Functional dyspepsia

　　The etiology and pathogenesis of functional dyspepsia (FD) are not fully understood to date and may be related to multiple factors. Currently, it is believed that:

　　1. The occurrence of gastric fundus receptive relaxation after eating is impaired, and the coordination of gastric antrum and duodenum movement and visceral hypersensitivity are related to the pathogenesis of FD.

　　2. Psychological, environmental, and social factors can affect and worsen the clinical manifestations of FD patients.

　　Functional dyspepsia is a benign gastrointestinal functional disease that can be effectively controlled with appropriate treatment and has a good prognosis. If clinical symptoms (such as early satiety, loss of appetite, nausea, and vomiting) cannot be relieved, vitamin deficiency and hypoproteinemia may occur. Depression, anxiety, and constipation are also common complications of functional dyspepsia.

　　Functional dyspepsia (FD) has no characteristic clinical manifestations, mainly including upper abdominal pain, upper abdominal distension, early satiety, belching, loss of appetite, nausea, and vomiting. These symptoms can appear alone or in a group.

　　Early satiety refers to the feeling of fullness soon after eating, resulting in a significant reduction in food intake.

　　Upper abdominal distension often occurs after meals or becomes worse after continuous eating.

　　Early satiety and upper abdominal distension are often accompanied by belching. Nausea and vomiting are not common and often occur in patients with明显 delayed gastric emptying, and vomiting is usually the contents of the meal.

　　Many patients also have accompanying symptoms such as insomnia, anxiety, depression, headache, and inattention, which are related to the fear of cancer in some patients.

　　Symptoms may also change during the course of the disease, onset is usually gradual, lasting for years, persistent or recurrent, and many patients have dietary and mental triggers.

　　To prevent functional dyspepsia, it is necessary to adjust diet and lifestyle, avoid triggers, and cultivate good living habits. Avoid smoking and drinking, and avoid spicy foods. Eat regularly, chew slowly, quit smoking, and limit alcohol intake; avoid emotional fluctuations, relax the body and mind, exercise moderately, and combine work and rest. Especially for police officers, drivers, flight attendants, and white-collar workers who often work overtime, the high level of stress and fatigue, irregular working hours, and irregular meals are all factors that can easily lead to gastrointestinal diseases, so special attention should be paid to the protection of the gastrointestinal tract.

　　Functional dyspepsia is relatively common in daily life, and patients should undergo the following examinations:

　　1. Fat determination in feces:Fat quantitative analysis is a simple and reliable test for diagnosing steatorrhea. In normal people, the amount of fat excreted in the feces within 24 hours is less than 6g, or the fat absorption coefficient is greater than 94%; using the 14C-triolein absorption test, normal people exhale a labeled substance greater than 3.5% of the administered dose per hour.

　　2. Schilling test for vitamin B12 absorption:Abnormal findings often suggest ileal terminal lesions, and patients with pancreatic exocrine dysfunction also often have vitamin B12 absorption disorders. The Schilling test is also helpful in diagnosing excessive growth of bacteria in the small intestine, especially in blind loop syndrome, scleroderma, and multiple small intestinal diverticula. For example, in the Schilling test for blind loop syndrome, the first and second parts are abnormal. After appropriate antibiotic treatment, the Schilling test can return to normal.

　　3. Imaging examinations:Ultrasound and endoscopy, other imaging examinations (including X-ray, CT, MRI, etc.), which are significant in excluding organic diseases and helping to differentiate from organic lesions such as gastric and duodenal ulcers, esophagitis, liver, gallbladder, pancreatic diseases, and tumors. X-ray and MRI imaging technology can also reflect the gastric emptying rate at different times to some extent.

　　4. Gastric emptying determination technology:Nuclear scan is considered the gold standard for determining gastric emptying, with 25% to 50% of patients showing an extended half-emptying time of the stomach, mainly for solid food.

　　Patients with functional dyspepsia should consume foods rich in protein or calcium, such as milk, dairy products, lean meats, fish and shrimp, egg yolks, salted eggs, preserved eggs, beans, etc.; they should eat fewer刺激性 foods, cold foods, as well as coffee, chocolate, potatoes, sweet potatoes, and acidic foods; they should avoid foods that are prone to cause bloating, such as dried beans, onions, potatoes, sweet potatoes, and sweets. Patients can also alleviate symptoms through food therapy, as follows:

　　1. Pu-erh Tea Porridge

　　Ingredients: Aged Pu-erh tea 12 grams, rice 100 grams.

　　Preparation: First, boil Pu-erh tea bricks with clear water to obtain the tea juice, then combine the tea juice with rice in the porridge pot and cook it into porridge.

　　Effectiveness: eliminates food accumulation and relieves bloating. This porridge is especially suitable for those who overeat greasy foods and have indigestion.

　　2. Baohuo Porridge

　　Ingredients: Hawthorn, Shengfu, and Chenpi each 5 grams, Maiya 30 grams, Fuling, Fahanxia, and Lianqiao each 10 grams, rice 100 grams, and sugar to taste.

　　Preparation: First, decoct the various herbs to obtain the medicinal juice, then combine the medicinal juice with rice in the porridge pot and cook it into porridge. After the porridge is cooked, add a small amount of sugar to taste.

　　Effectiveness: strengthens the spleen and stomach, eliminates food accumulation. This porridge is especially suitable for those with food accumulation that is difficult to move and meat accumulation that does not disappear.

　　3. Curdled Rice Porridge

　　Ingredients: Shengfu 15 grams, rice 50 grams.

　　Preparation: First, crush the Shengfu into powder, then decoct it in water to obtain the medicinal juice. Next, combine the medicinal juice with rice in the porridge pot and cook it into porridge. Serve warm.

　　Effectiveness: strengthens the spleen and stomach, aids digestion. This porridge is especially suitable for those with difficult-to-digest food accumulation and belching with acid regurgitation.

　　The treatment of functional dyspepsia is mainly symptomatic treatment, and should follow the principles of comprehensive treatment and individualized treatment. Patients need to establish good living habits, avoid smoking, alcohol, and non-steroidal anti-inflammatory drugs, avoid foods that may induce symptoms in personal life experiences; pay attention to psychological treatment based on the different characteristics of patients to eliminate fear and doubts about the disease they suffer from; those with insomnia and anxiety can take appropriate sedative-hypnotic drugs before going to bed. Functional dyspepsia currently has no specific drugs, and is mainly empirical symptomatic treatment, as follows:

　　1. Acid secretion inhibitors: Suitable for those with symptoms such as abdominal pain accompanied by acid regurgitation, and can choose alkaline antacids or acid secretion inhibitors, such as cimetidine and other H2 receptor antagonists or proton pump inhibitors such as omeprazole.

　　2. Prokinetic drugs: Suitable for those with symptoms such as upper abdominal bloating, early satiety, and belching. Domperidone is a peripheral dopamine receptor antagonist, the commonly used dose is 10mg, 3 times/d, taken 15 minutes before meals; Cisapride is a 5-HT receptor agonist, the dosage is 5mg-10mg, 3 times/d, taken 15-30 minutes before meals, for 2-8 weeks. However, Cisapride can cause abdominal rumbling, loose stools or diarrhea, abdominal pain, and prolongation of myocardial QT interval as side effects, so it is now less used, and patients with heart disease should be used with caution; Metoclopramide (Stomach Comfort) is a central and peripheral dopamine receptor antagonist, as it has a large extrapyramidal side effect due to long-term use, it is now rarely used or not used. In recent years, new prokinetic agents such as Motilium and Etozil can also be chosen, Motilium commonly used dose is 5mg each time, 3 times/d, taken half an hour before meals. For those with poor efficacy, acid secretion inhibitors and prokinetic drugs can be alternated or used together.

　　3. Antidepressants: Antidepressants can be tried for those with poor efficacy of the above treatment and obvious symptoms such as anxiety, tension, and depression, but they take effect slowly. Commonly used drugs include tricyclic antidepressants, such as amitriptyline 25mg, 2-3 times/d; antidepressants with 5-HT action, such as fluoxetine 20mg, 1 time/d, etc., should start with a low dose and pay attention to the side effects of drugs.

　　4. Others: Mucosal protective agents such as aluminum hydroxide gel, bismuth preparations, sucrose aluminum, Maizilin-S, etc., can be used.