Functional nonulcer dyspepsia

Functional (non-ulcer) dyspepsia is a symptom complex that includes pain or discomfort, a feeling of fullness in the epigastric region (related or not to food intake, physical exercise), early satiety, bloating, nausea, vomiting, heartburn or regurgitation, intolerance to fatty foods, but at the same time a thorough examination of the patient does not reveal any organic lesion (peptic ulcer, chronic gastritis, duodenitis, stomach cancer, reflux esophagitis (Tytgar, 1992). If the above clinical symptoms of functional dyspepsia continue for more than 3 months, it is called chronic.

Functional dyspepsia is the most common reason for patients to visit a clinic. Approximately 25-30% of the population complain of dyspeptic symptoms at least once a year, while only 1/3 of those who seek help have an organic stomach disease, and 2/3 have functional non-ulcer dyspepsia.

The following variants of functional (non-ulcer) dyspepsia are distinguished:

• reflux-like;
• ulcer-like;
• dyskinetic (motor type);
• non-specific.

In the non-specific variant of functional dyspepsia, the symptoms can be multifaceted, varied, sometimes combining symptoms of different variants and it is difficult to classify them into any one of the three types.

Classification and symptoms of functional (non-ulcer) dyspepsia

• Reflux type - Heartburn, epigastric pain, retrosternal burning, sour belching, increased pain after eating, bending, lying on the back, due to stress.
• Ulcer type - pain on an empty stomach, waking up at night due to stomach pain, episodic pain in the epigastric region, disappearance of pain after eating or taking antacids.
• Motor type - a feeling of heaviness and fullness after eating, a quick feeling of satiety, belching, flatulence, nausea, occasionally prolonged vomiting combines symptoms of different variants and is difficult to attribute to any one of the three types.

Symptoms of functional (non-ulcer) dyspepsia are also accompanied by numerous neurotic manifestations: weakness, headaches, cardialgia, irritability, sleep disturbances, psycho-emotional lability, unstable mood. Manifestations of depression of varying degrees of severity, a "lump in the throat" are often detected.

Often, under the guise of non-ulcer dyspepsia, there is an abdominal variant of "masked", "hidden" depression, which is now much more common than before. Depressive states are observed in 10% of patients who seek medical attention, including 6% with masked depression.

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

• psychopathological criteria: vital depression - causeless depression, inability to enjoy life as before, unwillingness to communicate and difficulty in communicating with others, lack of previous energy, difficulty making decisions, fatigue, a feeling of physical inferiority, anxiety, pseudophobia, hypochondria;
• psychosomatic criteria: pain, paresthesia in the epigastrium, pain along the intestines of changing nature and intensity, not associated with food intake, constipation, less often - diarrhea; many complaints that do not fit the criteria of any disease, insomnia, menstrual disorders, potency, ineffectiveness of conventional therapy;
• criteria for the course: spontaneity and periodicity (seasonality) of exacerbation of the disease, daily fluctuations in symptoms - worsening in the pre-dawn and especially morning hours, improvement in the evening;
• psychopharmacological criteria: effectiveness of treatment with antidepressants; sometimes a final diagnosis of endogenous depression can only be made after successful treatment with these drugs;
• constitutional-genetic predisposition: aggravated psychopathic heredity.

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

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