1. General treatment Generally speaking, the most important thing in treatment is to establish a stable relationship between doctors and patients. Doctors should gain the trust of patients through detailed medical history and comprehensive and meticulous physical examination. After the initial examination, we should discuss the differential diagnosis with the patient, including the possibility of functional dyspepsia. Reasonable diagnosis and examination procedures should be recommended to patients and their concerns should be explained. After diagnostic examination, patients should be informed of the diagnosis of functional dyspepsia, and at the same time, they should be educated to dispel doubts, curb the trend of "over-examination" and shift their focus from finding the causes of symptoms to helping patients overcome these symptoms.
Doctors should discuss patients' life stress, including things related to family, school, interpersonal relationship and living environment. It is impossible to change their living environment. Patients should be instructed to take measures to reduce stress, such as physical exercise, good diet and sleep habits.
You should also know about the patient's recent changes in diet or medicine. Carefully understand the food and drugs that may aggravate the symptoms of patients and stop using them.
2. Drug treatment of functional dyspepsia, the effect of drug treatment is not satisfactory. So far, there is no specific medicine that can completely relieve the symptoms. Moreover, the improvement of symptoms may also be related to the severity of symptoms in the natural course of disease, or to the role of placebo. Therefore, the focus of treatment should be to change living habits and adopt active strategies to overcome them, rather than relying on drugs blindly. When the symptoms get worse, medication may be helpful, but the dosage should be reduced as much as possible, and it can only be used for a long time when there are clear benefits.
The following are some commonly used drugs to treat functional dyspepsia:
(1) antacids and antisecretory drugs:
① antacids: among the drugs used to treat dyspepsia, antacids are the most widely used. In western countries, it is an over-the-counter drug, and some patients have their symptoms relieved after taking antacids, but there are also reports that antacids are similar to placebos in treating functional dyspepsia.
The commonly used antacids (sodium bicarbonate, aluminum hydroxide, magnesium oxide and magnesium trisilicate) in China are: Rone, compound aluminum hydroxide (vitamin Ping Shu), vitalo tablets (Letterway), aluminum magnesium carbonate (Vidaxi) and compound bismuth aluminate. These drugs have obvious effects on relieving hunger pain, acid reflux, heartburn and other symptoms. However, the drug has a short action time and needs to be taken many times, and long-term use is easy to cause adverse reactions.
② Antisecretory drugs: Antisecretory drugs mainly refer to H2 receptor antagonists and proton pump inhibitors.
There are many reports on the treatment of functional dyspepsia with H2 receptor antagonists, and the drug efficacy is statistically superior to placebo. Cimetidine 20 ~ 30 mg/(kg d) was taken orally twice. Ranitidine 5 ~ 7 mg/(kg d), taken orally twice; Famotidine 0.6 ~1mg/(kg d) was taken orally twice.
The proton pump inhibitor omeprazole, 0.6 ~ 0.8 mg/(kg d), 1 time /d orally, can inhibit H+-K+-ATPase in parietal cells, and has a strong long-term inhibitory effect on acid secretion, so it is suitable for patients who fail to respond to H2 receptor antagonist treatment.
(2) prokinetic drugs: According to the clinical verification of the control group, metoclopramide, domperidone and cisapride have been proved to be effective in eliminating the symptoms of functional dyspepsia. Domperidone is widely used in pediatrics.
Metoclopramide (metoclopramide): It can antagonize central and peripheral dopamine, excite 5-HT4 receptor at the same time, promote the release of endogenous acetylcholine, increase the coordinated movement of gastric antrum and duodenum, and promote gastric emptying. The dosage for children is 0.2mg/kg each time for 3 ~ 4 days, 15 ~ 20min before meals. Because of many adverse reactions, the clinical application is gradually decreasing.
② Modigline, a peripheral dopamine receptor antagonist, can promote solid and liquid gastric emptying, inhibit gastric relaxation, coordinate antro-duodenal movement, relax pylorus, and thus relieve dyspeptic symptoms. The dosage for children is 0.3mg/kg each time for 3 ~ 4 days, before meals 15 ~ 30 min. 1 year-old children should not take it because the blood-brain barrier function has not been fully developed.
③ Cisapride: By promoting the release of acetylcholine from the postganglionic fiber endings of the parasympathetic nerve in the gastrointestinal tract, the tension of the sphincter at the lower end of esophagus is enhanced, and the propulsion of esophagus, stomach, small intestine and colon is enhanced. The main effect on the stomach is to increase the contraction of gastric antrum and improve the coordinated movement of gastric antrum and duodenum. Reduce the frequency of pyloric contraction, make gastric electrical activity tend to be normal, and thus accelerate gastric emptying. The dosage for children is 0.2mg/kg each time for 3 ~ 4 days, before meals 15 ~ 30 min. Clinical studies have found that the drug can obviously improve the symptoms of dyspepsia, but its application is limited due to adverse cardiac reactions.
④ Erythromycin: Although it is an antibiotic, it is also a motilin agonist, which can increase the contractile activity of proximal and distal stomachs, promote gastric peristalsis, and accelerate fasting and postprandial gastric emptying. It can be used in children with FD.
(3) Gastric mucosal protective agents: These drugs mainly include colloidal bismuth, sucralfate, misoprostol, enprost, dioctahedral montmorillonite (Smecta) and so on. The clinical application of these drugs is mainly because the incidence of functional dyspepsia may be related to chronic gastritis, and patients may have weakened gastric mucosal barrier function.
(4)5-HT3 receptor antagonist and opioid receptor agonist: These two kinds of drugs have weak effect on promoting gastric emptying, and the principle of treating patients with functional dyspepsia is to adjust visceral sensory threshold. However, there is no experience in using such drugs in pediatrics.
(5) Anti-anxiety drugs: Some people in China used low-dose doxepin and domperidone combined with psychological counseling to treat patients with functional dyspepsia, and found that it had obvious relief effect on symptoms such as epigastric pain and belching, which was significantly higher than that of patients who did not use doxepin. Therefore, in the treatment of FD, the use of drugs to treat psychological disorders has certain clinical significance.
(2) Prognosis
Most of them carefully find the cause, gain the trust and cooperation of patients, and then adjust the treatment to relieve symptoms.