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Functional Dyspepsia

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Pediatric Neurogastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Dyspepsia has been defined as chronic recurrent pain or discomfort centered in the upper abdomen, characterized by symptoms of nausea, vomiting, bloating, and early satiety, all of which are usually exacerbated by food intake. Essential features offunctionaldyspepsia include persistent pain or discomfort above the umbilicus, not associated with or relieved by a change of stool frequency or form, as well as a lack of evidence for inflammatory, anatomic, metabolic, or neoplastic conditions. In about 50 % of adults and greater than 70 % of children, the pathophysiology of symptoms of functional dyspepsia is related to abnormalities in the upper gastrointestinal motor function, such as delayed gastric and small intestinal transit, decreased gastric accommodation, and gastric dysrhythmia. Diagnostic evaluation should be driven by an index of clinical suspicion based on pertinent red flags in the history and physical examination. A comprehensive treatment approach uses the biopsychosocial model, which involves a combination of educational, pharmacological, psychological, as well as complementary therapies. Determining the patient’s most distressing symptom may also help to target particular treatment options and individualize therapy. Follow-up of dyspeptic patients at 6 months to 2 years revealed that 70 % of subjects were either asymptomatic or much improved regardless of the cause; however, the remainder had neither improvement nor worsening of their symptoms despite aggressive medical management.

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References

  1. Di Lorenzo CR, R Andree, D Forbes, E Guiraldes, J Hyams, A Staiano, LS Walker. Childhood functional gastrointestinal disorders: child/adolescent. In: Drossman DA, editor. Rome III: the functional gastrointestinal disorders, 3rd ed. McLean, VA: Degnon Associates, Inc.; 2006. p. 733–8.

    Google Scholar 

  2. Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr. 1996;129(2):220–6.

    Article  PubMed  CAS  Google Scholar 

  3. Hyams JS, Davis P, Sylvester FA, Zeiter DK, Justinich CJ, Lerer T. Dyspepsia in children and adolescents: a prospective study. J Pediatr Gastroenterol Nutr. 2000; 30(4):413–8.

    Article  PubMed  CAS  Google Scholar 

  4. De Giacomo C, Valdambrini V, Lizzoli F, et al. A population-based survey on gastrointestinal tract symptoms and Helicobacter pylori infection in children and adolescents. Helicobacter. 2002;7(6):356–63.

    Article  PubMed  Google Scholar 

  5. Talley NJ. Dyspepsia: management guidelines for the millennium. Gut. 2002;50 Suppl 4:iv72–8. discussion iv79.

    Article  PubMed  Google Scholar 

  6. Youssef NN, Murphy TG, Langseder AL, Rosh JR. Quality of life for children with functional abdominal pain: a comparison study of patients’ and parents’ perceptions. Pediatrics. 2006;117(1):54–9.

    Article  PubMed  Google Scholar 

  7. Thumshirn M. Pathophysiology of functional dyspepsia. Gut. 2002;51 Suppl 1:i63–6.

    Article  PubMed  Google Scholar 

  8. Friesen CA, Lin Z, Garola R, et al. Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying in children with dyspepsia. Dig Dis Sci. 2005;50(6):1012–8.

    Article  PubMed  Google Scholar 

  9. Chitkara DK, Delgado-Aros S, Bredenoord AJ, et al. Functional dyspepsia, upper gastrointestinal symptoms, and transit in children. J Pediatr. 2003;143(5):609–13.

    Article  PubMed  Google Scholar 

  10. Chitkara DK, Camilleri M, Zinsmeister AR, et al. Gastric sensory and motor dysfunction in adolescents with functional dyspepsia. J Pediatr. 2005;146(4):500–5.

    Article  PubMed  Google Scholar 

  11. Bisschops R, Karamanolis G, Arts J, et al. Relationship between symptoms and ingestion of a meal in functional dyspepsia. Gut. 2008;57(11):1495–503.

    Article  PubMed  CAS  Google Scholar 

  12. Walker MM, Salehian SS, Murray CE, et al. Implications of eosinophilia in the normal duodenal biopsy—an association with allergy and functional dyspepsia. Aliment Pharmacol Ther. 2010;31:1229–36.

    Article  PubMed  CAS  Google Scholar 

  13. Friesen CA, Sandridge L, Andre L, Roberts CC, Abdel-Rahman SM. Mucosal eosinophilia and response to H1/H2 antagonist and cromolyn therapy in pediatric dyspepsia. Clin Pediatr (Phila). 2006;45(2): 143–7.

    Article  Google Scholar 

  14. Schappi MG, Borrelli O, Knafelz D, et al. Mast cell-nerve interactions in children with functional dyspepsia. J Pediatr Gastroenterol Nutr. 2008;47(4): 472–80.

    Article  PubMed  Google Scholar 

  15. Walker MM, Talley NJ, Prabhakar M, et al. Duodenal mastocytosis, eosinophilia and intraepithelial lymphocytosis as possible disease markers in the irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2009;29(7):765–73.

    Article  PubMed  CAS  Google Scholar 

  16. Fried M, Feinle C. The role of fat and cholecystokinin in functional dyspepsia. Gut. 2002;51 Suppl 1:i54–7.

    Article  PubMed  CAS  Google Scholar 

  17. Van Oudenhove L, Vandenberghe J, Geeraerts B, et al. Relationship between anxiety and gastric sensorimotor function in functional dyspepsia. Psychosom Med. 2007;69(5):455–63.

    Article  PubMed  Google Scholar 

  18. Van Oudenhove L, Vandenberghe J, Dupont P, et al. Abnormal regional brain activity during rest and (anticipated) gastric distension in functional dyspepsia and the role of anxiety: a H(2)(15)O-PET study. Am J Gastroenterol. 2010;105(4):913–24.

    Article  PubMed  Google Scholar 

  19. Thomson AB, Barkun AN, Armstrong D, et al. The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment—Prompt Endoscopy (CADET-PE) study. Aliment Pharmacol Ther. 2003;17(12):1481–91.

    Article  PubMed  CAS  Google Scholar 

  20. Drumm B, Rowland M. The epidemiology of Helicobacter pylori: where to from here? J Pediatr Gastroenterol Nutr. 2003;36(1):7–8.

    Article  PubMed  Google Scholar 

  21. Raguza D, Machado RS, Ogata SK, Granato CF, Patricio FR, Kawakami E. Validation of a monoclonal stool antigen test for diagnosing Helicobacter pylori infection in young children. J Pediatr Gastroenterol Nutr. 2010;50(4):400–3.

    PubMed  Google Scholar 

  22. Miele E, Simeone D, Marino A, et al. Functional gastrointestinal disorders in children: an Italian prospective survey. Pediatrics. 2004;114(1):73–8.

    Article  PubMed  Google Scholar 

  23. Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006;4:CD001960.

    PubMed  Google Scholar 

  24. Talley NJ, Lauritsen K. The potential role of acid suppression in functional dyspepsia: the BOND, OPERA, PILOT, and ENCORE studies. Gut. 2002;50 Suppl 4:iv36–41.

    Article  PubMed  Google Scholar 

  25. Veldhuyzen van Zanten SJ, Jones MJ, Verlinden M, Talley NJ. Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis. Am J Gastroenterol. 2001;96(3):689–96.

    Article  PubMed  CAS  Google Scholar 

  26. FDA Requires Boxed Warning and Risk Mitigation Strategy for Metoclopramide-Containing Drugs. 2009.http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2009/ucm149533.htm. Accessed 27 Apr 2010.

  27. Tack J. Prokinetics and fundic relaxants in upper functional GI disorders. Curr Opin Pharmacol. 2008; 8(6):690–6.

    Article  PubMed  CAS  Google Scholar 

  28. Mertz H, Fass R, Kodner A, Yan-Go F, Fullerton S, Mayer EA. Effect of amitriptyline on symptoms, sleep, and visceral perception in patients with functional dyspepsia. Am J Gastroenterol. 1998;93(2): 160–5.

    Article  PubMed  CAS  Google Scholar 

  29. Bouras EP, Talley NJ, Camilleri M, et al. Effects of amitriptyline on gastric sensorimotor function and postprandial symptoms in healthy individuals: a randomized, double-blind, placebo-controlled trial. Am J Gastroenterol. 2008;103(8):2043–50.

    Article  PubMed  CAS  Google Scholar 

  30. Friesen CA, Kearns GL, Andre L, Neustrom M, Roberts CC, Abdel-Rahman SM. Clinical efficacy and pharmacokinetics of montelukast in dyspeptic children with duodenal eosinophilia. J Pediatr Gastroenterol Nutr. 2004;38(3):343–51.

    Article  PubMed  Google Scholar 

  31. Friesen CA, Neilan NA, Schurman JV, Taylor DL, Kearns GL, Abdel-Rahman SM. Montelukast in the treatment of duodenal eosinophilia in children with dyspepsia: effect on eosinophil density and activation in relation to pharmacokinetics. BMC Gastroenterol. 2009;9:32.

    Article  PubMed  Google Scholar 

  32. van Tilburg MA, Chitkara DK, Palsson OS, et al. Audio-recorded guided imagery treatment reduces functional abdominal pain in children: a pilot study. Pediatrics. 2009;124(5):e890–7.

    Article  PubMed  Google Scholar 

  33. Vlieger AM, Menko-Frankenhuis C, Wolfkamp SC, Tromp E, Benninga MA. Hypnotherapy for children with functional abdominal pain or irritable bowel syndrome: a randomized controlled trial. Gastroenterology. 2007;133(5):1430–6.

    Article  PubMed  Google Scholar 

  34. Weydert JA, Shapiro DE, Acra SA, Monheim CJ, Chambers AS, Ball TM. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial. BMC Pediatr. 2006;6:29.

    Article  PubMed  Google Scholar 

  35. Youssef NN, Rosh JR, Loughran M, et al. Treatment of functional abdominal pain in childhood with cognitive behavioral strategies. J Pediatr Gastroenterol Nutr. 2004;39(2):192–6.

    Article  PubMed  Google Scholar 

  36. Schurman JV, Wu YP, Grayson P, Friesen CA. A pilot study to assess the efficacy of biofeedback-assisted relaxation training as an adjunct treatment for pediatric functional dyspepsia associated with duodenal eosinophilia. J Pediatr Psychol. 2010;35: 837–47.

    Article  PubMed  Google Scholar 

  37. Xu S, Hou X, Zha H, Gao Z, Zhang Y, Chen JD. Electroacupuncture accelerates solid gastric emptying and improves dyspeptic symptoms in patients with functional dyspepsia. Dig Dis Sci. 2006;51(12): 2154–9.

    Article  PubMed  Google Scholar 

  38. Takahashi T. Acupuncture for functional gastrointestinal disorders. J Gastroenterol. 2006;41(5):408–17.

    Article  PubMed  Google Scholar 

  39. Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2004;3:CD002301.

    PubMed  Google Scholar 

  40. Melzer J, Rosch W, Reichling J, Brignoli R, Saller R. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20(11–12): 1279–87.

    Article  PubMed  CAS  Google Scholar 

  41. von Arnim U, Peitz U, Vinson B, Gundermann KJ, Malfertheiner P. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102(6):1268–75.

    Article  Google Scholar 

  42. Micklefield GH, Redeker Y, Meister V, Jung O, Greving I, May B. Effects of ginger on gastroduodenal motility. Int J Clin Pharmacol Ther. 1999;37(7):341–6.

    PubMed  CAS  Google Scholar 

  43. Ghayur MN, Gilani AH. Pharmacological basis for the medicinal use of ginger in gastrointestinal disorders. Dig Dis Sci. 2005;50(10):1889–97.

    Article  PubMed  Google Scholar 

  44. Tack JT, NJ, Camilleri M, et al. The functional gastrointestinal disorders: functional dyspepsia. In: Drossman DA, editor. Rome III: the functional gastrointestinal disorders. McLean, VA: Virginia Degnon Associates, Inc.; 2006. p. 426–450.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Pediatric Gastroenterology and Nutrition, Goryeb Children’s Hospital, Atlantic Health, Morristown, NJ, USA

    Alycia Leiby M.D. & Denesh K. Chitkara M.D. (Assistant Professor)

  2. Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA

    Denesh K. Chitkara M.D. (Assistant Professor)

  3. Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ, 07962, USA

    Denesh K. Chitkara M.D. (Assistant Professor)

Authors
  1. Alycia Leiby M.D.
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  2. Denesh K. Chitkara M.D.
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Correspondence to Denesh K. Chitkara M.D. .

Editor information

Editors and Affiliations

  1. Sainte-Justine Hospital, Department of Pediatrics, Division of Pediatric Gastroenterology, Université de Montréal, Montreal, H3T 1C5, Québec, Canada

    Christophe Faure

  2. Nationwide Children's Hospital, Division of Pediatric Gastroenterology, The Ohio State University, Columbus, 43205, Ohio, USA

    Carlo Di Lorenzo

  3. Gastroenterology and Neural Development, University College London, Institute of Child Health, Great Ormond Street Hospital for Children, London, WC1N 1EH, United Kingdom

    Nikhil Thapar

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Leiby, A., Chitkara, D.K. (2013). Functional Dyspepsia. In: Faure, C., Di Lorenzo, C., Thapar, N. (eds) Pediatric Neurogastroenterology. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-709-9_33

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  • DOI: https://doi.org/10.1007/978-1-60761-709-9_33

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-708-2

  • Online ISBN: 978-1-60761-709-9

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