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The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Treatment of dyspepsia

Dyspepsia medications

• prokinetics;
• antibiotics;

Prokinetics appointed during dyspepsia

Treatment of infection Helicobacter pylori
Before conducting treatment aimed at eliminating Helicobacter, the detection of this microorganism is initially carried out. The gold standard of detection of Helicobacter infection is a breathing test. It is carried out before antibacterial treatment and after it to confirm the success of therapy.
In this case, several treatment schemes are used.

Captions against Helicobacter Infection

Scheme

Combination of antibiotics

Three-component scheme, option 1

Eating products depressing fermentation processes There are vegetable crops that suppress the fermentation processes. It is recommended to cook drinks, which should be used for 200 milliliters per day, sharing a total volume into several techniques. Some plants are recommended for the preparation of desserts, salads and other culinary purposes. Cultures that brake in the intestine are: mint ( can be used for cooking tea, salads, desserts); lamberry ( used for compote, tea, stuffing in baking); raspberries ( supplement to cottage cheese, baking filling); kizil ( used for tea, compote, jam). Herbal teas can also be prepared from calendula, chamomile, sage. Reduce the fermentation processes such as a bay leaf, carnation, rosemary. Power Supply Excessive consumption of protein rich in protein against the background of a lack of carbohydrates is one of the main conditions for the development of putrid dyspepsia. The protein becomes the cause of rotten processes that flow with the formation of toxins. That is why there is a general weakness, headache and other symptoms of intoxication for rotary dyspepsia. To stop rotting in the intestine, patients with this disease should be observed a number of rules in the preparation of a daily diet. The rules for power dissipation are as follows: limited protein food consumption; reduction of consumed fats; an increase in carbohydrates in the diet; the use of products overwhelming in the intestines. Limited protein food consumption With a putrid dyspepsia, the norm of protein food is 50 grams per day. It is recommended to minimize or completely abandon the time from meat. Fish should be used metered, 2 - 3 times a week, 100-150 grams. Preference should be given to river fish rocks ( carpu, Crash, Pike, To). The daily norm of the protein must be filled with dairy products, since the cultures contained in them are normalized by microflora composition. prostokvash - 2.8; sour cream - from 2.5 to 3; kefir - 3; milk - 3; yogurt - 5; ryazhenka - 5; sweet curd masses - 7; glazed raws - 8; cottage cheese - from 14 to 18. The number of protein contained in 100 grams of the product is indicated by the numbers. Reducing consumed fats The amount of fats used with food during rotary dyspepsia should be reduced to 25-30 grams per day. At the same time, no less than 70 percent of fats consumed should be vegetable ( vegetable oil, nuts). The norm of animal fats should be filled, using butter, eggs. Products that need to be filled with the norm of fats during putrid dyspepsia are: corn oil - 100; sunflower oil - 100; butter creamy - 82; cedar nuts - 62; hazelnut - 67; walnuts - 62; eggs - 11.5. The numbers are indicated by the number of fats that are 100 grams of the product. Increase carbohydrates in the diet With a rotary dyspepsia per day, it is recommended to use from 400 to 450 grams of carbohydrates. To do this, in the menu should include porridge, crackers from wheat and / or rye bread, cracker. Much attention to this disease should be given to vegetables and fruits. Under the acute stage, only baked or boiled vegetable crops should be eaten. Subsequently, it is gradually necessary to introduce dishes from raw vegetables and fruits. Useful for rotary dyspepsia unloading vegetarian days. Use of products that are overwhelming in the intestine With rotary processes, it is recommended to eat acidophilus. Acidofilin is milk productwhich is carried out with the help of acidophilic sticks. In the stores, acidophilus can be sold in the form of a swax or attend the composition of milk, prostrochashi ( the presence of acidophilies in the product is indicated on the package). You can prepare the acidophilia using an acidophilic break, which is sold in a pharmacy or food store. Prepare acidophilic drink in several stages. Stages of preparation of acidophiline at home as follows: milk should be brought to a boil and lean on low heat for 30 minutes; then the milk should be cooled to 40 degrees; in the cooled milk it is necessary to add acidophilic bacteria; mix thoroughly and leave for 10 hours, keeping the temperature of 25 degrees ( it is better to use thermos). Some plants also contribute to the braking of grinding processes. From these crops should be prepared champs, teas or compotes. You need to drink daily, 1 - 2 glasses per day. Plants that suppress rotting in the intestine are: black currant ; red rowan; garnet ( juice); thyme ( can be used as seasonings); Prevention of dyspepsia Dyspepsia prevention is in compliance with a number of rules that provide normal functionality. digestive system. Also, in order to prevent the disease, the factors that contribute to the development of this disorder should be limited. Dyspepsia Prevention Activities: compliance with the rules of a healthy diet; control of bad habits; adequate stress response; control of your own state. Compliance with the rules of a healthy diet Healthy nutrition is the main requirement of preventing dyspepsia of any type. Useful diet based on several rules related to quality, quantity and culture of food intake. The norms of healthy food are as follows: refusal of hard diets; compliance with the proportions between proteins, fats and carbohydrates; limited fast food consumption, semi-finished products; sufficient consumption of vegetables and fruits; salt use in accordance with the recommended norm. Refusal of hard diets In order to prevent dyspepsia, it is recommended to abandon any diets that imply a strong cutting of calories. Daily calorie rate for an adult in the absence of systematic physical Loads is approximately 2200 ( for women) and 2800 ( for men). In case of hard physical work Or regular sports daily rate should not be less than 2,700 ( for women) and 3200 ( for men) Calories. If you need to lose weight, the daily rate can be reduced by 400 - 600 calories. More sharp limitations are stress for the digestive system and can lead to various diseases. Another type of weight loss diet today is protein diets. The predominance of protein food against the background of a lack of carbohydrates is one of the main reasons for putrid dyspepsia. Therefore, such diets should also be refused. The only type of diet that should be followed is a diet appointed by a physician for medical testimony. Compliance with proportions between proteins, fats and carbohydrates A healthy diet should consist of one piece of proteins, one piece of fats and 4 parts of carbohydrates. Since these elements can be of different types, it is necessary to take note of the recommendations for the consumption of protein, fat and carbohydrate-containing products. The rules for the consumption of proteins, fats and carbohydrates, the following: Proteins. To replenish the norm of proteins, which varies from 80 to 120 grams, it is necessary to include meat, fish, dairy products in the diet. In this case, it is necessary to prefer natural, not canned products. Fats. The norm of fats is 80 - 120 grams per day. Among fat 70 percent should be plant origin ( vegetable oil, nuts). The rest must be represented by natural animals ( not modified) Fats ( meat, Fish and Dairy Products). Carbohydrates. The norm of carbohydrate varies from 350 to 500 grams per day. From carbohydrates it is necessary to give preference to those who are slowly absorbed ( crup, vegetables). The number of these products should be 65 - 70 percent of the total carbohydrate consumed. The rest must be represented by rapid carbohydrates, namely fruits that are rich in glucose. The share of food sugar and products, which it includes, should have no more than 5 percent of the total amount of carbohydrates consumed. Limited fast food consumption, semi-finished products A healthy diet implies failure or maximum restriction of fast food products to which fast food belongs ( hamburgers, Hot Dogs, Shaurma) and semi-finished products. Factors that indicate the harmfulness of these products are: Elevated calorie. In the preparation of fast food and semi-finished products, modified and saturated fats, sauces, fatty meat, wheat flour and other components with plenty of calories are used. All this provides high caloric content of the finished product. Minimum nutritional value. Mostly fast food and semi-finished products consist of fast carbohydrates, therefore, despite the high calorie content, they do not provide a long sense of satiety. The value of such food is also low, as it contains a minimum amount of vitamins, fiber and other necessary elements. Overeating. Fast food and semi-finished products contain a large number of addition supplies consumer properties (fragrance, taste, external view ) Product. Under the action of these components, a person does not distinguish between signals about saturation, resulting in overeating. Preservatives. To increase the storage period in the components from which fast food is prepared, a large number of preservatives are added. Many preservative substances are also contained in semi-finished products. Finding into the body together with the food product, preservatives have a comprehensive negative impact. So, some of them destroy vitamins, others - break the balance of useful intestinal microflora. Sufficient consumption of vegetables and fruits Plant products are the main source of the necessary organism of elements as vitamins, minerals, antioxidants, fiber. Therefore, healthy diet implies use per day at least 400 grams of vegetables and 300 grams of fruit. So that the benefits of vegetables and fruits are maximum, when choosing and cooking, you need to comply with a number of rules. When buying should choose local products grown in the open soil. Bridge vegetables and fruits are processed by preservatives and other harmful substances To increase their storage period. The optimal choice is seasonal vegetables and fruits that are grown outdoors. There are many nitrates from greenhouses. Exotic products should be included in the diet in limited quantities. Before use, vegetables and fruit peel should be boiled water. Products that do not require heat treatment should mainly be consumed in raw. Potatoes and other cultures that require cooking should be baked or boiled. During the frying, many valuable elements are destroyed, and the benefits of vegetables becomes minimal. Salt use in accordance with the recommended norm The recommended rate of the cook salt per day is 6 grams ( teaspoon without a slide). According to studies, on average, people exceed the recommended salt rate by 50 percent. Excess salt in the body leads to numerous health problems. For example, this product is annoying the gastric mucosa and can provoke disorder of digestion, gastritis, ulcers. Therefore, given that the daily menu includes many ready-made foods that already contain salt, it should be minimal. Control of harmful habits Harmful habits adversely affect both the digestive system and on human health as a whole. Smoking, which belongs to one of the most common bad habits, provokes spasm of vessels. As a result of this, the organs of the digestive system are worse than the blood, they begin to allocate not enough enzymes, as a result of which their functionality is reduced. Nicotine, falling into the blood, has a negative effect on the nervous system and specifically to the area that controls the saturation processes. Therefore, many smokers with experience have problems with appetite. To bad habits, along with smoking, other human habits are from which it is necessary to refuse to ensure the health of the digestive system. To harmful habits that worsen the digestion process include: frequent use of alcohol; overeating; snacks on the go; nutrition dry; caffeine abuse; abundant food overnight; lack of full breakfast. Adequate stress response During stress in the body, hormones are synthesized, which adversely affect the operation of the digestive organs. Also during stress, man eating, swallows a lot of air, which provokes gas formation and can lead to dyspepsia. Therefore, the prevention of this disease requires the development of sustainability for stressful circumstances. Measures that help adequately react to stress are: planning affairs; work with negative emotions; employment of a favorite thing; soothing techniques; physical activity; full holiday. Planning business Planning workers and domestic affairs makes it possible to minimize unforeseen situations that are a frequent source of stress. Often, man is experiencing negative emotions from the need to keep a large number of tasks in memory. The problem of choosing the most priority case currently also refers to the number of frequent causes of stress. If you pre-fix the cases you need to do on paper ( or on other carriers), the need to remember all tasks and choose the most important of them disappears. Also planning makes it possible to provide many problems ( for example, late) who provoke stress. To compile plans to be effective, it is necessary to adhere to a number of rules. Planning rules are as follows: planning things, it is necessary to determine the priority of each task; to implement each task, you need to take time taking into account the fact that unforeseen circumstances may arise; if possible, the most important things should be appointed for the first half of the day; among the tasks must always leave the time to rest. Plans can be on the next day, week. It is also planned to plan separate events - a trip, shopping trip, repair. Work with negative emotions Negative emotions that were suppressed, sooner or later manifest as stress. Therefore, experts recommend working with a sense of discontent, anger or other negative emotions. So, if a negative situation occurred, time after time ( not right away) It should be done by analyzing. This will make it possible to objectively assess the factors that provoked it and provide for the development of a similar situation in the future. A person should not be silent in cases where relatives, friends or colleagues neglect his interests or infringe on rights. To talk about their own negative emotions, due to the incorrect behavior of others, without transition to individuals, in compliance with all the rules of courtesy. In some cases, especially with intra-daisy conflicts, it is advisable to apply to a psychologist or psychotherapist. Employment beloved According to scientific research, people who have a hobby carry the consequences of stressful circumstances are much easier. An employment of a favorite thing allows you to distract from the experiences and brings positive emotions. In addition, doing dancing, embroidery or other hobbies and achieving certain results, a person is joy that allows him to be more efficient to withstand stress. Soothing techniques Meditation, respiratory gymnastics and other soothing techniques are positively reflected on the nervous system. It is useful for relaxation and classical music, listening to which can be combined with soothing baths. Since in the human body, physical and mental processes are interrelated, to relax the nervous system, it is also recommended to engage in yoga or do exercises to eliminate tension in muscles. Physical activity Physical exertion normalize the level of hormones that provoke and enhance the negative effects of stress. According to the recommendations of specialists, in case a person is experiencing negative emotions, he needs to stroll a quick step in the fresh air, run or swim. Daily charges in the mornings, systematic sports, dancing or other active activities are also useful. Full holiday In order for the body to be fully restored after experienced stresses, it needs to provide high-quality timely rest. Night sleep should continue at least 7 - 8 hours. At the same time, it should begin no later than 23.00 hours, since it is during this period a dream is the most useful. It is also necessary to arrange breaks during the day to relax from workers or household cases. Before use, you must consult with a specialist.

It is almost impossible to significantly establish the cause of functional disorders, since they occur even in the absence of diseases of the stomach and other pathologies of the gastrointestinal tract. An important role in the treatment is playing proper nutrition And a healthy lifestyle.

Disease statistics

In Russia, the syndrome of functional dyspepsia is distributed, it is found in 35-40% of the population, mainly in women. At least once in life every second person came across the manifestations of this violation.

More often such a disease is diagnosed in patients aged 17 to 35 years.

Classification

Functional gastric dyspepsia happens three types:

• Yazwned-like. The patient complains of pain in the field of epigastria, and it occurs even at night or on an empty stomach.
• Discinetic. This form is characterized by early saturation. Even if a person ate quite a bit, he feels heaviness and.
• Nonspecific. This species is characterized by the symptoms of the previous two varieties.

Causes

The appearance of functional dyspepsia is associated with a violation of motor skills and secretion. This may occur for such reasons:

• slow integration process;
• violation of the accommodation of the stomach;
• suffered infectious diseases;
• inflammation of the 12-roscent;
• constant stress;
• mental and neurological diseases;
• overeating, which provoke the stretching of the stomach walls;
• lack of digestive enzymes;
• excess production of hydrochloric acid;
• disabilities digestion disaccharides;
• unbalanced diet or lack of power mode;
• use of medicines that adversely affect the gastric mucosa.

There is a relationship between dyspeptic disorders and, stomach tumors, diseases, gallbladder and biliary ducts, endocrine dysfunctions, as well as pregnancy.

Functional dyspepsia in children younger age group It may arise due to the immaturity of the digestive system, overeating or non-compliance with the child's age. In the kids up to a year, such a violation appears with incorrectly administering dust, the absenteeism of hormones becomes the cause of adolescents.

Symptoms

Functional dyspepsia is a set of digestive disorders. That is why the symptomatics of it is pronounced, similar to many gastrointestinal diseases.

General symptoms of functional dyspepsia:

• epigastria pain (intensity can be different);
• the feeling of gravity and cutting in the upper part of the abdomen, which does not leave a person even after the act of defecation;
• fast saturation of food, even with a small amount of consumable food;
• burning in the chest;
• heartburn and belching (not related to meals);
• nausea;
• nonsense, fatty intolerance;
• , meteorism;
• rumbling in the stomach;
• irregular stool, diarrhea;
• weakness, drowsiness.

The child's symptoms of ugly dyspepsia can be a loss of appetite and frequent joins, sometimes a fountain. The baby becomes restless and capricious, sleep is disturbed. The chair is liquid and frequent, sometimes green, particles of undigested food can be present. The child is worried about colic, swollen belly.

Such symptoms can be maintained for a long time, at least 3 months. Moreover, according to the results of the survey, any organic diseases will be absent.

What doctor is engaged in the treatment of functional dyspepsia?

With functional non-dumpy dyspepsia (FNT), you must contact the gastroenterologist. Sometimes it is required to help the psychotherapist.

Diagnostics

Mandatory conditions for making a diagnosis "Unemic Dyspepsia" is a constant or recurrent pain in the epigastric area, which is worried about the patient for at least 3 months, the absence organic diseases The gastrointestinal tract, as well as the feeling of gravity, which does not pass after the act of defecation. These are three main signs of a functional disorder. digestive tract.

To make a diagnosis correctly, it is necessary to differentiate a non-zero dyspepsia with. Both diseases are caused by a violation of the motor function of the tract.

The diagnosis of the functional dyspeption of the stomach involves the use of laboratory and instrumental techniques:

• clinical and biochemical blood test;
• general analysis urine;
• research feces for hidden blood, helminth eggs, coprogram;
• gastric ferrous test;
• fibrogastroscopy (FGS) is necessary to eliminate esophagitis, ulcers and stomach cancer;
• electrheasterographography - Study of the engineering function of the stomach;
• Ultrasound busty bodies;
• scyntigraphy - technique for estimating the speed of stomach feces;
• gastroduodenal pressure gauge - a pressure assessment method that occurs when the stomach walls are reduced;
• x-ray examination;
• CT or MRI.

Treatment

Treatment of functional dyspepsia complex. It includes such events:

• medication therapy;
• compliance with diet;
• normalization of lifestyle.

Sometimes to cure the manifestations of the disease, it is necessary to undergo a course of psychotherapeutic rehabilitation.

Medical therapy:

• prokinetics - metoclopramide, cisaprid and domperidon;
• antisecretory preparations (with excessive hydrochloric acid products), for example, ranitidine, Famotidine, pantoprazole;
• antacids - Renni,;
• enzyme preparations -, festal;
• antimicrobial means - Flexin.

To improve the efficiency of drug therapy, a diet is important. Treat dyspepsia, not normalizing the diet and power mode, it is useless. Principles of diet:

• Abandon coffee, carbonated drinks, oily, fried and acute food, Fast Fud, smoked, marinades and canned food.
• It is necessary to observe the power mode, it is impossible to allow long interruptions between meals. It is important to eat often, but in small portions.
• Drink up at least 1.5 liters of water.

To get rid of non-union dyspepsia, you need to abandon bad habits, as well as minimize physical and emotional loads. They adversely affect the motorcycle gastrointestinal tract.

Therapy in children

Children's therapy is similar to an adult. Yazwned-like dyspepsia is treated with antisecretory preparations (Famotidine or omeprazole). With diskinetic form, prokinetics (cisaprid) are effective.

Prevention

The basis of prevention is balanced and proper nutrition. Food must match the child's age. It is also worth conducting a calm and correct way of life, avoid emotional overvoltage. It is necessary to respect the regime of labor and recreation.

The state of the digestive system depends well-being of a person. To be healthy and feel cheerful, you need to follow how and what to eat.

Useful video about functional dyspepsia

As evidenced by world statistics, functional dyspepsia is the fourth diagnosis by the diagnosis established by general practitioners and family doctors according to the results of the primary inspection of patients. We often began to put gastroenterologists, although the therapists and family doctors still use the term "chronic gastritis" when setting a preliminary diagnosis of patients who addate complaints about dyspeptic phenomena.

This is not correct, because chronic gastritis is a disease with a well-known morphological basis. At the same time, functional dyspepsia is a diagnosis of an exception that requires a thorough examination of the patient to confirm the absence of a morphological substrate symptoms.

As a rule, the functional dyspepsia suffer to people of working age, more often women. The quality of life of patients is significantly reduced, performance is disturbed, they are subject to depressive disorders, which, in general, predetermines the high medical and social significance of the problem. The task of treating such patients can be more difficult than helping patients with a clearly defined organic pathology, for example, ulcerative disease, since with functional dyspepsia there is no usual framework for therapy; Digestive disorders have nonspecific chronic nature and are difficult to corrected.

Dyspepsia is a feeling of pain or discomfort, localized in the epigastric region, closer to the median line, in the absence of reflux symptoms (although the patient may complain about heartburn). Frequent symptoms Dyspepsia is a feeling of gravity in the stomach, belching, pain, or discomfort, blown in the field of epigastria, rapid saturation, less frequently, periodic vomiting.

According to modern ideas, the cause of functional dyspepsia is the discordination of regulatory effects in the brain system - the digestive channel, the result of which is the violation of the two functions of the tract - secretory (acid-industry) and motor. A prerequisite for establishing a diagnosis of functional dyspepsia is the absence of an inflammatory reaction of the gastric and intestine mucous membranes. Inflammation is a sign of organic pathology.

It is the violation of the motor function that most often determines the symptoms of functional dyspepsia. So, insufficient relaxation of the bottom of the stomach in response to the flow of food causes a feeling of gravity and early saturation. Violation of the stomach motility can acquire various forms: arrhythmia (lack of reductions of certain stomach departments), tachigastria or bradyigastry (rapid or, on the contrary, slow down reduction), stomach paresis with a violation of gastroduodenal evacuation.

It should be noted that the violation of the engine function of the stomach always causes the dyphoric of the small intestine and biliary tract, since these structures are closely related to the action of local hormones - cholecystokinin, secretine, etc.

In the diagnosis of functional dyspepsia, three stages are distinguished. At the first stage, the doctor must evaluate complaints, the clinic and the course of the disease according to the Anamnese data. Complaints, as a rule, numerous, noted a decrease in the trophic status, psycho-emotional state; In history - the experience of dietary food with the exception of certain products, which, according to the patient, it does not tolerate. The second stage is a general blood test, feces on hidden blood, test for infection N. pylori. The third stage is to conduct fibrogastodenoscopy with biopsy and morphological research to eliminate chronic gastritis, ulcers or other organic pathology.

According to unified clinical protocols of medical care patients with dyspepsia, non-drug treatment methods are used (normalization of the day mode, diet, psychological correction), as well as drugs, depending on the presence or absence of an infection N. pylori. Patients with helicobacter infection shows an eradication therapy according to standard diagrams of 10-14 days. Patients without cheilicobacter infection are prescribed inhibitors of proton pumps or prokinetics (depending on the clinical version of dyspepsia) for 4 weeks or a combination of drugs of these two classes.

In the clinical protocol, there are no instructions for probiotics or enzyme preparations. Patients with functional dyspepsia do not need these tools, as they do not affect the course of the disease.

Classic and well-studied prokinetics, which is widely used in the treatment of patients with functional dyspepsy for more than 30 years, is the drug Motilium (Domperidon). Motilium is a drug selection for the treatment of patients with dyspepsia symptoms, which provides a rapid effect directly in the stomach and has a favorable safety profile.

A comprehensive mechanism of action of the drug Mothilium allows you to directly affect the symptoms of dyspepsia. Motilium increases the tone of the lower esophageal sphincter (while it is eliminated by such a symptom as a belching, a gastroesophageal reflux is warned), normalizes the peristalsis of the stomach, speeds up the evacuation of gastric content in the duodenum (removes the feeling of gravity, overflow, nausea).

Normalization of the stomach motility under the influence of domperidone improves the processing coordination, which positively affects the motor function of the small intestine, the Sphinteer of the Odda and the gallbladder, helps to restore the physiological processes of the evacuation of the bile and pancreatic secret, the passage of Himus.

Due to the complex action of the drug, the Mothilium is effectively eliminated by such a symptom of dyspepsia, as a feeling of gravity in the epigastrium, which greatly worsens the quality of life of patients. The feeling of gravity, which patients often describe the words "Food a stone lies in the stomach," does not pass between feeding food, and sometimes forces patients artificially cause vomiting.

Most patients with functional dyspepsia have a reduced trophy, therefore the diet should provide a sufficient amount of energy, plastic material and micronutrients (vitamins and trace elements). In addition, the purpose of diet and therapy is to prevent violations of secretion, motility and digestion, improving the psycho-emotional state of patients. This contributes to the inclusion in the diet of products containing amino acids glutamine, glycine, omega-3 fatty acids.

Patients with functional dyspepsia can poorly carry bean plants (contain protease inhibitors), products rich in untranslated fiber, organic acids, transgira, prolamin, glyadin (rye, wheat, oats), histamine, thiramine (cheeses, red wine, beer).

Some doctors in patients with complaints about the severity in the stomach unreasonably use drugs of pancreatic enzymes. Exodus-treated pancreatic insufficiency, which remains the main indication for the appointment of enzyme preparations, develops in conditions of deficiency of about 75% of the volume of digestive enzymes, and it is not so common as functional dyspepsia.

Since the functional dyspepsia is due to a violation of the stomach motility, it does not concern such a diagnosis as chronic pancreatitis. Prokinetics, in particular, Motilium are the first line with functional dyspepsia, since directly eliminate its cause is the slowdown in the evacuation of the stomach in the duodenum.

The enzyme preparations act in the lumen of the small intestine and do not affect the motorcycle gastrointestinal motorcycle, but suppress the secretion of the mucous membrane of the small intestine of the cholecystokinin, reducing the outer-cultural function of the pancreas and the gallbladder motorcy. Therefore, the appointment of enzymes with a patient functional dyspepsy does not benefit.

Differential diagnosis of functional dyspepsia and the excess of the pancreas is based on some typical differences in the clinic and the flow of these diseases. Sick functional dyspepsia is, as a rule, young people, mainly women who are prone to depression, self-medication with a variety of diets.

With functional dyspepsia, there are no periods of exacerbation and remission characteristic of the flow of chronic pancreatitis. With excessive pancreas deficiency, polyfexaly (pancreatic diarrhea) with steamen phenomena is usually observed, whereas with functional dyspeptation of feces normally.

Compliance with the clinical protocol of the treatment of functional dyspepsia, which is based on the use of prokinetics, prevents medical errors, allows doctors to protect themselves from legal prosecution, and most importantly, effectively eliminate the symptoms of dyspepsia, returning the sickness of life.

- This is a disruption of digestion due to the causes of organic and functional nature. The symptoms are pains in the top of the abdomen of unclear localization, nausea, heartburn, a sense of overflow of the stomach, fast saturation after meal and others. The diagnosis is established only in case of excluding other pathology of the gastrointestinal tract, the fundamental importance has an endoscopic examination. upper departments digestive tract. Treatment is symptomatic: enzyme preparations, means for improving the motorcycle gastrointestinal motorcycle, etc. It is of great importance to psychotherapy - after classes with a psychologist, most patients note a decrease in the intensity of complaints.

MKB-10.

K30.

General

Dyspepsia is one of the main problems of modern gastroenterology, since uncertain complaints about digestive discomfort places up to 40% of the population of developed countries, while only every fifth addresses to doctors. Digestion disorders may have an organic or functional basis.

Organic dyspepsia arises against the background of various pathology of the digestive organs (gastritis, ulcerative disease, inflammatory diseases Hepatobiliary system, pancreas and various departments of the intestine, tumors of the tract and other). The functional dyspepsia is said in the case when, in the presence of symptoms of the violation of the stomach, no organic pathology is detected, which could call these complaints. Women suffer from a functional dyspexia 1.5 times more often than men; The main age contingent, which detects this disease, make up the face 17-35 years.

Causes of dyspepsia

The pathology is assumed to be a psychosocial disease, in which the regulation of the functions of the stomach and the initial departments of the intestine is disturbed as a result of various stress factors. In addition to emotional overvoltage, the causes of the development of functional dyspepsia may be nutritional disorders, medicinal preparations, increasing the secretion of hydrochloric acid, helicobacter seamation of the gastric mucosa, dyskinesia of the initial departments of the digestive tract, disruption of digestion of complex sugars and others. It is known that hypovitaminosis (insufficiency of vitamins C and group B) can also contribute to the development of dyspepsia.

As a result of the impact of the listed factors on the wall of the stomach, the sensitivity of visceral receptors increases, the discoorination of the stomach motility and fine intestineThe normal secretion of digestive juices is disturbed. Manifestations of these disorders are gastroparesis (accompanied by weight in epigastria, nausea and vomiting), increased visceral susceptibility susceptibility (feeling of the overflow of the stomach, hungry pain in the opposite region), incomplete relaxation of the muscular layer of the organ (the feeling of early saturation), slowing the promotion of dietary masses from the stomach in the intestines.

Diseases such as food allergies, gastroesophageal reflux disease, a diaphragmal hernia with a displacement of the abdominal esophagus in a chest cavity, gastritis, ahlorohydry, ulcerative disease, cholecystitis, state after cholecistectomy, pancreatitis, pylororostenosis, pylorostenosis , Tumors of the GCT, various infections of the digestive tract.

The most common cause of dyspepsia in children are nutritional toxicinosis, in which case, to the fore, along with dyspeptic, the toxicosis syndrome is released. Since the signs of organic dyspepsia are discussed in sections on the relevant diseases of the gastrointestinal tract, this article will be part of the functional dyspepsia.

Pathogenesis

As a result of the impact of the listed factors on the wall of the stomach, the sensitivity of visceral receptors increases, the discoordination of the motility of the stomach and the small intestine occurs, the normal secretion of digestive juices is disturbed. Manifestations of these disorders are gastroparesis (accompanied by weight in epigastria, nausea and vomiting), increased visceral susceptibility susceptibility (feeling of the overflow of the stomach, hungry pain in the opposite region), incomplete relaxation of the muscular layer of the organ (the feeling of early saturation), slowing the promotion of dietary masses from the stomach in the intestines.

Dyspepsia classification

Based on the pathogenetic principle, the functional and organic dyspepsia distinguish. Organic pathology accompanies various diseases of the digestive tract, and the functional proceeds against the background of the absence of organic lesion of the gastrointestinal tract. For the causal factor, the following dispersion options are allocated:

• Alimentary- Usually associated with a violation of the ratio of the main nutrients in the diet. The fermentation dyspepsia develops when the carbohydrates is predominant in the carbohydrate menu, shredder - proteins and stupid meat, soap - when re-fulfilled by refractory fats.
• Enzymatic- associated with insufficient formulation of digestive enzymes. Depending on which enzyme failure developed in which the organ, the gastrogen, pancreatogenic, hepatogenic and enterogenic dyspepsia is distinguished.
• Dyspepssentials in Mal Absorption Syndrome - associated with impaired nutritional suction in the intestine.
• Infectious- develops with different intestinal infections, most often in dysentery and salmonelles.
• Inxication- arises with acute poisoning, heavy common infections, extensive injuries.

There are also four clinical forms of functional dyspepsia: Yazve-like, dyskinetic, reflux-like and uncertain.

Symptoms of dyspepsia

The diagnosis of functional disorder is established in the presence of three mandatory criteria. The first one is the complaints of pain and discomfort in the upper half of the abdomen on the middle line for one week monthly, or 12 weeks a year. The second is the lack of organic changes in the gastrointestinal tract in physical, endoscopic and ultrasound examination of the upper digestive tract. The third criterion is the lack of signs of irritable bowel syndrome (relief of symptoms after defecation or changing the character and frequency of the chair).

There are a number of features, in the presence of which the diagnosis is excluded: it is dysphagia, an increase in body temperature, the appearance of blood in a chair, inflammatory changes in clinical analyzes, anonymous weight loss, anemia. If there are listed symptoms, a deeper examination of the patient is required for the formulation of the right diagnosis.

There are four options for the flow of functional dyspepsia, each of which has its clinical and physical signs. A yazwned-like version is manifested by sufficiently strong night or hungry pain in the epigastric region, often arising after emotional overvoltage. The pain syndrome is borne by meals, introducing antacids. Characteristic sign It is a feeling of fear during an attack, obsessive thoughts about the presence of an incurable disease.

The diskinetic option is expressed by a feeling of overcrowding the stomach after eating, heaviness in the epigastria, nausea, bloating. Possible vomiting, bringing relief. Patients note that after eating rapid saturation occurs. Reflux-like dyspepsia is manifested by heartburn, a feeling of burning pain behind the sternum, belching and joking the acid. The last form of the disease is uncertain, or non-specific - characterized by polymorphism of symptoms, while allocating one presenter is not possible. For functional dyspepsia, a long time is characterized by no progression of symptoms.

Diagnostics

The consultation of the gastroenterologist will allow to identify the leading complaints, decide on the necessary amount of research. The diagnosis of functional dyspepsia is established only after a complete examination of the patient and the exclusion of other pathology of the gastrointestinal tract. The following studies are required: Consultation of an endoscopist doctor for eviopagogastroduodenoscopy, ultrasound of the abdominal bodies, blood tests (generally increasing and biochemical blood tests), Cala's research to assess digestive activities, detecting hidden blood.

With functional dyspepsia during EGDS changes in the mucosa are not visualized. In the ultrasound of the abdominal organs, chronic pancreatitis, gall-eyed disease can be detected. Deviations in analyzes with this diagnosis usually does not happen. For differential diagnosis with other gastrointestinal diseases, additional research may be required. With the radiography of the stomach, the expansion of the body cavity can be detected, slowing the evacuation of food. On the electroasterography, a violation of the stomach peristals is recorded (most often the gentle of its rhythm).

To determine the acidity, a study of gastric juice is carried out, intragastric pH-metry (possibly both an increase and lowering pH). To assess the degree of relaxation of the stomach, an anthrododenal pressure gauge is used, during which a special sensor transmitting pressure indicators is introduced into the organ cavity. With functional dyspepsia, the manometry may indicate insufficient relaxation or, on the contrary, relaxation of the stomach walls.

In a situation where symptoms are progressing, or not enough against the background of treatment, two different studies are required to detect Helicobacter infection. The use of methods with different diagnostic mechanisms (determination of the Helicobacter in feces using the ELISA, PCR diagnostics Helicobacter, determining the blood of antibodies to the Helicobacter method of the ELISA, the respiratory test for Helicobacter) will avoid the error.

Prediction and prevention

Functional dyspepsia worsens the patient's life, but the forecast this disease favorable. In the absence of alarming symptoms listed above, the presence of a serious tract pathology is unlikely. However, for dyspepsia, a wave-like flow is characterized, so after the course of therapy, the high probability of recurrence of symptoms is preserved. Specific dispersion prevention measures are not developed, but maintaining a healthy lifestyle, rational nutrition and the elimination of stressful situations significantly reduce the likelihood of developing this disease.

The term "dyspepsia" is relatively often used by doctors in practical work during examination of patients, but often interpreted in different ways, although literally under this term is meant a digestive disorder. Nevertheless, in practice, when it comes to patients with dyspepsia, such symptoms such as pain and unpleasant sensations arising in the abdomen during eating or at different times after it, meteorism, stool disruption.

Ethiopathogenetic aspects of dyspepsia. Dyspepsia as a symptom of many diseases of the gastrointestinal tract is relatively often both with functional and organic diseases. Different causes can lead to the appearance of symptoms, usually included in dyspepsia syndrome. Functional dyspepsia in gastroenterological practice is detected in 20-50% of cases, while most of the patients are combined with chronic gastritis. The risk of functional dyspepsia is associated not only with a violation of the diet, but also with the reception of patients with nonsteroidal anti-inflammatory drugs, as well as with such, seemingly "non-traditional" factors, as a low educational level, housing rental, lack of central heating, joint sleep ( Sibsi), finding in marriage. In some patients, the appearance of symptoms of dyspepsia may be associated with tobacco and even with psychological disorders.

For functional dyspepsia, the absence of any noticeable gastrointestinal (including esophagus) lesions is considered characteristic. This implies only the presence or absence of gastritis and eliminates not only the relatively small focal lesions (ulcers, erosion), but also, in some cases, relatively large in length, diffuse lesions, such as reflux-esophagitis, sarcoma, stomach lymphomatosis, etc.

Currently, the chronic gastritis is increasingly considered as a morphological concept, which includes a complex of inflammatory and dystrophic changes in the stomach mucosa. Different clinical symptoms that appear from the patients, previously typosed with inflammatory changes in the stomach mucosa and are considered characteristic of chronic gastritis (in the absence of organic stomach changes), are currently being considered as functional manifestations that are not due to the morphological changes that constitute the essence of the concept " gastritis".

The pathogenesis of the syndrome of functional dyspepsia, both in general and most of its symptoms is still unclear. However, it is noted that dyspeptic disorders with a functional dyspepsia, including those combined with chronic geastritis, are possible in patients with a weakened motility of the anthral ventricular department, leading to a slowdown in the evacuation of the contents of the stomach into the duodenum, which is probably the appearance of antrumpendenal coordination. , with the intelligent nature of gastric discounts (rhythm violations). Only the pathogenesis of the symptom of rapid saturation of the stomach associated with the slowdown in the gastric emptying seems to be quite clear.

However, the part of patients with normal engineering function of the stomach is also possible symptoms of functional dyspepsia (including in patients with gastroesophageal reflux disease), which is most likely due to visceral increased sensitivity Stomach, mainly to stretching. The increased sensitivity of the stomach to stretching can be associated with a violation of the receptor perception of normal stimuli, including muscle peristaltic cuts, as well as stretching the walls of the stomach of food. In part of patients, dyspeptic disorders are also possible with increased secretion of hydrochloric acid (due to the increase in the duration of the contact of the acid content of the stomach with its mucous membrane).

Perhaps there is a consistent relationship between clinical symptoms of functional dyspepsia, in particular the appearance of discomfort after meals (especially after the use of products and beverages irritating the gastric mucosa), and the weakening of the relaxation of the stomach. Indeed, in many reports there is an increase in the frequency of the appearance of clinical symptoms characteristic of functional dyspepsia, after receiving patients with certain foods, but there are almost no messages indicating that the use of any food leads to a decrease in or disappearing these symptoms.

Symptoms of functional dyspepsia. Most clinical symptoms marked with organic dyspepsia are found at functional dyspepsia. Among the symptoms of the functional dyspepsia, the following can be distinguished: the feeling of gravity, cutting and overflowing the stomach, premature (fast) saturation, "swelling" of the abdomen after eating; The emergence of non-specific pain, burning in the epigastric region, heartburn, belching, regurgitation, nausea, vomiting, joining, salivation, anorexia. The frequency of development of certain symptoms of functional dyspepsia, the occurrence, intensity and duration, according to our observations, may be different. A complex of all symptoms considered characteristic of functional dyspepsia, during a significant deterioration in the state of patients occurs only in a small part of patients; In particular, according to our observations, among patients hospitalized in the hospital, in 7.7% of cases (in 13 of 168 patients).

Most of patients with functional dyspepsia, including combined with chronic gastritis, are relatively rarely examined and treated not only in hospitals, but also in outpatient polyclinic conditions. Only a few patients with a worsening of the state turn to the doctor, insisting on hospitalization to the hospital to clarify the diagnosis and treatment.

When examining patients with chronic gastritis with functional dyspepsia, hospitalized gastroenterology, pain in the epigastric region was noted in 95.5% of cases, nausea - in 13.4% of cases; The feeling of gravity in the epigastric region is 91.1% and the feeling of early saturation, arising during or immediately after meals, in 87.5% of cases; Exciration - in 67.9%, "bloating" of the abdomen - in 77.7% of cases.

Apparently, differences in the contingent of surveyed patients with functional dyspepsia affect the incidence of certain symptoms of this syndrome submitted in the literature by various researchers. So, according to other data, patients with functional dyspepsia pain in the upper belly sections are installed only in 36% of cases: only 60% of these patients presented complaints of pain arising after meals, 80% of patients were disturbed by night pains (at the same time Pain in the stomach that prevented the patients to sleep - in 89.3% of cases). The feeling of early saturation patients were noted in 85.7% of cases, burning sensation (heartburn), mainly in the epigastric region, in 88.4% of cases, nausea - in 92.9% of cases.

It is known that the periodically arising heartburn (burning) is possible in patients and with normal contact of hydrochloric acid with the mucous membrane of the esophagus and / or stomach (43%); In such patients, the normal pressure of the lower esophageal sphincter is 10 mm Hg. Art. and more. Approximately 30% of persons constantly hosting antacid drugs to eliminate heartburn (burning), there is an increased visceral sensitivity of the esophagus to mechanical or chemical incentives (with normal eviopagoscopy data and daily pH metry). In contrast to organic dyspepsia, such a characteristic symptom, as a sense of fast saturation after meals, is noted only in patients with functional dyspepsia. In addition, excessive belching, vomiting in the morning more often worried patients with functional dyspepsia.

Unfortunately, description different symptomsconsidered characteristic of dyspepsia in general, including functional dyspepsia, as well as the interpretation of these symptoms with different patients make a certain confusion when comparing the data obtained and submitted by various researchers. In particular, pain in the stomach (and even behind the sternum) can "interrupt" patients and as a feeling of burning, spasm and an indefinite sensation, heartburn - as a feeling of burning not only for the sternum, but also in the epigastric region, regurgitation - as "the appearance of acid" In the oral cavity.

Diagnosis of functional dyspepsia. It is known that the diagnosis of functional dyspepsia is established on the basis of the study and analysis of symptoms, anamnesis of the disease, the results of the physical examination of patients, as well as the data of the laboratory and instrumental examination, in essence, by eliminating organic diseases in which the symptoms of dyspepsia occurred, i.e. exceptions Organic dyspepsia.

Repeatedly suggested in the diagnosis of functional dyspepsia to take into account certain deadlines for the appearance of symptoms, which are considered as characteristic of this syndrome, the frequency of their occurrence, the duration (for a certain time, including for one year), but this approach is unlikely To the examination of the patients will be widespread use. The intensity, frequency and time of the appearance of symptoms of dyspepsia may be different. At the same time, a significant part of the patients are so accustomed to the symptoms of dyspepsia, which often does not pay attention to them (and no longer perceive them as a manifestation of any disease). Sometimes certain drugs accept (without consultation with doctors) in order to eliminate the unpleasant sensations of various types. Finally, most often the patient cannot accurately recall the time for the appearance of many dyspeptic disorders, the frequency of their occurrence (even intensive symptoms in the severity). Therefore, as a rule, the beginning of the development of functional dyspepsia, and often its doctor can trace the patients with only approximately.

Differential diagnosis. In the differential diagnosis of dyspepsia symptoms, the following should be considered: in 40% of cases, the symptoms of dyspepsia are found in patients with benign ulcers of the stomach and duodenal of various etiology, with gastroesophageal reflux disease and stomach cancer. In 50% of patients, the reason for the appearance of clinical symptoms of dyspepsia remains unclear, so they are often mistakenly considered as manifestations of functional dyspepsia. That is why, with the differential diagnosis of organic and functional dyspepsia, along with the clarification of the symptoms and anamnesis of the disease and the analysis of the data obtained, the results of such objective methods such as endoscopic and x-ray examination, ultrasonicography, are essential (in doubtful cases); In some cases, when examining patients, computer tomography is also shown. The use of these methods allows you to identify or eliminate the presence of other diseases (including to establish the cause of organic dyspepsia).

The authors of some publications, reporting on the functional dyspepsia, are not construed in the allocation of this or other symptom complex. We note the two most common classifications of functional dyspepsia. According to one of them, a dyskinetic, dyskineic, associated with a violation of motility, and non-specific options are distinguished; At the same time, the reflux-like dyspepsia is considered as part of the symptomatic complex of gastroesophageal reflux disease. However, according to another classification, the following variants of the functional dyspepsia are allocated: an option associated with a violation of motorcycles, ulcene-like dyspepsia, reflux-like dyspepsia and nonspecific dyspepsia.

Our own observations indicate that the division of functional dyspepsia to different types can only be considered as very conditional. Only in part of the patients has the opportunity to identify one or another complex of symptoms, which can be more or less accurately associated with one of the variants of functional dyspepsia, especially if you adhere to the definition of functional dyspepsia proposed by the proprieties of Roman criteria for the functional diseases of the gastrointestinal tract. When diagnosing the functional dyspepsia is proposed to take into account the following criteria:

• the presence of constant or intermittent dyspepsia arising within 12 weeks per year is not necessarily sequentially for the last 12 months;
• lack of organic diseases of the gastrointestinal tract with similar symptoms;
• the preservation of the symptoms of dyspepsia, not related to the irritable bowel syndrome, in which the state of patients is improved after defecation.

As practice shows, in the majority of patients with functional dyspepsia during the treatment of patients to the doctor, it is often quite difficult to determine the dispersion option to select the most optimal treatment option. To a certain extent, it is due to the fact that during the treatment of the patient's doctor, not all the symptoms, which, according to the history of the disease, remained 12 weeks and more than the last year. Only if there are many symptoms, it is possible to determine the option of functional dyspepsia more or less. Therefore, according to our observations, with the selection of drug treatment, it is advisable to take into account primarily the basic symptoms of dyspepsia, which cause the patient the greatest concern.

Therapy of functional dyspepsia. The main purpose of the treatment of patients with functional dyspepsia is to improve the objective and subjective state, including the elimination of pain and dyspeptic disorders.

The success of the treatment of patients with functional dyspepsia is largely determined by the following factors:

• perseverance and goodwill of the doctor in relation to the patient;
• patient's attitude to their health;
• the disciplination of patients with respect to the reception of food, drugs, compliance with general preventive recommendations;
• correction of lifestyle, improving its quality.

It is known that in the treatment of patients with functional dyspepsia, including those combined with chronic gastritis, in our country are most often used (depending on the state of patients), the following drugs (or combinations thereof): Prokinetics (domperidone, metoclopramide), antisecretory drugs (Inhibitors of the proton pump, antagonists H 2 -receptors), disadvantaged antacid drugs (bismuth tricia Dicitrate (Denol)), enzyme preparations (festal, micrazim, panzinorm, penza et al.). Sometimes in patients with chronic gastritis associated with Helicobacter Pylori (HP), and combined with functional dyspepsia, antihelicobacteric therapy is carried out, during which bismuth is more often used by bismuth tricia dicyrate (de nol) or proton pump inhibitors.

The presence of a large number of variants of drug therapy offered to treat patients with functional dyspepsia to a certain extent testifies to dissatisfaction with doctors with the results of the treatment of patients with functional dyspepsia. It is probably due not only to the lack of pathogenesis of most of the symptoms of dyspepsia, but also pathogenesis of the functional dyspepsia syndrome as a whole, as well as with often arising from differentiation of options for functional dyspepsia on a complex of certain symptoms of difficulties. This is due to the fact that the interpretation of many symptoms of dyspepsia patients in different populations of the population, including ethnic groups, differs significantly.

In the treatment of patients with functional dyspepsia, domperidone (Motilium, Motylonium) or Metoklopramide (Cerukal) is commonly used. These drugs enhance the peristaltics of the esophagus and the stomach, and also provide normalization of gastroduodenal coordination and emptying of the stomach, an increase in the tone of the lower esophageal sphincter. Applying data from the patients with a functional dyspexia of such symptoms as a slowdown in the gastric emptying (a sense of early saturation occurring during meals or immediately after receiving small number food), as well as symptoms associated with increased sensitivity of the stomach to stretching (sense of gravity, cutting and / or overflowing the stomach, arising during or immediately after meals); If you have heartburn (burning). The usual dose of prokinetics is 10 mg 3 times a day in 20-30 minutes before meals. In severe cases, the dosage of prokinetics can be increased to 10 mg 4 times a day (last time per night), until the intensity of pronounced manifestations of dyspepsia, then continue the treatment of patients with drugs in the usual dosage.

When using domperidone (Motilium, Motonium) there is a smaller compared to metoclopramide, the probability of appearance side Effects . Therefore, if necessary, domperidon can be used in the treatment of patients for a longer time, but at least 3 weeks.

Treatment of patients with domperidone allows you to eliminate the sense of premature saturation in 84% of cases, cutting in the opposite region - in 78%, discomfort after meals - 82% and nausea - in 85% of cases. Unfortunately, the timing of the treatment of patients (this applies to all prokinetics) quite often exceed 2-5 weeks.

To eliminate pronounced pain and / or hearth (burning) in the epigastric region in patients with functional dyspepsia, it is quite sufficient for the first 7-10 days to use proton pump inhibitors in the standard dosage 1 time per day (Lansoprazole, Pantoprazole, Rabeprazole, Ezomeprazole, respectively, 30 , 40, 20 and 40 mg), after this patients can be transferred to the treatment of H2 receptor antagonists (Ranitidine or Famotidine, respectively, 150 mg and 20 mg 2 times a day). It is known that omeprazole (losek) in a dose of 20 mg makes it an average to reduce the daily level of isolating hydrochloric acid in the stomach by 80%, ranitidine at a dose of 300 mg per day by an average of up to 60%, which determines the effectiveness of these drugs to a certain extent. The aforementioned course of treatment is advisable to carry out in persons with a functional dyspepsey with an ulcer-like variant or if patients with reflux-like dyspepsia in patients.

However, is it always necessary to significantly inhibit acid formation in the stomach for the successful treatment of patients with functional dyspepsia, including combined with chronic gastritis? This question involuntarily rises to doctors and researchers due to the fact that hydrochloric acid in the human body plays a certain protective role; In addition, an excessive decrease in the secretion of hydrochloric acid increases the likelihood of an increase in the microflora in the stomach. It is also known that the proton pump inhibitors and H 2 antagonists are more effective in hypersecretion of hydrochloric acid. Therefore, in the treatment of patients with functional dyspepsy with a non-specific version, as well as a part of patients with a violation of the motorbers of the upper departments of the gastrointestinal tract, it is advisable to use bismuth tricia dicyrate, which has a cytoprotective effect on the gastric mucous membrane. It is prescribed 120 mg 4 times a day; If necessary, to eliminate pain as therapy "on demand", it is advisable to additionally take one of the antagonists of H 2 -receptors 1-2 times a day in the therapeutic dosage before eliminating pain and burning in the epigastric area.

And yet, the main thing in the treatment of patients is a treatment with one or more drugs, the mechanism of action of which allows to eliminate the symptoms of functional dyspepsia, which cause the greatest concern to patients. In particular, if there are frequently repeated symptoms of dyspepsia, commonly united by a single term "discomfort", in patients with functional dyspepsia, enzyme preparations should be used (pancreatin, microzima, festal, pantomitin, and other), even with a normal outer-generating function of the pancreas, In the necessary cases, combining their use with antagonists H 2 -receptors or with prokinetics, with bismuth tricia dicyrate. A certain improvement in the processes of digestion and the normalization of the engineering function of the gastrointestinal tract contributes to the elimination of symptoms of functional dyspepsia associated with an increased visceral sensitivity of the stomach to stretching, mechanical and chemical stimulation, as well as with a violation of motility.

The duration of treatment of patients is determined by their common state, which largely depends on the attitude of their health and the implementation of the recommendations of doctors.

Equally, it is important to teach patients to observe the regime of labor and recreation, avoid the reception of those or other products that poorly carry them; To advise them in a timely manner to doctors for medical help, if this is necessary.

Functional dyspepsia and HP. When considering the issue of the existence of communication between the functional dyspepsy and NR, It is necessary to take into account three aspects.

• The syndrome of functional dyspepsia is possible in patients and in the absence of chronic gastritis.
• Functional dyspepsia syndrome can be combined with chronic gastritis not related to NR.
• Functional dyspepsia syndrome can be combined with chronic gastritis associated with NR. Only in this case it makes sense to consider the question of the feasibility or inappropriateness of eradication therapy.

Relationship between NR And the functional dyspepsia remains unclear. According to some observations, the functional dyspepsia is only in 28-40% of cases combined with chronic gastritis associated with NR. However, between clinical symptoms considered characteristic of functional dyspepsia, and the presence of a non-examination NR The stomach mucosa does not have any reliable communication: no specific symptoms are identified for HP-positive patients with functional dyspepsia. And the value of HP in the development of violations of the stomach motility is controversial.

Views on the feasibility of the eradication NR With functional dyspepsia and gastroesophageal reflux disease, it is very contradictory. In particular, some researchers believe that eradication NR with functional dyspepsia, as in the gastroesophageal reflux disease, is necessary, while others believe that infection NR In patients with reflux-esophagitis and chronic gastritis, there may have a protective effect.

According to observations of some researchers, infection NR The population is significantly related to the presence of dyspepsia syndrome and can be "responsible" only in 5% of symptoms considered characteristic of the upper departments of the gastrointestinal tract: Eradication helps to reduce the frequency and intensity of dyspepsia, but this does not lead to improved quality of life of patients. Eradication therapy can be economically justified with functional dyspepsia combined with chronic gastritis, in patients infected HP, but decision makers should be prepared to pay such treatment.

Taking into account the remote results of the treatment of patients, it was established that the eradication therapy of chronic cheilicobacter gastritis did not meet the hopes imposed on it in the elimination of symptoms of functional dyspepsia. An increase in the level of gastric secretion, which occurs in part of patients with gastroesophageal reflux disease after the eradication NR It is a significant factor that provokes the exacerbation or occurrence of reflux-esophagitis. Considering the contraction of messages of various researchers, in wide clinical practice in the treatment of patients with chronic gastritis associated with HP and combined with functional dyspepsia syndrome or with gastroesophageal reflux disease, it should not be preferred by antisheelicobacter therapy before antisecretory.

Literature

Yu. V. Vasilyev, doctor of Medical Sciences, Professor
Tsnyya Gastroenterology, Moscow