Functional dyspepsia - Diagnosis

The diagnosis of functional dyspepsia should be assumed in the presence of corresponding complaints and exclusion of organic pathology with similar symptoms: gastroesophageal reflux disease, gastric ulcer or duodenal ulcer, gastric cancer, chronic pancreatitis, cholelithiasis. In addition, symptoms characteristic of functional dyspepsia are observed in scleroderma, systemic lupus erythematosus, diabetic gastroparesis, hyperparathyroidism, hyper- and hypothyroidism, ischemic heart disease, osteochondrosis of the thoracic spine, pregnancy.

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

• Persistent or recurrent dyspepsia (pain or discomfort in the upper abdomen in the midline) lasting at least 12 weeks in the past 12 months.
• Absence of evidence of organic disease, confirmed by careful history taking, endoscopic examination of the upper gastrointestinal tract (GIT) and ultrasound of the abdominal organs.
• Lack of evidence that dyspepsia is relieved by defecation or is associated with a change in stool frequency or form (characteristic of irritable bowel syndrome).

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

Laboratory examination

Mandatory examination methods

As part of a general clinical examination: clinical blood, urine, stool tests, stool test for occult blood.

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

Instrumental research

Mandatory examination methods

• FEGDS allows to exclude organic pathology of the upper gastrointestinal tract: erosive esophagitis, gastric ulcer or duodenal ulcer, stomach cancer.
• Ultrasound of the hepatobiliary region allows to detect cholelithiasis and chronic pancreatitis.

Additional examination methods

• Intragastric pH-metry allows to evaluate the acid-producing function of the stomach.
• Scintigraphy allows to determine the rate of gastric emptying; food labeled with isotopes is used. The method allows to calculate the rate of gastric emptying.
• Electrogastrography: the method is based on recording the myoelectric activity of the stomach using electrodes installed in the epigastric region. Electrogastrography reflects the myoelectric rhythm of the stomach and allows identifying gastric arrhythmias. Normally, the rhythm is 3 waves per minute, with bradygastria - less than 2.4 waves per minute, with tachygastria - 3.6-9.9 waves per minute.
• Gastroduodenal manometry: uses perfusion catheters or miniature manometric sensors mounted on catheters inserted into the antrum and duodenum; the sensors reflect the change in pressure during contraction of the stomach wall.
• Gastric barostat: studies the processes of normal and impaired receptive relaxation of the stomach, contractile activity.
• X-ray examination allows us to identify stenosis or dilation of various parts of the digestive tract, slow emptying of the stomach, and to exclude the organic nature of the disease.

If dyspepsia symptoms persist (despite empirical therapy and the absence of “alarming” signs), a test for Helicobacter pylori should be performed.

Differential diagnosis of functional dyspepsia

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

• gastroesophageal reflux disease;
• gastric ulcer and duodenal ulcer;
• stomach or esophageal cancer;
• side effects of taking medications (MP) – 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.

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