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1 in 5 people develop indigestion, and women, those who are positive for Helicobacter pylori and those taking NSAIDs are at higher risk.
If you have symptoms, timely gastroscopy and Helicobacter pylori testing.
The information in this article is only popular science, does not constitute a diagnosis and treatment recommendation, and cannot replace the doctor's individualized judgment on a specific patient.
In modern society, the pressure of life and work is quite large, coupled with the lack of attention to diet, a little problem with the gastrointestinal tract is simply too common.
Today, I would like to talk to you about indigestion, which is a particularly common health problem that especially affects the quality of life.
Indigestion, which is a disease but in most cases is not "disease"
It's sick but not "sick", what does it mean?
This requires first being clear about what indigestion is.
What is indigestion?
Dyspepsia is a symptom or group of symptoms located in the upper abdomen. When you experience epigastric pain, burning sensation in the epigastric region, postprandial fullness and early fullness, as well as symptoms such as epigastric flatulence, belching, nausea and vomiting, it is likely to be indigestion.
The prevalence of dyspepsia is 21% worldwide, with 1 in 5 people at higher risk, and women, smokers, those taking NSAIDs, and those who are positive for Helicobacter pylori are at higher risk.
Dyspepsia is divided into organic and functional according to whether there is a clear cause.
The so-called organic dyspepsia is a clear organic, systemic or metabolic disease, such as peptic ulcer, gastrointestinal tumors, hepatobiliary tumors, parasitic infections, hyperthyroidism/hypothyroidism, chronic renal failure, electrolyte disorders and adverse drug therapy reactions.
Functional dyspepsia is that although you do have a series of symptoms in the epigastric region and last for a period of time (3-6 months), you are also very uncomfortable, but there is no organic cause mentioned above.
Most are functional and symptomatic and disease-free
Data at home and abroad show that most of the unchecked patients with dyspepsia are functional. Studies in different parts of the continent showed that about 51%-69% of unchecked patients were eventually diagnosed as functional, while a study in Singapore found that 79.5% of them were functional after examining more than 5,000 (unchecked) patients.
In other words, you may be diagnosed by your doctor as a "functional indigestion", but your body may not have any pathological changes.
Many people even have symptoms that are fine when they are busy, and the symptoms are more serious when they stop to relax. This may be related to the fact that you think of some normal peristalsis as abnormal, increased visceral sensitivity, etc.
Is there no "disease" still need to be tested?
Absolutely.
Doctors diagnosing functional dyspepsia first exclude organic causes, which are unlikely to be done by consultation and physical examination alone.
Therefore, the doctor will prescribe you some auxiliary tests based on the information obtained during the consultation and physical examination, such as blood routine, blood biochemistry, epigastric ultrasound, parasites, and sometimes colonoscopy, epigastric CT or MRI to rule out malignancy.
In addition, in order to confirm the diagnosis, an upper gastrointestinal endoscopy is also required.
Gastroscopy is important
The Functional Dyspepsia Consensus, just released last year by the European Federation of Gastroenterology (UEG) and the European Society of Neuro-Gastroenterology and Kinesiology (ESNM), explicitly requires the diagnosis of functional dyspepsia to be preceded by upper gastrointestinal endoscopy.
Considering the high incidence of Helicobacter pylori infection and the incidence of upper gastrointestinal tumors in mainland residents, the mainland guidelines recommend that patients with dyspepsia who are newly diagnosed undergo gastroscopy in a timely manner.
A study in Shanghai reviewed the gastroscopy and Helicobacter pylori in nearly 15,000 patients with indigestion who had been treated consecutively from 2002 to 2003 and found that 16.7% of stomach cancers were missed when only helicobacter pylori-positive patients were examined.
If you are particularly afraid of gastroscopy or don't want to do it for various reasons, your doctor can start with 2-4 weeks of empiric treatment based on your symptoms, but only if you don't have alarm symptoms (weight loss, melena, anemia, progressive dysphagia, fever, jaundice, etc.).
However, if empiric therapy is ineffective or accompanied by alarm symptoms, gastroscopy and Helicobacter pylori examination must be done.
Helicobacter pylori detection can not be less
Mainland guidelines recommend helicobacter pylori testing in patients who do not respond to empiric therapy. The European consensus on functional dyspepsia is more positive, requiring all patients with dyspepsia to be tested for Helicobacter pylori and positive patients to undergo eradication therapy.
However, since they were all checked at the beginning, I recommend doing Helicobacter pylori together with a gastroscope, early detection and early treatment.
Helicobacter pylori infection is closely related to functional dyspepsia, and the infection rate of Helicobacter pylori infection in mainland China can be as high as 70%, and only 13%-27% in European and American countries. Previous studies have also found that after the eradication of Helicobacter pylori in patients with dyspepsia, the symptoms of dyspepsia were also significantly improved.
Furthermore, Helicobacter pylori may also cause Helicobacter pylori gastritis.
Therefore, the consensus on functional dyspepsia in Asia recommends helicobacter pylori testing in patients with dyspepsia and recommends eradication therapy in patients with positive patients.
What helps?
Functional dyspepsia, this disease does not sound like a disease to die to live, but once it is obtained, it is quite affecting the quality of life.
You think, ah, the food is not fragrant, then what is the meaning of life? The food can not be eaten well, where is the energy to work, go out to play?
Does diet have an impact?
In addition to taking the medicine prescribed by the doctor to alleviate the symptoms, is there any impact on the food eaten?
Indeed there is.
Indigestion is related to heredity, diet, mental state, lifestyle, etc. Although there are few high-quality studies on food and dyspepsia, the prevailing view is that different foods and feeding patterns are associated with functional dyspepsia.
- Find sensitive foods -
For patients with functional dyspepsia, problems focus on gastroduodenal motor dysfunction (resulting in delayed gastric emptying, decreased ability to contain food), decreased ability to clear stomach acid, and excessive visceral sensitivity.
From this line of thinking, foods that increase the burden of digestion, stimulate gastric acid secretion, and stimulate the gastrointestinal tract are foods that are unfriendly to patients with dyspepsia and should be avoided.
Foods that worsen symptoms: high-fat diets, stimulating or spicy foods, whole grains, carbonated drinks, alcohol and strong tea.
Foods that reduce symptoms: rice, bread, yogurt, apples, etc.
You can record your diet to be able to compare what foods the retrospective may have to do with.
For example, some time ago, I found that I often had digestive discomfort in the morning, and then I found out that it was fish oil and some vitamin pills that I got up in the morning to eat.
- Pay attention to how you eat -
Eating style and whether eating regularly or not will also have an impact, irregular eating, rapid eating will aggravate the symptoms. Studies from China have shown that skipping breakfast, multiple meals, spicy foods, sweets and gas-producing foods can induce functional indigestion.
I hope you have a healthy stomach and intestines and eat everything!
Resources
Chen Minhu. Chinese Expert Consensus Opinion on Functional Dyspepsia (2015, Shanghai)[J].Chinese Journal of Digestion,2016,36(04):230.
[2] Miwa H, Nagahara A, Asakawa A, et al. Evidence-based clinical practice guidelines for functional dyspepsia 2021[J]. J Gastroenterol. 2022 Jan 21. doi: 10.1007/s00535-021-01843-7.
[3] Ford AC, Marwaha A, Sood R, Moayyedi P. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut. 2015 Jul;64(7):1049-1057. DOI: 10.1136/gutjnl-2014-307843. PMID: 25147201.
[4] Wauters L,Dickman R,Drug V,et al. United European Gastroenterology(UEG)and European Society for Neurogastroenterology and Motility(ESNM)consensus on functional dyspepsia[J]. United European Gastroenterol J.2021.9(3):307-331
Ke Meiyun. Guidelines for the Diagnosis and Treatment of Dyspepsia in China (Dalian 2007)[J].Gastroenterology,2008(02):114-117.