What is it?
From Greek dys-pepsia (poor digestion). It denotes a sensation that is difficult to classify and define, characterized by a set of symptoms, episodic or permanent, pain or discomfort, related to disorders in the upper abdominal cavity in the absence of an organic, metabolic or psychaitric disease that justifies them.
Given the nonspecific nature of the symptoms, it is believed that many causes are involved in their occurence, including altered gastric acid secretion, stress, psychological factors, altered visceral perception and altered gastrointestinal motility. There are also doubts about the role of Helicobacter pylori, since its prevalense in Italy is about 30-50%; these patients often have functional dyspepsia, and about half of them have improved symptoms after eradication of the bacterium. It has been ghypnotized that the bacterium may play a role in dyspepsia, but the studies conducted so far have been inconlusive in terms of demonstrating regression or disappearance of symptoms after the destruction of the bacterium.
Which are the symptoms?
Non-painful disorders: vague sense of discomfort that does not reach painful intensity, postprandial heaviness, premature fullness, nausea, vomiting, abdominal bloating, halitosis
It is helpful to remember that these symptoms are nonspecific, meaning that they can be associated not only with many gastroenterological conditions, but also with diseases of other areas, so you should seek medical advice to see if these complaints are minor or merit further evaluation or specialist consultation.
How is it diagnosed?
Esophagogastroduodenoscopy is the test of first choice for dyspepsia: it allows, on the one hand, to detect or rule out the presence of organic disease underlying the symptoms (e.g. ulcer, cancer) and, on the other hand, to determine the degree of chronic gastritis that may be present and the presence of Helicobacter pylori infection, by performing a gastric mucosal biopsy). Alternatively, especially in younger patients without warning symptoms (e.g., weight loss, anemia, difficulty eating), a "test and treat" strategy is preferable, at least initially, using noninvasive tests such as a breath test or stool test for Hp antigen. In patients with symptoms suggestive of delayed gastric emptying (prolonged digestion, postprandial heaviness, and bloating), a radioisotopic gastric emptying study may be helpful.
How is it treated?
After the exclusion of organic, metabolic or psychiatric causes, therapy is exclusively medical in nature. Not all patients with dyspepsia benefit from the same treatment, therefore there are several classes of drugs: prokinetics, antacids, acid secretion inhibitors, psychotropic medicines.
Where do we treat it?
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