Functional Dyspepsia
Dyspepsia is the most common upper gastrointestinal (GI) symptom. Functional dyspepsia(FD) refers to symptoms that originate in the upper gastrointestinal tract . Globally, the prevalence of uninvestigated dyspepsia (UD) varies between 7%-45%.(Seid et al., 2018). 8%-30% and 8%-23% of Asian people suffer from of uninvestigated dyspepsia and FD, respectively. In Pakistan, 5-40% % of general population suffers from FD.(Jamil et al., 2016)
Functional dyspepsia (FD) is diagnosed when upper GI endoscopy reveals no organic lesions that might explain the dyspeptic symptoms.Functional dyspepsia (FD) is most commonly observed health issue present everywhere at global level because of poor life style habits, inadequate eating habits, stress and poor quality of food. It is a set of relapsing or chronic symptoms in the absence of structural organic lesions characterized by Rome IV criteria comprising of
i)Bothersome epigastric pain or burning, معدہ میں جلن یا تکلیف
ii)Post prandial fullness۔ کھانےکےبعداپھارہ
iii)Early satiation, کھانے سےجلد جی اکتاجانا
iv)Belching ,ڈکاریں آنا
- v) Bloating, یا بھاری پن پیٹ کا پھول جانا
vi)Nausea and discomfort in upper abdomen . متلاہٹ ۔ پیٹ کے اوپر والے حصہ میں تکلیف
FD is currently divided into 2 distinct subtypes, namely, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). PDS is defined as the presence of meal-induced dyspeptic symptoms, such as postprandial fullness and early satiation, while EPS is characterized by the presence of epigastric pain or burning sensation.(Futagami et al., 2018)
Prevalence
Approximately 80% of individuals with dyspepsia have no structural explanation for their symptoms and have functional dyspepsia. Functional dyspepsia affects up to 16% of otherwise healthy individuals in the general population. Risk factors include psychological comorbidity, acute gastroenteritis, female sex, smoking, use of non-steroidal anti-inflammatory medicines (Ford et al., 2015)
In developed countries, 15-20% of the general population experiences dyspeptic symptoms at some point over the course of any given year.(Elias et al., 2020) whereas 5-25 % of general population suffer from FD.(Siversten, 2017). Globally, the prevalence of uninvestigated dyspepsia (UD) varies between 7%-45%, depending on definition used and geographical location.(Barberio et al., 2020).
The prevalence of FD ranged from 26 % in the United States to 41 % in U.K. Approx. 1 in 54 or 1.84% or 5 million people in USA are suffering from gastric ulcer. Major contributing reasons were found to be Helicobacter pylori and use of Non-steroidal anti inflammatory drugs (NSAID)(Oshima and Miwa, 2015). It was observed that 10-20 % prevalence of Gastric ulcer and 2-5% prevalence of duodenal ulcer was found in chronic NSAID users.(Narayanan et al., 2018) . The prevalence of dyspepsia in west part of Iran was 54.6%. 8%-30% and 8%-23% of Asian people suffered from uninvestigated dyspepsia and FD, respectively. Most patients with uninvestigated dyspepsia were found to have FD.(Fass et al., 2017).Most patients with uninvestigated dyspepsia were found to have FD. (Chang FY, Hou X, Wong BC2011)
A study from India reported prevalence of dyspepsia to be 30.4%.(KANTILAL et al., 2021). A study revealed that FD consists of 11-15% of a physician’s practice in Pakistan.(Shankar et al., 2020) Though very common in Pakistan, no exact data is available so far. However some studies conducted in Pakistan have shown that the prevalence ranges from 14% to 22% in different studies (Talley et al., 2017).
Functional dyspepsia results in substantial health care costs both the direct costs of visits to doctors, expensive tests,medications,and abstinence from work .The most common organic disorders causing dyspepsia are peptic ulcer, gastroesophageal reflux disease, and gastric cancer. In 50 percent of patients, no cause is found and the dyspepsia is considered to be idiopathic – functional dyspepsia .Evaluation of dyspepsia includes a thorough history and physical examination, with significance given to symptoms that suggest the presence of serious disease. Functional dyspepsia may lead to Peptic ulcer which is a breach in the mucosa that extends through the muscularis mucosae, and is usually 5 millimeter in diameter. There are two types; gastric and duodenal. There are three main causes of ulcers that include: non-steroidal anti inflammatory drugs (NSAIDs), chronic H.pylori infection and hypersecretory states like Zollinger-Ellison syndrome. Cigarette smoking, hurry,worry and curry are detrimental for stomach health and unluckily these are very frequent here in Pakistan. Clinical features include epigastric pain (dyspepsia), which is localized to epigastrium and described as dull aching and gnawing in nature. Nausea and vomiting is also a feature especially with gastric ulcers.(Enck et al., 2017)