Essence and localization of the syndrome
The concept of dyspepsia encompasses all manifestations indicating disruptions in the normal digestive process, regardless of their exact cause. In clinical practice, it is customary to divide this syndrome according to the level of the digestive tract lesion.
Gastric dyspepsia includes a characteristic set of patient complaints: the appearance of heartburn and belching, a feeling of heaviness in the upper abdomen (epigastrium), and pain in the same area. In addition, nausea and vomiting are typical signs. Intestinal dyspepsia has its own clinical specificity and in propedeutics of internal diseases is traditionally considered in isolation, within the framework of intestinal pathology.
Organic dyspepsia and extra-gastric factors
From the standpoint of pathogenesis, all causes of dyspeptic disorders are divided into two large groups: those associated with structural organ lesions (organic) and those without such damage (functional).
Primary lesions of the gastrointestinal tract include peptic ulcer disease, various types of gastritis, and reflux esophagitis. Digestion is also disrupted in diseases of neighboring organs: chronic pancreatitis, cholelithiasis (gallstone disease), and malignant neoplasms (e.g., gastric cancer).
Special attention should be paid to extra-gastrointestinal pathologies, in which dyspepsia is secondary:
- Cardiovascular diseases: severe heart failure leads to venous blood stasis and marked edema of the GI mucous membranes. The abdominal variant of myocardial infarction manifests as epigastric pain due to radiation through the celiac plexus.
- Intoxications: toxins can accumulate endogenously in the body, as occurs in chronic kidney disease (uremic intoxication).
- Neurological lesions: central nervous system diseases, such as meningitis.
- Medication effects: adverse reactions during pharmacotherapy or drug overdose.
- Gynecological sphere: for example, the presence of large ovarian tumor masses.
Functional dyspepsia: a diagnosis of exclusion
Functional dyspepsia is diagnosed only when organic pathology is completely ruled out. According to international standards, confirming the diagnosis requires relying on the following criteria:
- Clinical manifestations: the presence of discomfort or pain in the epigastric area (constant or recurrent).
- Exclusion of organics: mandatory endoscopic confirmation (performing an EGD) of the absence of structural damage that could explain the patient's complaints.
- Differences from IBS: unlike irritable bowel syndrome, in dyspepsia the symptoms do not decrease after defecation and do not correlate with changes in stool frequency or consistency.
- Chronology: symptoms persist for many weeks over the course of the current year (not necessarily consecutively).
There are three main clinical variants of the course: ulcer-like (epigastric pain comes to the fore), dyskinetic (complaints of early satiety, a feeling of fullness, discomfort, and nausea prevail), and nonspecific (a mixed picture of complaints).
Symptomatology of nausea and vomiting
These manifestations are key components of gastric dyspepsia and require careful semiotic analysis.
Nausea is a distressing sensation in the epigastric region. It is based on the irritation of the branches of the vagus nerve (n. vagus). If nausea is caused by the pathology of the stomach itself, it is often provoked by eating, occurs against the background of pain, and precedes vomiting. In extra-gastric conditions, nausea can act as an isolated symptom.
Vomiting is a reflex act aimed at the paroxysmal expulsion of stomach contents through the esophagus and oral cavity. This process is ensured by powerful and synchronous contraction of the abdominal press and respiratory muscles. At the same time, the exit from the respiratory tract closes reflexively, protecting against the aspiration of vomit.
Briefly: answers to topical questions
What complications can develop in a patient with repeated and intractable vomiting?
In repeated vomiting, the following complications and disorders may be associated according to sources:
- Mallory–Weiss syndrome — tears of the esophageal/gastric mucosa or cardio-esophageal junction during vomiting.
- Hypovolemia — vomiting is listed as one of the causes of reduced circulating blood volume.
- Metabolic alkalosis — occurs with vomiting and aspiration of gastric contents.
- Hypokalemia — loss of potassium through the gastrointestinal tract during vomiting.
What macroscopic characteristics of vomit are assessed during a physical examination?
During a physical examination of vomit, its color, odor, and the nature of impurities are assessed.
- Bloody vomiting (haematemesis) — color is assessed: bright red blood or "coffee grounds" appearance (brown color with clots).
- Undigested food — detected as impurities in esophageal vomiting.
- Putrid odor — is a sign of prolonged stasis and decomposition of food in pyloric stenosis.
- Fecal odor — indicates the presence of a gastrocolic fistula and antiperistaltic regurgitation of intestinal contents.
To memorize the extra-gastric causes of secondary dyspepsia, use the rule of five systems: Toxic (uremia), Pharmacological (drugs), Nervous (meningitis), Cardiac (CHF and infarction), Genital (ovarian tumors).
Class and exam questions
How to distinguish functional dyspepsia from irritable bowel syndrome?
In irritable bowel syndrome, clinical symptoms are directly related to the act of defecation and changes in stool. In functional dyspepsia, such patterns are absent.
Why can the stomach hurt in myocardial infarction?
Such a clinical picture is characteristic of the abdominal form of infarction, in which the pain impulse from the heart irradiates into the epigastric region through the celiac plexus.
What is the difference between nausea of gastric and extra-gastric origin?
Gastric nausea is usually associated with eating, accompanied by pain syndrome, and precedes vomiting. Extra-gastric nausea often occurs suddenly and can be a completely isolated symptom.
What else to study on this topic
- Clinical presentation and symptomatology of intestinal dyspepsia
- Differential diagnosis of the ulcer-like variant of dyspepsia and true peptic ulcer disease
- The role of endoscopic studies (EGD) in the algorithm for examining a patient with abdominal pain
- Pathophysiology of venous stasis in the GI tract in chronic heart failure
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