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Functional DyspepsiaFunctional Dyspepsia
Norbert WelkovicsNorbert WelkovicsHeine van der WaltHeine van der Walt
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
DefinitionDefinitionCharacteristics: – Central abdomen– Pain or discomfort– Not associated with bowel movements
No structural or biochemical abnormalty
Part of Gastroduodenal disorders (Rome II)
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Fx GastroFx Gastro--intstinal disordersintstinal disordersRome II (1999)Rome II (1999)
A. Esophagial disorders E. Billiary disordersA1. Globus E1. Gallbladder dysfunction
A2. Rumination Syndrome E2. Sphincter of Odi dysfunctionA3. Functional chest pain of presumed oesophageal originA4. Functional heartburnA5. Functional dysphagiaA6. Unspecified oesophageal disorder
B. Gastroduodenal disorders F. Anorectal disordersB1. Functional dyspepsia F1. Functional faecal incontinence
B1a. Ulcer like dyspepsia F2. Functional anorectal painB1b. Dysmotility like dyspepsia F2a. Levator ani syndromeB1c. Non-specific dyspepsia F2b. Proctalgia fugax
B2. AerophagiaB3. Functional vomiting
C. Bowel disordersC1. Irritable bowel syndromeC2. Functional abdominal bloatingC3. Functional constipationC4. Functional diarrhoeaC5. Unspecified functional bowel disorder
D. Functional abdominal painD1. Functional abdominal pain syndromeD2. Unspecified functional abdominal pain
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
ClassificationClassificationOrganic dyspepsia– PUD, GERD, Pancreatico-billiry disease– Functional dyspepsia– Ulcer-like dyspepsiea
• Pain
– Dysmotility-like dyspepsia• Discomort; nausea, vomiting, postprandial fullness and upper
abdominal bloating
– Reflux-like dyspepsia• Heartburn but not the predominant symptom
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
EpidemiologyEpidemiologyCommon complaint (15 – 25%)
On upper GIT endoscopy:– Peptic ulcer disease 22%– Esophagitis 10%– Cancer 1%– Functional dyspepsia 67%
Comparable to asymptomatics
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
AetiologyAetiologyCause and effect difficult to establish1. Symptoms experienced are intermittent and
changing2. High placebo response rate (30%)3. No specific findings in all patients present4. Findings present in asymptomatic patients as well5. Symptoms and findings often do not correlate6. There is no universal effective treatment7. The response to treatment is difficult to predict
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology PostulatesPostulates
UlcerUlcer--likelikeDyspepsiaDyspepsia
– Helicobacter pylori– Gastritis / Duodenitis– Missed PUD– Acid sensitivity– Occult GERD
DysmotilityDysmotility--likelikeDyspepsiaDyspepsia
– Gastroparesis– Abnormal relaxation– Visceral hypersensitivity– Brain-gut disorder– Psychological disorder
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology Helicobacter pyloriHelicobacter pylori
Controversial:– Background infection rates increase with age– H.pylori gastritis equal in asymptomatics
Possible CagA+ strain
For treatment– WHO declared HP carcinogen– Response to treatment 20% at 1 year
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology Helicobacter pyloriHelicobacter pylori
Against treatment– Response to PPI not to antibiotics– Low background infection rate in 1st world countries
MAASTRICHT CONSENSUSMAASTRICHT CONSENSUSTest and treat approach in uninvestigated dyspepsia in
patients younger than 45 in the absence of:1. Alarm symptoms
2. NSAID use
3. Predominant reflux symptoms
4. Family history of gastric carcinoma
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology GastritisGastritis
NSAID gastropathy and functional dyspepsia can occur simultaniously– Stop NSAID– If symptoms don’t improve, treat as functional
dyspepsia
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology DuodenitisDuodenitis
Presence of past PUD diagnosis– Manage as PUD even if endoscopy normal– Missed PUD?
Absence of past history– Treat as functional dyspepsia
Functional DyspepsiaFunctional DyspepsiaFunctional Dyspepsia
Aetiology Aetiology Acid sensitivityAcid sensitivity
Normal acid secretion
Acid sensitivity increased– 20% incidence in functional dyspepsia– Decreased acid clearance by duodenum
? H2 treatment response– 20% above placebo rate