기능성 소화불량, Functional dyspepsia

Functional dyspepsia is suspected in patients with a clinical history of postprandial fullness, early satiety, or epigastric pain/burning.

윗배가 아프거나 타는듯한 증상이 있다고 dyspepsia를 배제하는 것은 아닙니다. 꼭 위염, 위궤양만 통증을 수반하는 것이 아니다. 식후 팽만감, 이른 포만감, 명치 부위의 통증은 기능성 소화불량의 증상에 포함됩니다.

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A clinical diagnosis of functional dyspepsia requires the fulfillment of symptom-based diagnostic criteria and an evaluation to exclude other causes of dyspepsia.

따라서 다른 질환을 배제한 이후에 진단이 가능합니다. 과민성대장증후군도 암과 같은 구조적 질환을 배제해야 하듯이 기능성 소화불량도 위염, 위궤양, 위암을 배제하는 과정이 필요합니다.

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This evaluation consists of a history (eg, dietary, medical, surgical, family, and medications/supplements), physical examination, laboratory studies, and endoscopic evaluation to exclude organic/structural disease to explain the symptoms (algorithm).

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Approach to the evaluation and management of dyspepsia in adults

H. pylori: Helicobacter pylori.

* Gastric mucosal biopsies should be obtained at the time of upper gastrointestinal endoscopy to rule out infection with H. pylori.

¶ Additional evaluation may be required based on symptoms (eg, abdominal imaging in patients with concurrent jaundice or pain suggestive of a biliary/pancreatic source).

Δ Refer to UpToDate topic reviews.

◊ Patients with continued symptoms of dyspepsia for 3 months with symptom onset at least 6 months before diagnosis and no evidence of structural disease to explain the symptoms should be diagnosed and treated as functional dyspepsia.

§ Eradication of H. pylori infection can be confirmed with a urea breath test, stool antigen testing, or upper endoscopy-based testing performed 4 weeks after completion of antibiotic therapy. The choice of test depends on the need for an upper endoscopy (eg, follow-up of bleeding peptic ulcer) and local availability. H. pylori serology should not be used to confirm eradication of H. pylori. Refer to UpToDate topic on diagnostic tests for H. pylori.

¥ Allow 8 to 12 weeks before reassessing symptomatic response.

‡ For patients with a partial clinical response to a proton pump inhibitor, a tricyclic antidepressant can be initiated as combination therapy with a proton pump inhibitor.

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Diagnostic criteria — Symptom-based criteria

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●Rome IV criteria for functional dyspepsia – According to the Rome IV criteria, functional dyspepsia is defined as the presence of one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain or epigastric burning, and no evidence of structural disease (including at upper endoscopy) to explain the symptoms (table).

While patients with these symptoms and a negative diagnostic evaluation likely have functional dyspepsia, according to the Rome IV guidelines, the criteria should be fulfilled for the last three months with symptom onset at least six months before diagnosis. Criteria for symptom frequency and duration are particularly useful in defining patient eligibility for research, but clinician judgement may allow diagnosis in practice without rigid adherence to them.

진단 6개월 이전에 시작된 증상이 지난 3개월 동안 지속되어야 합니다.

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● Functional dyspepsia subtypes – Two subtypes of functional dyspepsia are recognized based on the predominant symptoms. However, overlap between these subtypes is common.

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• Postprandial distress syndrome is characterized by bothersome postprandial fullness and/or early satiation (table).

• Epigastric pain syndrome is characterized by bothersome epigastric pain or burning that is not exclusively postprandial (table).

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Rome IV Criteria for Functional Dyspepsia​

B1. Functional dyspepsia*

Diagnostic criteria¶

1. One or more of the following:

a. Bothersome postprandial fullness

b. Bothersome early satiation

c. Bothersome epigastric pain

d. Bothersome epigastric burning

AND

2. No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms

B1a. Postprandial distress syndrome

Diagnostic criteria¶

Must include one or both of the following at least three days per week:

1. Bothersome postprandial fullness (ie, severe enough to impact on usual activities)

2. Bothersome early satiation (ie, severe enough to prevent finishing a regular-size meal)

No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy)

Supportive remarks

● Postprandial epigastric pain or burning, epigastric bloating, excessive belching, and nausea can also be present

● Vomiting warrants consideration of another disorder

● Heartburn is not a dyspeptic symptom but may often coexist

● Symptoms that are relieved by evacuation of feces or gas should generally not be considered as part of dyspepsia

Other individual digestive symptoms or groups of symptoms, eg, from gastroesophageal reflux disease and the irritable bowel syndrome may coexist with PDS

B1b. Epigastric pain syndrome

Diagnostic criteria¶

Must include at least one of the following symptoms at least one day a week:

1. Bothersome epigastric pain (ie, severe enough to impact on usual activities)

AND/OR

2. Bothersome epigastric burning (ie, severe enough to impact on usual activities)

No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy)

Supportive remarks

1. Pain may be induced by ingestion of a meal, relieved by ingestion of a meal, or may occur while fasting

2. Postprandial epigastric bloating, belching, and nausea can also be present

3. Persistent vomiting likely suggests another disorder

4. Heartburn is not a dyspeptic symptom but may often coexist

5. The pain does not fulfill biliary pain criteria

6. Symptoms that are relieved by evacuation of feces or gas generally should not be considered as part of dyspepsia

Other digestive symptoms (such as from gastroesophageal reflux disease and the irritable bowel syndrome) may coexist with EPS

PDS: postprandial distress syndrome; EPS: epigastric pain syndrome.

* Must fulfill criteria for PDS and/or EPS.

¶ Criteria fulfilled for the last three months with symptom onset at least six months before diagnosis.

Original table modified for this publication. Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal disorder. Gastroenterology 2016; 150:1380. Table used with the permission of Elsevier Inc. All rights reserved.

 

REF. UpToDate 2020.03.29