausea, digestive dysfunction, and yellow skin.

Only a doctor can determine the exact cause of the existing condition. It is possible that dyspepsia could occur against the background of actively developing diseases, such as cholecystitis, Zollinger-Elisson syndrome, and pyloric stenosis.

ICD-10 disease code

According to the international classification of diseases, dyspepsia has a code of K 30. This disorder was designated as a separate disease in 1999. Thus, the prevalence of this disease ranges from 20 to 25% of the entire population of the planet.

Classification

Dyspepsia has a fairly extensive classification. Each subspecies of the disease has its own special features and specific symptoms. Based on them, the doctor carries out the necessary diagnostic measures and prescribes treatment.

Attempts to eliminate the manifestations of dyspepsia on their own often do not lead to positive results. Thus, if suspicious symptoms are found, it is necessary to contact the clinic.

Very often, the doctor needs to conduct a series of tests to establish the exact cause of the onset of the disease and prescribe adequate measures to eliminate the disturbing symptoms.

In medicine, there are two main groups of disorders of the dyspeptic type - functional dyspepsia and organic. Each type of disorder is caused by certain factors that must be considered when determining the approach to treatment.

functional form

Functional dyspepsia is a type of disorder in which specific damage of an organic nature is not fixed (there is no damage to internal organs, systems).

At the same time, functional disorders are observed that do not allow the gastrointestinal tract to function fully.

fermentation

The fermentative type of dyspepsia occurs when a person's diet consists mainly of foods containing a large amount of carbohydrates. Such products include bread, legumes, fruits, cabbage, kvass, beer.

As a result of the frequent use of these products, fermentation reactions develop in the intestines.

This leads to unpleasant symptoms, namely:

• increased gas formation;
• rumbling in the stomach;
• stomach upset;
• malaise;

When passing feces for analysis, it is possible to detect an excessive amount of starch, acids, as well as fiber and bacteria. All this contributes to the emergence of the fermentation process, which has such a negative impact on the patient's condition.

putrid

This type of disorder occurs if a person's diet is full of protein foods.

The predominance of protein products in the menu (poultry, pork, lamb, fish, eggs) leads to the fact that an excessive amount of toxic substances are formed in the body, which are formed during the breakdown of protein. This ailment is accompanied by severe intestinal upset, lethargy of a person, the presence of nausea and vomiting.

fatty

Fatty dyspepsia is typical for those people who very often abuse the consumption of refractory fats. These mainly include mutton and pork fat.

With this disease, a person has a strong disorder of the stool. Feces are often light in color and have a strong, unpleasant odor. Such a failure in the body occurs due to the accumulation of animal fats in the body and due to their slow digestibility.

organic form

The organic variety of dyspepsia appears in connection with organic pathology. Lack of treatment leads to structural damage to internal organs.

Symptoms in organic dyspepsia are more aggressive and pronounced. Treatment is carried out in a complex way, since the disease does not recede for a long time.

neurotic

A similar condition is characteristic of people who are most strongly affected by stress, depression, psychopathy and have a certain genetic predisposition to all this. The final mechanism for the appearance of this condition is still not determined.

toxic

Toxic dyspepsia is observed with poor nutrition. So, this condition can be caused by insufficiently high-quality and healthy products, as well as bad habits.

The negative impact on the body occurs due to the fact that the protein breakdown of food and toxic substances negatively affect the walls of the stomach and intestines.

In the future, it affects the interoreceptors. Already with the blood, toxins reach the liver, gradually destroying its structure and disrupting the functioning of the body.

Symptoms

Symptoms of dyspepsia can vary greatly. It all depends on the individual characteristics of the patient's body, as well as on the reasons that caused the disease.

In some cases, the symptoms of the disease may be sluggishly expressed, which will be associated with a high resistance of the body. However, most often dyspepsia manifests itself acutely and pronounced.

So, for alimentary dyspepsia, which has a functional form, the following features are characteristic:

• heaviness in the stomach;
• discomfort in the stomach;
• malaise;
• weakness;
• lethargy;
• feeling of fullness in the stomach;
• bloating;
• nausea;
• vomit;
• loss of appetite (lack of appetite, which alternates with hunger pains);
• heartburn;
• pain in the upper parts of the stomach.

Dyspepsia has other variants of the course. Most of the time they are not significantly different from each other. However, such specific symptoms allow the doctor to correctly determine the type of disease and prescribe the optimal treatment.

The ulcerative type of dyspepsia is accompanied by:

• belching;
• heartburn;
• headache;
• hungry pains;
• malaise;
• stomach ache.

The dyskinetic type of dyspepsia is accompanied by:

• feeling of fullness in the stomach;
• bloating;
• nausea;
• persistent abdominal discomfort.

The non-specific type is accompanied by a whole range of symptoms that are characteristic of all types of dyspepsia, namely:

• weakness;
• nausea;
• vomit;
• abdominal pain;
• bloating;
• bowel disorder;
• hungry pains;
• lack of appetite;
• lethargy;
• fast fatiguability.

During pregnancy

Dyspepsia in pregnant women is a fairly common phenomenon that most often manifests itself in the last months of pregnancy.

A similar condition is associated with the reflux of acidic contents into the esophagus, which causes a number of unpleasant sensations.

The lack of measures to eliminate painful symptoms leads to the fact that the constantly thrown acidic contents cause an inflammatory process on the walls of the esophagus. There is damage to the mucous membrane and, as a result, a violation of the normal functioning of the organ.

To eliminate unpleasant symptoms, pregnant women may be prescribed antacids. This will help to suppress heartburn and pain in the esophagus. Dietary nutrition and lifestyle adjustments are also shown.

Diagnostics

Diagnosis is one of the main and main stages, allowing to achieve rational and high-quality treatment. To begin with, the doctor must carry out a thorough history taking, which involves a number of clarifying questions regarding the patient's lifestyle and genetics.

Palpation, tapping and listening are also mandatory. After that, as necessary, the following studies of the stomach and intestines are carried out.

It is extremely rare for a doctor to prescribe other, rarer research methods - skin and intragastric electrogastrography, a radioisotope study using a special isotope breakfast.

Such a need may arise only if, in addition to dyspepsia, the patient is suspected of having another, parallel developing disease.

Treatment

Treatment of a patient for dyspepsia is based strictly on the results of the tests. It includes both pharmacological and non-pharmacological treatment.

Non-drug treatment involves a number of measures that must be followed in order to improve the general condition.

They include the following:

• adhere to a rational and balanced diet;
• avoid overeating;
• choose for yourself not tight clothes that fit;
• refuse exercises for the abdominal muscles;
• eliminate stressful situations;
• competently combine work and leisure;
• walk after eating for at least 30 minutes.

During the entire period of treatment, it is necessary to be observed by a doctor. In the absence of results of treatment, it is necessary to undergo additional diagnostics.

Preparations

Drug treatment for dyspepsia occurs as follows:

• Laxatives are used to relieve constipation that may occur during an illness. Self-administration of any drugs is prohibited, they are prescribed only by the attending doctor. Medicines are used until the stool normalizes.
• Antidiarrheal drugs are used to achieve a fixing effect. It is necessary to resort to them only on the recommendation of a doctor.

Additionally, the reception of such funds is shown:

• painkillers and antispasmodics - reduce pain, have a sedative effect.
• enzyme preparations - help to improve the process of digestion.
• blockers - reduce the acidity of the stomach, help eliminate heartburn and belching.
• H2-histamine blockers are weaker drugs than hydrogen pump blockers, but also have the necessary effect in combating the signs of heartburn.

In the presence of neurotic dyspepsia, consultation with a psychotherapist will not hurt. He, in turn, will prescribe a list of necessary drugs that will help control the psycho-emotional state.

Diet for dyspepsia of the stomach and intestines

The correct diet for dyspepsia is prescribed, taking into account the initial nature of the violations in the patient. Thus, nutrition should be based on the following rules:

• Fermentative dyspepsia involves the exclusion of carbohydrates from the diet and the predominance of proteins in it.
• With fatty dyspepsia, fats of animal origin should be excluded. The main emphasis should be on plant foods.
• With nutritional dyspepsia, the diet must be adjusted in such a way that it fully meets the needs of the body.
• The putrefactive form of dyspepsia involves the exclusion of meat and meat-containing products. Plant foods are preferred.

Also, when drawing up a therapeutic diet, the following should be considered:

• Food should be fractional;
• Eating should be done slowly and leisurely;
• Food should be steamed or baked;
• Raw and carbonated water should be abandoned;
• Liquid dishes must be present in the diet - soups, broths.

Also, be sure to give up bad habits - and smoking. Neglect of such recommendations can contribute to the return of the disease.

Folk remedies

In the treatment of dyspepsia, folk methods are often used. Herbal decoctions and herbal teas are mainly used.

As for other means, such as soda or alcohol tinctures, it is better to refuse them. Their use is extremely irrational and can lead to an exacerbation of the condition.

Successful elimination of dyspepsia is possible if you adhere to a healthy lifestyle and adjust your diet. The use of additional treatment in the form of the use of folk remedies is not needed.

Complications

Complications of dyspepsia are extremely rare. They are possible only with a strong exacerbation of the disease. Among them may be observed:

• weight loss
• loss of appetite;
• exacerbation of gastrointestinal diseases.

Dyspepsia by its nature is not dangerous to human life, but it can cause a number of inconveniences and disrupt the usual way of life.

Prevention

To exclude the development of dyspepsia, it is necessary to adhere to the following rules:

• nutrition correction;
• exclusion of harmful products;
• moderate physical activity;
• plentiful drink;
• compliance with hygiene measures;
• refusal of alcohol.

With a tendency to dyspepsia and other diseases of the gastrointestinal tract, it is necessary to visit a gastroenterologist at least once a year. This will allow you to detect the disease in the early stages.

Video about dyspepsia of the gastrointestinal tract: