In the past year, Ms. He has often had symptoms such as full upper abdomen, belching, early satiety, and nausea. A small amount of food will cause a feeling of fullness and blockage. He went to several hospitals for medical treatment and performed various examinations, but no abnormalities were found. For this reason, Ms. He was worried all day, unable to eat or sleep, and she lost more than 20 catties.
What kind of illness did Ms. He get, and why is it so persistent? In fact, Ms. He has no organic disease or only chronic gastritis, with dyspepsia as its manifestation. It is clinically called functional dyspepsia, which is relatively common. The prevalence reported in various countries is 20%～49. %between. Although the disease does not pose a threat to the life safety of patients, it often recurs and has a longer course. Patients often seek medical treatment and do a large number of repeated examinations. This not only consumes a lot of medical resources, but also brings a huge economic burden to individuals and society, and also causes The patient is physically and mentally exhausted, prone to depression and anxiety, and affects the quality of sleep, seriously affecting his life and work, and the quality of life is low. So, how do we deal with the troubles of such “healthy people”?
At present, the etiology of functional dyspepsia is unknown and the pathogenesis is complicated. Therefore, clinical medicine is mainly used to reduce or relieve the symptoms of patients and improve their quality of life. The specific medication plan includes-
1. Acid inhibitors
Studies have confirmed that gastric acid stimulation can affect the motility and sensory function of the stomach. A large number of clinical randomized controlled studies have found that acid inhibitors are effective for some functional dyspepsia. Therefore, the current consensus in various countries is that acid inhibitors can be used as common drugs in the treatment of functional dyspepsia.
Acid inhibitors include H2 receptor antagonists (H2RA), such as cimetidine, ranitidine, famotidine, etc.; proton pump inhibitors (PPI), such as omeprazole. This type of medicine has obvious effects on alleviating symptoms such as abdominal pain, acid reflux, and heartburn. The course of treatment is generally 4 to 8 weeks. If the improvement of symptoms is not satisfactory, the treatment drugs should be considered. However, PPI is not very effective for patients with functional dyspepsia with dysmotility, so it is effective for postprandial discomfort syndrome (PDS, which is manifested by postprandial discomfort of fullness and early satiety, and is sufficient to affect daily activities, and attacks at least weekly 3 days) PPI preparations are not recommended for patients.
Prokinetic drugs are drugs that stimulate smooth muscle contraction to enhance gastric emptying and small intestinal transit. Commonly used prokinetic drugs are metoclopramide, domperidone, mosapride and so on. Metoclopramide has a strong central antiemetic effect and can enhance gastric motility, but because it can cause extravertebral system reactions, it is not suitable for infants, and adult patients cannot be used in large doses for a long time. Domperidone does not penetrate the blood-brain barrier and has no adverse reactions outside the vertebral system. It can increase gastric antrum and duodenal motility, promote gastric emptying, and significantly improve symptoms such as postprandial fullness and early satiety, but long-term use can cause blood Prolactin is elevated, and individual patients have breast tenderness or lactation. Mosapride has higher receptor selectivity and can selectively act on 5-HT4 to enhance gastric motility by stimulating the release of acetylcholine.
3. Eradication of Helicobacter pylori (Hp) drugs
Many studies have confirmed that there is a close connection between functional dyspepsia and Hp infection. Studies have found that persistent infection can lead to varying degrees of acute and chronic inflammation of the mucosa, which can further lead to gastric mucosal atrophy, intestinal metaplasia and even intraepithelial neoplasia. Hp eradication therapy can improve gastric mucosal inflammation, delay the progression of atrophy, intestinal metaplasia and other diseases, and reduce the incidence of peptic ulcers and tumors. Therefore, if the application of acid inhibitors and prokinetic agents is ineffective, Hp detection and eradication therapy are recommended. The first eradication treatment is quadruple therapy-PPI + amoxicillin + levofloxacin + bismuth, or PPI + metronidazole + tetracycline + bismuth.
Patients with functional dyspepsia are often accompanied by negative emotions such as depression or anxiety, and antidepressants have a certain effect on relieving symptoms. Therefore, antidepressants can be selected for patients who are ineffective in acid suppression and prokinetic therapy and have obvious mental disorders. Antidepressants include traditional tricyclics, monoamine oxidase antagonists, tetracyclics and other drugs, and selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and paroxetine (Serrot).
5. Traditional Chinese Medicine
The “Consensus Opinions on the Diagnosis and Treatment of Functional Dyspepsia with Integrated Traditional Chinese and Western Medicine (2010)” believes that functional dyspepsia is divided into liver-qi stagnation syndrome, liver-qi invading stomach syndrome, spleen-stomach qi deficiency syndrome, damp-heat stagnation syndrome, cold-heat complex syndrome, etc., respectively. Corresponding treatments such as Chaihu Shugan Powder and Yueju Pills, Sini Powder and Chenxiang Jiangqi Powder, Xiangsha Liujunzi Decoction, Sanren Decoction, Banxia Xiexin Decoction and other treatments can achieve certain curative effects. .