Pediatric functional dyspepsia
Introduction
Introduction to functional dyspepsia in children Functional dyspepsia (FD) refers to persistent or recurrent episodes of upper abdominal pain, bloating, early satiety, belching, anorexia, heartburn, acid reflux, nausea, vomiting, etc. A group of pediatric digestive medicines of the most common clinical syndrome. basic knowledge The proportion of sickness: 0.5% (accounting for 10% of the proportion of digestive diseases in pediatric outpatients) Susceptible people: children Mode of infection: non-infectious Complications: pediatric malnutrition
Cause
Pediatric functional dyspepsia
Diet and environmental factors (20%):
The symptoms of patients with functional dyspepsia are often related to diet. Many patients often complain about some carbonated beverages, coffee, lemon or other fruits and fried foods will aggravate indigestion, although the significance of the double-blind food-induced test on food incentives Questioned, but many children still feel the symptoms are alleviated after avoiding the above foods and balancing the dietary structure.
Gastric acid (18%):
Some patients with functional dyspepsia will develop ulcer-like symptoms, such as hunger pain, gradually relieve after eating, tenderness in the abdomen, and symptoms of antacids or acid-suppressing drugs can be relieved in a short period of time. The incidence is related to stomach acid.
Chronic gastritis and duodenitis (15%):
About 30% to 50% of patients with functional dyspepsia have been confirmed by sinus gastritis by histological examination. Chronic gastritis is regarded as functional dyspepsia in many European countries. It is believed that chronic gastritis may affect the movement of the stomach through nerve and body fluid factors. Function, some authors believe that non-erosive duodenitis is also a functional dyspepsia, it should be noted that the symptoms of functional dyspepsia are not parallel to the gastric mucosal inflammatory lesions.
Helicobacter pylori infection (15%):
Hp is a Gram-negative bacterium that is generally colonized on the mucus layer of the stomach. The infection rate of Hp in asymptomatic adults is more than 35%. More than 90% of duodenal ulcer patients have Hp, and tincture plus antibiotics can eradicate. Hp, which causes histological gastritis to subside, can also reduce the recurrence rate of ulcers from more than 80% per year to less than 10% per year, so Hp is an important cause of duodenal ulcer and chronic antral sinusitis.
Visceral paresthesia (12%):
Many patients with functional dyspepsia are abnormally or too sensitive to physiological or slightly harmful stimuli, and some patients have increased sensitivity to perfusion of acid and saline; some patients use H2 receptor antagonists to block acid secretion even when H2 receptor antagonists are used. Intravenous pentagastrin gas is still painful. Some studies have reported that the pain of patients with functional dyspepsia tends to increase when the balloon is inflated at the proximal end. The level of balloon inflation during pain is significantly lower than that of the control. group.
Psychosocial factors (10%):
Whether psychological factors are related to the pathogenesis of functional dyspepsia has been controversial. Some scholars in China have studied the age, sex, living habits, and educational level of 186 FD patients, and assessed the degree of anxiety and depression. The results showed that FD patients were more common in older women, and its occurrence was more related to anxiety and depression. However, there is no definite evidence of functional dyspepsia, which is related to mental or chronic stress. The number of major life stress events in patients with dyspepsia is not necessarily higher than that of other people, but it is likely that these patients are more sensitive to stress, so as a doctor, understanding the patient's disease requires understanding the patient's personality traits. Living habits, etc. This may be very important for treatment.
Other gastrointestinal disorders (8%):
(1) Gastroesophageal reflux disease (GERD): heartburn and reflux are specific symptoms of gastroesophageal reflux, but many patients with GERD do not have this obvious symptom. Some patients complain of both heartburn and indigestion. Many scholars have accepted the following observations: There are a few patients with GERD who have no esophagitis. Many patients with GERD have a complicated history of dyspepsia, and not only the symptoms of heartburn and acid reflux, but also about 20% of the esophageal 24h pH monitoring study. Functional dyspepsia patients are associated with reflux disease. Recently, Sandlu et al reported that in 20 children with anorexia, 12 patients (60%) had gastroesophageal reflux. Therefore, there are good reasons to think that gastroesophageal reflux disease and certain Some cases of functional dyspepsia are related.
(2) Swallowing: Many patients often subconsciously swallow excessive amounts of air, causing bloating, fullness and belching. This condition is often secondary to stress or anxiety. For such patients, appropriate behavior during treatment Adaptation is often very effective.
(3) Irritable Bowel Syndrome (IBS): There is often a lot of overlap between functional dyspepsia and other gastrointestinal disorders. About one-third of IBS patients have dyspeptic symptoms; IBS in patients with functional dyspepsia The proportion of symptoms is also similar.
Prevention
Pediatric functional dyspepsia prevention
Not all children with functional dyspepsia need to be treated with drugs. Some patients are diagnosed as disease-free according to the doctor's diagnosis and the test results are normal. They can be prevented by changing lifestyles and adjusting food types, such as establishing a good Living habits, avoid psychological stress factors and irritating foods, avoid taking non-steroidal anti-inflammatory drugs, and apply gastric mucosal protective agents or H2 receptor antagonists for those who cannot stop taking drugs.
Complication
Pediatric functional dyspepsia complications Complications, malnutrition in children
Often causing thinness and lack of nutrition, and the body's resistance is reduced, prone to infectious diseases.
Symptom
Symptoms of functional dyspepsia in children Common symptoms Anorexia, dyspepsia, bloating, nausea, vomiting, abdominal pain, neonatal snoring, heartburn, early fullness
Clinical symptoms mainly include upper abdominal pain, abdominal distension, early satiety, hernia, anorexia, heartburn, acid reflux, nausea and vomiting. The course of the disease is more than 2 years, the symptoms can be repeated, and it can be asymptomatic for a considerable period of time. Mainly, there may be a superposition of multiple symptoms, and most of them are difficult to clearly cause or aggravate the cause of the disease.
At present, more types are classified into 4 types: 1 dyskinesia type; 2 regurgitation type; 3 ulcer type; 4 non-specific type.
1. Dyskine-like dyspepsia: The performance of this type of patients is bloating, early satiety, hernia, and the symptoms are more severe after eating. When full, abdominal pain, nausea, and even vomiting will occur. The kinetic test is about 50%-60. % of patients have proximal and distal gastric contractions and diastolic disorders.
2. Reflux dyspepsia: prominent manifestations of sternal pain, heartburn, reflux, endoscopic examination did not find esophagitis, but 24hpH monitoring can be found in some patients with gastroesophageal acid reflux, for acid-free reflux These symptoms are thought to be related to an increase in acid sensitivity to the esophagus.
3. Ulcer-like dyspepsia: The main manifestations are the same as duodenal ulcers, nighttime pain, hunger pain, eating or taking antacids can be relieved, may be accompanied by acid reflux, a small number of patients with heartburn, symptoms are chronic periodicity, No endoscopic examination revealed ulcers and erosive inflammation.
4. Non-specific dyspepsia: Indigestion can not be classified into the above types, often with irritable bowel syndrome.
However, in addition to reflux-like dyspepsia, several other classifications have no important clinical significance, and many patients are not limited to a subtype, and this classification has nothing to do with pathophysiological disorders and clinical outcomes, such as: dysmotility subtypes In patients with indigestion, the incidence of gastroparesis is not higher than other subtypes. The efficacy of prokinetic drugs is not necessarily better than that of other subtypes. However, reflux dysfunction in patients with dyspepsia The incidence is indeed higher than other subtypes of patients, and anti-reflux treatment is better.
Examine
Pediatric functional dyspepsia examination
Should do blood routine, liver and kidney function, blood sugar, thyroid function, fecal occult blood test and gastroesophageal 24hpH monitoring, routine examination often no abnormal findings, and some may have mild anemia, exclude diabetes, connective tissue disease, thyroid dysfunction and liver Kidney and pancreas and other diseases.
Should do upper digestive tract endoscopy, hepatobiliary and pancreatic ultrasound, chest X examination, ultrasound or radionuclide gastric emptying examination, gastrointestinal pressure measurement and other gastrointestinal motility examination methods, in the diagnosis and differential diagnosis of FD It has played a very important role.
Endoscopy mainly excludes esophageal, gastric, duodenal inflammation, ulcers, erosion, tumors and other organic lesions, except for ultrasound examination of liver, gallbladder, pancreas, kidney and other diseases.
Diagnosis
Diagnosis and diagnosis of functional dyspepsia in children
diagnosis
Diagnosis
For the diagnosis of functional dyspepsia, organic dyspepsia should be excluded first. In addition to careful medical history and comprehensive physical examination, appropriate auxiliary examinations and laboratory tests should be performed. Most of the functional examinations can be basically determined according to the first line examination. Inappropriate diagnosis, in addition, many unexplained abdominal pain, nausea, vomiting patients often find the cause through gastrointestinal pressure examination, these tests are gradually applied to pediatric patients.
2. General diagnostic criteria for functional dyspepsia
(1) Clinical manifestations: chronic upper abdominal pain, abdominal distension, early satiety, belching, acid reflux, heartburn, nausea, vomiting, feeding difficulties and other upper gastrointestinal symptoms, lasting at least 4 weeks.
(2) Auxiliary examination: endoscopic examination did not find gastric, duodenal ulcer, erosion, tumor and other organic lesions, no esophagitis, no history of the above disease, B-ultrasound, X-ray examination, exclusion of liver, gallbladder , pancreatic disease.
(3) Laboratory examination to exclude liver, gallbladder and pancreatic diseases.
(4) No history of diabetes, connective tissue disease, kidney disease and mental illness.
(5) No history of abdominal surgery.
3. Rome II diagnostic criteria
Rome II uses adult standards for the diagnosis of functional dyspepsia in children, as follows:
The following symptoms appear for at least 12 weeks in 12 months, but do not need to be continuous:
(1) Persistent or recurrent pain or discomfort in the upper abdomen.
(2) Evidence of no organic disease.
(3) There is no relief after defecation, and the number and shape of stools are unchanged.
Differential diagnosis
Gastroesophageal reflux
Gastroesophageal reflux disease functional dyspepsia in the reflux subtype and its differential identification, gastroesophageal reflux disease with typical or atypical reflux symptoms, endoscopic evidence of varying degrees of esophageal inflammation changes, 24h esophageal pH monitoring In patients with acid-responsive, endoscopic esophagitis, reflux dyspepsia or gastroesophageal reflux disease is difficult to determine, but the two are therapeutically identical.
2. Peptic ulcer
Organic dyspepsia with ulcer-like symptoms include: duodenal ulcer, duodenitis, pyloric canal ulcer, anterior pyloric ulcer, erosive antral sinusitis, must be performed before the diagnosis of functional dyspepsia ulcer subtype Endoscopy to exclude the above organic lesions.
3. Gastroparesis
Many systemic or digestive tract diseases can cause disorders of gastric emptying function, causing gastroparesis. The more common causes are diabetes, uremia, connective tissue disease, and in the diagnosis of functional dyspepsia dyskinesia subtypes. Carefully rule out stomach cramps caused by other causes.
4. Chronic refractory abdominal pain (CIPA)
70% of CIPA patients are women, with a history of physical or psychological trauma. Patients often complain of long-term abdominal pain (more than 6 months), and abdominal pain is diffuse, often accompanied by symptoms outside the abdomen. Most patients undergo extensive examination and the results are Negative, most of these patients have serious potential psychological disorders, including depression, anxiety and physical disorder. They often insist that they have serious diseases and require further examination. These patients should be provided with multiple ways of psychology. Behavioral and drug combination therapy.
