1. FUNCTIONAL DYSPEPSIA
H Ali Djumhana

2. DEFINITION
Dyspepsia refers to pain or discomfort centered in the upper abdomen

3. Centered implies that the pain or discomfort is mainly in or around the midline.
Pain in the right or left hypochondrium is not considered to be representative of dyspepsia

4. Dyspepsia
Discomfort may be characterized by or associated with upper abdominal fullness, early satiety, bloating , or nausea
These symptoms typically are accompanied by a component of upper abdominal distress

5. Spectrum of Dyspepsia

6. Dyspepsia
The painful or uncomfortable symptoms may be intermittent or continuous , and may or may not be related to meals

7. Causes of dyspepsia Those with an identified cause for the symptoms
Those with an identifiable of pathophysiological or microbiological abnormalities, however the clinical relevance is uncertain
Those with no identifiable explanation for the symptoms

8. FUNCTIONAL DYSPEPSIA
FD is a clinical syndrome which is defined by chronic or recurrent upper abdominal symptoms without a cause that is identifiable by conventional diagnostic means such as endoscopy, radiology or histology.

9. Diagnostic approach
Symptom alone are unable to discriminate organic dyspepsia from non organic dyspepsia
Patients need to have further examination to rule out relevant organic disease
Functional dyspepsia is a diagnosis of exclusion

10. Definition of Functional Dyspepsia

11. (Based 0n Clinical symptoms)
CLASSIFICATION
(Based 0n Clinical symptoms)
Ulcer like dyspepsia
Pain is the predominant symptom
Dysmotility like dyspepsia
Discomfort is the predominant symptom and accompanied with abdominal fullness , early satiety, bloating, or nausea
Unspecified ( non specific) dyspepsia
The symptom is not fulfill the criteria for ulcer- like or dysmotility-like3 dyspepsia

12. FUNCTIONAL DYSPEPSIA Dyspepsia is a very common complaint.
In western country:
The prevalence rate of FD :10-40%.
The remission rate :10-20% annually
The recurrence rate :20-55%

13. PATHOPHYSIOLOGY OF FUNCTIONAL DYSPEPSIA
Pathophysiology of FD is poorly understood
The symptoms can be associated with
Motility abnormality of the stomach
Visceral hyperalgesia/hypersensitivity
Hp gastritis
Psychosocial factor

14. PATHOPHYSIOLOGY OF FUNCTIONAL DYSPEPSIA
In such a group of patient the symptoms are associated with abnormal motor function of the stomach:
Impairment of gastric accommodation
Delayed gastric emptying
Antral hypomotility
Bradygastria / Tachygastria
Intragastric maldistribution of solid and liquid food
small bowel dysmotility
(Malagelada etal.1985;Camilleri etal.1986;Waldron etal.1991;Hveem etal.1996;Stanghellini etal.1996)

15. Dilated gastric antrum
Disorders of gastric neuromuscular function: myoelectrical and contractile abnormalities
Impaired fundic relaxation
Abnormal fundic emptying
Weak 3 cpm rhythm
Gastric dysrhythmias
Dilated gastric antrum
Antral hypomotility
Gastroparesis
Small bowel
dysmotility

16. DIAGNOSTIC APPROACH Careful history taking and Physical examination
Alcohol, smoking, drugs (NSAID), weight loss, abdml surgery , intractable pain,dysphagia, recurrent vomiting GI bleeding, pallor, jaundice abdominal mass, abdominal scar.
Laboratory examination
CBC, Liver function test, Renal function test, ECG, Test for Hp
X ray examination and USG upper abdomen
Endoscopy examination and biopsy
EGG, Gastric emptying study, Manometry, 24 h
pH monitoring

17. Treatment
Empirical treatment could be started to the patient with uninvestigated dyspepsia without alarm symptoms. The treatment should be individualize
First line treatment is prokinetic agent or anti secretory drug. However the placebo response is high (20-60%)
Some patients should be avoid precipitating food or drink
Other patients may be need anti anxiety or anti depressant drugs

18. Uninvestigated vs Investigated Dyspepsia
It is important to distinguish the patient who presents dyspepsia that has not been investigated (uninvestigated dyspepsia ) from patients with diagnostic label after investigation, with either a structural diagnosis ( such as Peptic ulcer or GERD) or Functional dyspepsia

20. Alarm symtoms Weight loss Anaemia Dysphagia Recurrent vomiting
Haematemesis and or maelena
Abdominal mass

21. Pharmacologic Treatment for FD
Prokinetic agent
Dopaminergic ( Metoclopramid , Domperidone)
Serotonergic ( Cisapride, Ondansetron, Granisetron)
Anti secretion
H2 blockers(Cimetidin,Ranitidin,Nizatidin,Famotidin,Roxatidin)
PPI ( Omeprazole,Mesomeprazole,Lansoprazole,Rabeprazole, Pantopprazole)
Antacid
Cytoprotector agent
Sucralfate
Rebamipide
Trepenon
Anti anxiety or Anti depression

22. Thank You