Dyspepsia and functional dyspepsia

Chapter 4 DYSPEPSIA AND FUNCTIONAL DYSPEPSIA





DEFINITIONS


The definition of dyspepsia is controversial, with some authorities including reflux symptoms whereas others do not. An international committee of clinical investigators that meets in Rome have routinely excluded reflux symptoms.


Dyspepsia has historically been defined as pain or discomfort located in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium). Discomfort may include bloating, fullness, early satiety, postprandial fullness or nausea. Dyspepsia may be either organic, implying an organic, systemic or metabolic disease has been identified as the cause, or functional, where there is no identifiable explanation for the symptoms. Functional dyspepsia is also known as idiopathic or non-ulcer dyspepsia.


The Rome III committee has redefined functional dyspepsia and limited the term to refer to the four following symptoms: bothersome post-prandial fullness, early satiation, epigastric pain, or epigastric burning. The remaining symptoms of discomfort listed above have been allocated clinical entities of their own, and together they comprise the functional gastroduodenal disorders (Table 4.1). In addition, as shown in Table 4.2, there are two new diagnostic categories within functional dyspepsia; namely postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS).


TABLE 4.1 Functional gastroduodenal disorders











TABLE 4.2 Subtypes of functional dyspepsia























Diagnostic criteria*for postprandial distress syndrome
Must include one or both of the following:


Supportive criteria


Diagnostic criteria*for epigastric pain syndrome
Must include all of the following:





Supportive criteria




* Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis


There is some overlap between symptoms of gastro-oesophageal reflux disease (GORD) and dyspepsia. Heartburn is traditionally excluded from the Rome II and III criteria for dyspepsia, although in Rome III a burning sensation confined to the epigastrium is not considered to be heartburn unless it also radiates retrosternally. Despite the exclusion of heartburn, reflux oesophagitis is the most common structural finding when patients with dyspepsia are evaluated by upper endoscopy in Western nations. Heartburn more than twice weekly strongly suggests GORD in favour of dyspepsia.


Uninvestigated dyspepsia refers to new onset or recurrent dyspepsia for which no diagnostic investigations have yet been performed and subsequently a specific diagnosis has not been reached. This has implications for both diagnostic and management pathways.




CAUSES



Organic


Organic causes of dyspepsia are many and varied as outlined in Table 4.3, but the majority of cases are due to peptic ulcer disease, gastro-oesophageal reflux and malignancy.


TABLE 4.3 Causes of organic dyspepsia





Luminal

Mar 29, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Dyspepsia and functional dyspepsia
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