Functional dyspepsia: diagnosis

Diagnosis of functional dyspepsia should be assumed in the presence of appropriate complaints and exclusion of organic pathology, which has a similar symptomatology: gastroesophageal reflux disease, peptic ulcer of the stomach or duodenum, stomach cancer, chronic pancreatitis, cholelithiasis. In addition, the symptoms inherent in functional dyspepsia are observed in scleroderma, systemic lupus erythematosus, diabetic gastroparesis, hyper-parathyreosis, hyper- and hypothyroidism, IHD, osteochondrosis of the thoracic spine, pregnancy. 

The diagnosis of functional dyspepsia can be made with diagnostic criteria for functional dyspepsia (Rome, 1999):

• Constant or recurrent dyspepsia (pain or discomfort in the upper abdomen along the midline), which lasts no less than 12 weeks in the last 12 months.
• Absence of evidence of organic disease, confirmed by careful collection of anamnesis, endoscopic examination of the upper gastrointestinal tract (GIT) and ultrasound of the abdominal cavity.
• There is no evidence that dyspepsia is facilitated by defecation or is associated with a change in the frequency or shape of the stool (typical of irritable bowel syndrome).

An important role in the differential diagnosis is the identification of "anxiety symptoms", which include dysphagia, fever, unmotivated weight loss, visible impurity in the stool, leukocytosis, increased erythrocyte sedimentation rate (ESR), anemia. The detection of at least one of these symptoms excludes the diagnosis of functional dyspepsia and requires careful examination of the patient to identify a more serious disease.

Laboratory examination

Compulsory methods of examination

As part of a general clinical examination: clinical blood tests, urine, feces, analysis of feces for latent blood.

Biochemical blood tests: total protein, albumin, cholesterol, glucose, bilirubin, serum iron, aminotransferase activity, amylase. For functional dyspepsia, changes in laboratory parameters are not characteristic.

Instrumental research

Compulsory methods of examination

• FEGDS allows to exclude organic pathology of the upper digestive tract: erosive esophagitis, peptic ulcer of stomach or duodenum, stomach cancer.
• Ultrasound of the hepatobiliary region allows us to identify cholelithiasis, chronic pancreatitis.

Additional survey methods

• Intragastric pH-metry allows to evaluate the acid-producing function of the stomach.
• Scintigraphy allows to determine the rate of gastric emptying; use food labeled with isotopes. The method allows to calculate the rate of gastric emptying.
• Electrogastrography: The method is based on recording myoelectric activity of the stomach with the help of electrodes installed in the epigastric region. Electrogastrography reflects the myoelectric rhythm of the stomach and allows to identify gastric arrhythmias. In the norm rhythm - 3 waves per minute, with bradigastria - less than 2.4 waves per minute, with tachigastria - 3.6-9.9 waves per minute.
• Gastroduodenal manometry: perfusion catheters or miniature manometric sensors installed on catheters inserted into the cavity of the antrum and duodenum; The sensors reflect the change in pressure when the wall of the stomach is contracted.
• Gastric Barostat: study the processes of normal and disturbed receptive relaxation of the stomach, contractile activity.
• X-ray examination allows us to identify stenosis or dilatation of various parts of the digestive tract, delayed emptying of the stomach, exclude the organic nature of the disease.

When persisting the symptoms of dyspepsia (despite the empirical therapy and the absence of "disturbing" signs), a study should be conducted on Helicobacter pylori.

Differential diagnosis of functional dyspepsia

The diagnosis of functional dyspepsia is made after excluding all possible diseases that occur with similar clinical symptoms:

• gastroesophageal reflux disease;
• peptic ulcer of the stomach and duodenum;
• cancer of the stomach or esophagus;
• side effects of taking medicines (LS) - NSAIDs, etc .;
• cholelithiasis;
• chronic pancreatitis;
• celiac disease;
• diffuse esophagospasm;
• functional gastrointestinal diseases - aerophagia, functional vomiting;
• IHD;
• secondary changes in the gastrointestinal tract in diabetes mellitus, systemic scleroderma, etc.

Organic causes of dyspepsia are found in 40% of patients. The main differential diagnostic criteria are the results of instrumental research methods.

[1], [2], [3], [4]