Functional dyspepsia

Clinical manifestations and diagnostic criteria

The prevalence of this pathology in the pediatric population varies widely: from 3.5% to 27%. To standardize diagnostics, clinicians rely on the Rome IV criteria. According to these guidelines, a diagnosis of functional dyspepsia is made if the patient experiences episodes at least 4 days a month for at least the last 2 months.

To confirm the diagnosis, at least one of the following clinical symptoms must be present:

• Postprandial fullness that occurs immediately after eating.
• Early satiety, when the child is physically unable to finish their usual, physiologically normal portion.
• Pain or a persistent burning sensation in the epigastric region.

Crucial diagnostic condition: abdominal pain must not be related to defecation. This specific feature distinguishes functional dyspepsia from irritable bowel syndrome (IBS).

Etiopathogenesis and clinical variants

The development of the syndrome is caused by a complex of factors. Modern medicine considers a multifactorial etiology, in which the following mechanisms play a key role:

• Impaired normal gastric motility (delayed food evacuation).
• Visceral hypersensitivity (increased susceptibility of internal organ receptors to standard stimuli, such as gastric wall distension).
• Mild inflammation of the upper GI mucosa. Such low-grade inflammation is often a consequence of prior infectious diseases or food allergies.
• Genetic predisposition that determines the functioning of the nervous system and the digestive tract.

Depending on which complaints come to the forefront, specialists distinguish two main clinical variants of the course: postprandial distress syndrome and epigastric pain syndrome. These forms can occur either in isolation from each other or combined, worsening the young patient's overall well-being.

Diagnostic tactics and the role of endoscopy

Esophagogastroduodenoscopy (EGD) traditionally plays a major role in diagnosing digestive tract diseases. However, in pediatric practice, the approach to this invasive study has strict limitations. Routine, mass prescription of endoscopy for all children with dyspepsia symptoms is recognized as impractical, as serious organic mucosal changes are detected in them much less frequently than in the adult population.

There are strict absolute indications that make EGD mandatory:

1. Detection of so-called "alarm symptoms" (e.g., dysphagia — swallowing disorders).
2. Complete lack of clinical effect from ongoing antisecretory therapy (if symptoms persist or constantly recur despite medication).

Principles of functional dyspepsia therapy

Treatment is based on a comprehensive approach that begins with lifestyle modification. Basic measures include the strict discontinuation or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs). Diet therapy is a critical step: potential triggers must be excluded from the child's diet, including excessively fatty foods, spicy seasonings, and caffeine-containing beverages.

The pharmacological strategy is chosen individually, depending on the leading syndrome:

• If pain syndrome dominates, antisecretory agents become the first-line drugs. Proton pump inhibitors (omeprazole, esomeprazole) are used primarily.
• If discomfort in the upper abdomen, indicating motility disorders, comes to the forefront, prokinetics (domperidone, cisapride) are prescribed.

In the most severe cases, when standard regimens fail, doctors resort to rescue therapy. The use of tricyclic antidepressants (specifically, amitriptyline) in very low doses is justified. In refractory cases resistant to pharmacological correction, pediatrics considers the use of an innovative method — gastric electrical stimulation.

Class and exam questions

What else to study on this topic

• Mechanisms of visceral hypersensitivity development in gastrointestinal diseases
• Rome IV Criteria: Differential Diagnosis of Functional Disorders in Children
• Pharmacodynamics of prokinetics (domperidone, cisapride) and their effect on motility
• Alarm symptoms (red flags) in pediatric gastroenterology
• Gastric electrical stimulation: principle of operation and prospects of the method in pediatrics

Other topics in "Chapter 7. Digestive System Diseases"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.