Dyspepsia: symptoms, causes, treatment,diagnostics

Update: December 2018

The first sign of any disease of the digestive organ –
dyspepsia. This is a specific complex of symptoms (syndrome), which
manifests itself in different ways, depending on the level of the lesion
gastrointestinal tract. Most often the patient is nauseous,
abdominal pain and discomfort. Have 60% больных, это состояние возникает
without any apparent reason that makes the diagnosis extremely
difficult and requires special treatment approaches.

In the clinic, there are 2 main groups of the syndrome. To the first
refers functional dyspepsia which is
self-illness. The second is organic, accompanying
any gastroenterological disease (rotovirus or
bacterial infection, cholecystitis, toxic poisoning, etc.).
They need to be considered independently of each other, as they
differ significantly in symptoms, causes of development and
treatment.

Organic dyspepsia

Due to dyspepsia syndrome, it can be approximately determined
which organ is affected because the symptoms of the gastric and intestinal forms
significantly different. Having studied them in a patient, you can also
suggest the cause of the disease, which greatly facilitates the choice
additional diagnostic methods.

Digestive tract.

To understand the dyspepsia syndrome, it is necessary to present the course
digestive tract. After прохождения ротовой полости и
the esophagus, chyme (enzyme-treated lump of food) falls into
the stomach where it is affected by hydrochloric acid. Through
30-60 minutes, food moves into the duodenum, where
open pancreas and common bile ducts. Fully
split foods are absorbed in the small intestine. In the colon
fecal masses are formed, water with microelements is absorbed.
Through конечный отдел (прямую кишку), кал выводится в окружающую
Wednesday

Gastric dyspepsia

The stomach is an organ where a very high body is constantly maintained.
acidity that most cannot tolerate
microorganisms. Toxins also pass it in transit, due to
well protected mucosa. Therefore, gastric dyspepsia is like
usually does not occur due to poisoning and infections (roto-viral,
salmonellosis, escherichiosis, etc.).

The main cause of this unpleasant syndrome is
destruction or damage to the gastric mucosa. This state may
be observed when:

  • Gastritis. Helicobacter pylori (Helicobacter pylori) is
    one of the few bacteria that can live in
    high acidity. Can also lead to gastritis aggressive
    chemicals that irritate the stomach lining
    (alcohol, acetic acid, energy drinks);
  • Peptic ulcer disease;
  • Acute / chronic ulcer;
  • Cancer of the stomach or duodenum.

The above diseases can reduce / increase acidity in
stomach, since they have an effect on the cells that form
hydrochloric acid. The symptoms of dyspepsia will be
different:

Form of gastric dyspepsia What diseases are more common? Characteristic symptoms
With high acidity
  • Hyperacid (acid secretion increased) gastritis;
  • Duodenal ulcer / stomach ulcer;
  • Syndink Itsenko-Cushing;
  • Ellison-Zolinger syndrome;
  • Hyperthyroidism.
  • Heartburn, which increases after taking fatty, acute and
    salty foods;
  • Belching with sour taste;
  • Increased appetite;
  • Discomfort (heaviness) in the upper abdomen;
  • Pain, whining character. May occur in 30-90 minutes
    after meal;
  • �“Hungry” pains – long break between meals
    provokes acute pain in the upper abdomen;
  • Often patients have constipation – no more than 3 stools
    days
With reduced acidity
  • Hypoacidic (acid secretion reduced) gastritis;
  • Atrophic form of gastritis;
  • Stomach cancer (often adenocarcinoma);
  • Duodenal ulcer / stomach ulcer.
  • Appetite in such patients is changed. It can be lowered or
    completely absent. “Perversion” of taste is also possible –
    Some dishes can cause unpleasant emotions, even
    nausea;
  • The pain in the upper abdomen is dull or oppressive.
    character;
  • Propensity to diarrhea;
  • Vomiting may occur. Typically, after 15-25 minutes
    after meal.

Gastric dyspepsia при эндокринных болезнях.

Some hormonal disorders can lead to dyspepsia, so
how indirectly affect the gastric mucosa:

  • Itsenko-Cushing syndrome – reduced protective properties
    mucous, due to the high content of the hormone Cortisol;
  • Ellison-Zolinger syndrome, hyperthyroidism – significantly
    increases the release of hydrochloric acid in the stomach.

In these diseases, conventional treatment has no effect. therefore
it is important to identify these violations in a timely manner.

As a rule, when a stomach is affected, a person suffers from chronic
dyspepsia. To clarify the reason and decide on tactics
treatment, should conduct an adequate diagnosis.

Diagnosis of gastric dyspepsia

Laboratory methods, such as general blood tests (KLA), urine
(OAM) and feces, do not have high diagnostic value. how
the rule of change is not marked or they are non-specific.
The following deviations are possible:

  • Increased white blood cell count (WBC) in the KLA – more
    9,1*109/л;
  • Positive fecal occult blood test.

More informative are instrumental methods. For
diagnostic dyspepsia should be used:

  1. EGD with biopsy – fibrogastroduodenoscopy allows you to evaluate
    condition of the inner surface of the stomach, the presence of ulcers
    defects, tumors or signs of gastritis, take small
    �“Pieces” of the mucous membrane for microscopic examination and “seeding” on
    Helicobacter microbiological environment;

how подготовится к ФГДС? During this
studies, the patient is administered through the endoscopic oral cavity
probe – a small rubber tube with a camera and a flashlight at the end.
12 hours before fibrogastroduodenoscopy should not eat.
Other preparatory procedures, such as gastric lavage,
drink plenty of water, diet, etc., not shown. FGDS takes
about 10 minutes. This is a rather unpleasant method of examination,
so if the patient has a vomiting reflex, the oral cavity
spray a spray of lidocaine (anesthetic).

  1. pH-metry is currently rarely used, since
    The procedure is unpleasant for the patient. With it you can
    accurately determine the change in acidity in the stomach that is
    reliable sign of gastric dyspepsia.

how проводят pH-метрию? There are 2 versions of this.
method: short-term (measurement of acidity within 2 hours)
and extended (24 hours). To diagnose gastric
dyspepsia, a thin probe is inserted through the nose of the patient, which is one
end reaches the stomach, and the other connects to the special
device “pH-meter”. This unit records every hour of change.
acidity and writes to the memory card. It should be noted that
the patient does not have to be in the hospital – he can
observe your normal routine.

If the doctor suspects the endocrine nature of dyspepsia,
The survey must be supplemented by the study of certain
hormones.

Treatment of gastric dyspepsia

To eliminate this syndrome, should be the main therapy
diseases. Depending on this, the doctor will change
tactics. If the cause of dyspepsia is gastritis or ulcerative
disease, the following therapeutic measures are recommended:диспепсия симптомы

  • A diet that excludes fatty, salty and spicy dishes. Also not
    fiber-rich foods (rye bread,
    fruits, vegetables, juices, etc.), as they may increase the pain;
  • If the role of Helicobacter is proven, the doctor prescribes a complex
    antimicrobial therapy that necessarily includes 2
    antibiotic;
  • Acidity should be normalized to treat dyspepsia.
    Increased release of hydrochloric acid can be eliminated
    «ингибиторами H+-помпы» (Омепразол, Рабепразол,
    Lansoprazol) and antacid agents (Gaviscon, Almagel). With
    low acidity can stimulate acid-forming cells
    Pentaglucidum or plantain juice;
  • Perhaps the appointment of drugs that create a protective shell for
    gastric mucosa (De-Nol, Sukollfat, etc.).

Detection of an open ulcer or tumor is often an indication.
for surgery. If determined by the patient
hormonal disease, treatment can only determine
endocrinologist.

Dyspepsia due to NSAIDs

Due to the widespread anti-inflammatory
non-hormonal drugs and their uncontrolled intake in patients
often there are adverse reactions in the form of lesions of the stomach.
NSAID dyspepsia is a form of gastric, which is most often
occurs after therapy with the following drugs:

  • Indomethacin;
  • Piroxicam;
  • A long course of ibuprofen (Next, Long) or
    Ketorolaka.

how правило, симптомы ограничиваются изжогой, чувством
discomfort and pulling pain in the upper abdomen. To get rid of
from dyspepsia, you should stop taking NSAIDs or use more
modern drugs (Nimesulide or Neise). Also prescribed
«ингибиторы H+-помпы» и антациды.

Intestinal dyspepsia

This syndrome is rarely chronic. Most often, it occurs
acutely due to an infection or poisoning. Also reasons
bowel dyspepsia can be:

  • Insufficiency of secretion of enzymes or bile (for pancreatitis,
    cholelithiasis, hepatitis);
  • Crohn’s disease – аутоиммунная болезнь, при которой может
    damage any part of the digestive tract;
  • Intestinal mucosal damage by chemically active substances
    (toxic dyspepsia);
  • Intestinal dyskinesia – нарушение сокращения этого органа, из-за
    what food stagnates in the intestinal cavity. Is frequent
    cause dyspepsia of pregnant women.

Currently, it is customary to allocate two additional forms.
intestinal dyspepsia: putrid and fermenting. Each of them
occurs when there is a lack of enzymes, the first – with the defeat
pancreas (acute / chronic pancreatitis,
pancreatic necrosis, pancreas removal). The second is when
no lactase (a substance that digests dairy products).
They should be considered regardless of the usual syndrome.

Simple dyspepsia, which is not accompanied by failure
enzymes can manifest itself:

  • Partial pain throughout the abdomen, medium
    intensity;
  • Bloating;
  • Constant “rumbling” of the intestines;
  • Violation of the chair (most often patients are worried about diarrhea).

You can determine the cause of classical intestinal dyspepsia with
using laboratory methods. As a rule, this is enough
the following studies:

Possible cause of dyspepsia Complete blood count (KLA) General analysis of feces Bacteriological seeding feces
Intestinal infections (salmonella, escherichiosis, etc.)
  • Increased white blood cell count (WBC) in the KLA – more
    9,1*109/л. Часто больше 16*109/л;
  • Increased neutrophil count (NEU) – more
    6,1*109/л.
  • The presence of epithelium (normally absent);
  • The presence of leukocytes (normally absent);
  • The presence of pathological impurities (pus, mucus).

With aggressively current infection, it may appear in the feces
signs of blood.

Microbe is eliminated. An optimal antibiotic is determined for its
eliminate.
Poisoning (the action of toxins on the mucous membrane)

Increased white blood cell count (WBC) in the KLA – more
9,1*109/л. As a rule, slightly.

Various options are possible, depending on the toxin.

  • A large number of epithelium;
  • The presence of leukocytes;
  • Presence of blood and mucus.
Negative
Crohn’s disease
  • Increased white blood cell count (WBC) in the KLA – more
    9,1*109/л;
  • Reducing the number of red blood cells:
    • мужчины – менее 4,4*1012/л;
    • женщины – менее 3,6*1012/л;
  • Biochemical blood tests – increased C-reactive
    protein over 7 mg / l
  • A large number of epithelium;
  • Blood visible to the naked eye or black “tarry”
    chair;
  • The presence of leukocytes.
Negative
Intestinal dyskinesia Normal blood count The presence of muscle or connective tissue is possible.
fibers.
Negative

Instrumental diagnosis is not carried out with intestinal dyspepsia.
The exceptions are autoimmune pathologies (Crohn’s disease).

How to treat dyspepsia in these conditions? Firstly,
It is necessary to treat the underlying disease:

  • Intestinal infections – antibiotics;
  • Food toxins – elimination of general intoxication and use
    local local detoxicants (Enterodez, Polysorb MP);
  • Crohn’s disease – назначение гормональной терапии.

For any of these conditions, you should not eat foods with
plenty of fiber. It is important to take sorbents (Smecta,
Smectin, activated carbon, etc.) which is sufficient
effective to eliminate the syndrome. To reduce pain, perhaps
the appointment of antispasmodics (Drotaverine, Kellin, etc.).

Fermentation dyspepsia

This is one of the types of intestinal dyspepsia, in which
insufficiency of the lactase enzyme occurs. It is necessary for
digestion of a number of products: dairy and flour
products, chocolate, most sausages, etc. Most frequent
causes of fermentation dyspepsia:

  • Acute / chronic pancreatitis;
  • Pronounced dysbiosis (lack of normal bacteria in
    intestine);
  • Congenital deficiency of lactase enzyme;
  • Celiac Disease

The symptoms will be somewhat different from the usual intestinal
forms. Patients may complain of:

  • Severe bloating of the entire abdomen;
  • Severe pain that decreases / disappears after a discharge
    gases;
  • Profuse and frequent diarrhea (possibly up to 10 times a day). Feces when
    defecation with an unpleasant odor, has a light yellow color, liquid
    consistency, often foams;
  • Audible “rumbling” of the intestines, the sounds of transfusion of fluid in
    stomach;
  • Headache, irritability and general weakness (due to
    effects of toxic substances absorbed in the intestine on the nervous
    system).

The main method for determining fermentation dyspepsia remains
laboratory coprological analysis, that is, the study of feces
masses in the laboratory. It defines the acid reaction of feces,
increased amount of undigested fiber, starch grains,
fermentation microflora of the intestine.

Treatment should begin with a reduced diet.
carbohydrate food. Allowed to eat high-protein dishes (meat
boiled, broth, butter, steamed chicken), necessary
reduce the amount of bread, potatoes, vegetables and fruits, pastries,
porridge

Apply adsorbing substances (Smecta, Polysorb, Neosmektin),
probiotics (Atsipol, Laktofiltrum, Bifiform, Bifikol) and enzyme
drugs for dyspepsia (Creon, Pancreatin). As you recover
carbohydrate-containing foods are gradually introduced into the diet, but in
limited quantities. Menus and allowed dishes are determined in
depending on the cause of the development of this syndrome.

Fermentation dyspepsia у детей

It is this dyspepsia in children is more common than others. Have
child disease usually develops against the background of excessive
feeding with special mixtures, as well as fruit puree and
vegetables. The cause is often an innate enzyme deficiency.
lactase.

What will be the syndrome? The child’s chair is characterized
rapid, greenish color, mixed with mucus and white lumps
shade. Due to the accumulation of gases in the intestinal lumen baby
naughty, he was tormented by pain in the abdomen, constantly crying. After
gas discharge baby usually immediately calms down and falls asleep.

Adequate treatment can be prescribed only by a neonatologist or
qualified pediatrician. If one of the symptoms is present,
immediately contact these specialists.

Putrid dyspepsia

Another type of syndrome that occurs in violation of digestion
proteins in the small intestine. The causes of putrid dyspepsia can be
pancreatic diseases, intestinal mucosa damage
(toxins or microbes) or duodenal ulcers.

Symptoms that will be observed in patients have characteristic
features These include:

  • Cal dark brown with “putrid” or sour
    odor;
  • Mushy foaming chair. Typically, during a bowel movement,
    the patient feels a burning sensation in the anus;
  • Отхождение газов со зловонным odor;
  • There may be severe pain all over the abdomen, which
    weaken after stool.

Therapy is carried out similar to the fermentation form. First
turn, the patient is recommended a diet excluding protein (any varieties
meat and fish, dairy products, eggs, etc.). Should also
use sorbents and probiotics. As a rule, enzyme
drugs are not used in the treatment process. Need
antibiotic treatment is determined by the doctor.

Functional dyspepsia

This is the second large group of digestive disorders, which
occurs without any apparent reason. Have пациентов с этим
syndrome, disorders of enzymes and organs
the gastrointestinal tract is not detectable, even with careful
research.

Currently, the causes of functional dyspepsia are not completely
are clear. Doctors believe that psychosocial
factor (constant stress, emotional instability) and
heredity. To provoke an exacerbation of the disease can:

  • Smoking and drinking (even in small
    quantities);
  • Some drugs (Theophylline, drugs from digitalis,
    NSAIDs);
  • Stress.

This form of dyspepsia in adults is observed much more often than
in children. Symptoms of the disease may manifest in different ways. Distinguish
Three main forms of functional dyspepsia:

  1. Ulcer-like – it is characterized by “hungry” pain in the upper
    parts of the abdominal wall that weaken after eating;
  2. Diskinetic – the patient is worried about the heaviness in the stomach,
    after eating (especially fatty foods). May be accompanied
    nausea;
  3. Mixed – symptoms can be combined between
    ulcerative and dyskinetic forms.

It should be noted that stool disorders (diarrhea, changes
colors / consistency, fetid odor, blood impurities) does not happen
with this disease. Otherwise, it is necessary to repeat
examination due to the suspicion of another pathology.

In order to eliminate organic dyspepsia, it is recommended
carrying out the following diagnostics:

  1. General analysis of blood and feces;
  2. Blood biochemistry (ALT, AST, alpha-amylase, C-reactive
    protein);
  3. Microbiological study of feces; EGD with a biopsy.

If the above examinations showed normal, and in a patient
there are symptoms called, a diagnosis is made.

The treatment is general. The patient is recommended to exclude from
ration salty, spicy and fatty foods. Eat small
portions, but often (from 6 times a day). If necessary, you can
assign additional:

  • Antacids (Gaviscon, Almagel);
  • Ингибиторами H+-помпы (Омепразол, Рабепразол,
    Lansoprazole);
  • Haveспокаивающие средства (Феназепам, Адаптол, Грандаксин).

It should be noted that the necessary medicines for treatment can
pick only the attending doctor.

The most frequent syndrome of impaired digestion is dyspepsia.
It manifests itself in different ways, depending on the nature of the disease.
(organic or functional) and the affected department
digestive tract. Currently, there are simple methods
examinations that can be used to diagnose
1st day. After чего, назначается терапия и диета, что позволяет
quickly return the old quality of life to the patient.

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