Functional non-ulcer dyspepsia

Functional (non-ulcer) dyspepsia is a symptomatic complex that includes pain or discomfort, a feeling of overflow in the epigastric region (whether or not associated with eating, exercise), early satiety, bloating, nausea, vomiting, heartburn or regurgitation, intolerance to fatty foods, but careful examination of the patient does not reveal any organic damage (peptic ulcer, chronic gastritis, duodenitis, stomach cancer, reflux esophagitis (Tytgar, 1992) .If these clinical symptoms functional dyspepsia last more than 3 months, it is designated chronic.

Functional dyspepsia is the most frequent reason for patients to go to a polyclinic. Approximately 25-30% of the population at least once a year complain of dyspeptic phenomena, while only 1/3 of those who find themselves have an organic stomach disease, while in 2/3 - functional non-ulcer dyspepsia.

Distinguish the following options for functional (non-ulcer) dyspepsia:

• reflux-like;
• ulcerative;
• dyskinetic (motor type);
• nonspecific.

With nonspecific variant of functional dyspepsia, the symptomatology can be multifaceted, diverse, sometimes it combines the symptoms of different variants and it is difficult to attribute it to any one of the three types.

Classification and symptomatology of functional (non-ulcer) dyspepsia

• Reflux type - Heartburn, epigastric pain, retrosternalnoe burning, belching sour, increased pain after eating, bending, lying on the back, because of stress.
• Ulcerative type - Pain on an empty stomach, awakening at night due to stomach pains, episodic pain in the epigastric region, loss of pain after eating or antacid preparations.
• Motor type - A feeling of heaviness and overcrowding after eating, a quick sense of satiety, belching, flatulence, faintness, occasionally prolonged vomiting combines the symptoms of different options and it is difficult to classify it in any one of three types.

Symptoms of functional (non-ulcer) dyspepsia are also accompanied by numerous neurotic manifestations: weakness, headaches, cardialgia, irritability, sleep disturbance, psychoemotional lability, unstable mood. Often there are manifestations of depression of varying degrees of severity, a "feeling of a lump" in the throat.

Often, under the mask of non-ulcer dyspepsia, there is an abdominal variant of "masked", "hidden" depression, which is now much more common than before. In 10% of patients who seek medical treatment, depressive conditions are noted, including 6% - masked depression.

A. V. Frolkis (1991) cites the following diagnostic criteria for endogenous, masked depression:

• psychopathological criteria: vital depression - causeless depression, the inability to enjoy life as before, the reluctance to communicate and the difficulty in communicating with others, the absence of the previous energy, the difficulty of making decisions, fatigue, a sense of physical inferiority, anxiety, pseudophobia, hypochondria;
• psychosomatic criteria: pain, paresthesia in epigastrium, pain along the bowels of a changing character and intensity, not associated with eating, constipation, less often diarrhea; a lot of complaints that do not fit into the criteria of any disease, insomnia, menstruation disorder, potencies, ineffectiveness of conventional therapy;
• flow criteria: spontaneity and periodicity (seasonality) of the exacerbation of the disease, diurnal fluctuations in symptoms - deterioration in the pre-morning and especially morning hours, improvement in the evening;
• psychopharmacological criteria: effectiveness of antidepressant treatment; sometimes the final diagnosis of endogenous depression can be made only after successful treatment with these drugs;
• constitutional-genetic predisposition: weighed psychopathic heredity.

For a confident differential diagnosis of functional (non-ulcer) dyspepsia, a thorough laboratory and instrumental examination of the patient is necessary. To exclude chronic gastritis, a biopsy of the gastric mucosa is necessary.

[1], [2], [3], [4], [5]