Functional dyspepsia

Keywords Colon cancer functional dyspepsia functional gastrointestinal disorders gastroesophageal reflux disease Helicobacter pylori infection inflammatory bowel disease irritable bowel syndrome liver transplantation pharmacogenetics. 

The indications for these agents are in principle identical to those of the non-selective NSAIDs although the substances have not yet received approval for the whole spectrum of indications of the conventional NSAIDs. Because they lack COX-1-inhibiting properties, COX-2-selective inhibitors show fewer side effects than conventional NSAIDs. However, they are not free of side effects because COX-2 has physiological functions that are blocked by the COX-2 inhibitors. The most frequently observed side effects are infections of the upper respiratory tract, diarrhoea, dyspepsia, abdominal discomfort and headache. Peripheral oedema is as frequent as with conventional NSAIDs. The frequency of gastrointestinal complications is approximately half that observed with conventional NSAIDs. 

The most common adverse reactions seen with celecoxib include dyspepsia, abdominal pain, diarrhea, nausea, and headache Like other NSAIDs, celecoxib may compromise renal function. Elevation of aminotransferase levels also occurs. 

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

FGIDs present with variable combinations of chronic or recurring GI symptoms not explained by overt biochemical or structural abnormalities and encompass conditions like functional dyspepsia (FD), irritable bowel syndrome (IBS) and chronic idiopathic constipation [1], A variety of mechanisms that could explain the etiology of FGIDs are currently under investigation and include, but are not limited to altered GI motility, visceral hypersensitivity and post-infectious abnormalities [2],... 

Adverse reactions occurring in 3% or more of patients with RA include the following Nausea, dyspepsia, rash, headache, abdominal pain, vomiting, fever, dizziness, stomatitis, pruritus, abnormal liver function tests, and leukopenia. One report showed a 10% rate of immunoglobulin suppression, which was slowly reversible and rarely accompanied by clinical findings. 

Tebaldi M, Heading RC. Clinical economics review functional (non-ulcer) dyspepsia. Aliment Pharmacol Ther 1998 12(l) ll-9. 

Upper alimentary symptoms in the absence of a clear pathological cause are referred to as non-ulcer dyspepsia or functional dyspepsia. The diagnosis is, in essence, by exclusion. 

Toxicity—Initial hematocrit, fecal occult blood, then q6-l 2 mo electrolytes and renal function tests q6-12 mo LFTs q6-12 mo in high-risk patients query patient for dyspepsia, nausea, vomiting, right upper abdominal pain, anorexia, fatigue, jaundice, edema, weight gain, decreased urine output... 

Dyspepsia, including heartburn, indigestion, flatulence, abdominal cramping, constipation, nausea, diarrhea, epigastric pain, vomiting, headache, nervousness, dizziness, bleeding, elevated liver function tests, tinnitus... 

It is indicated in gastroesophageal reflux disease and functional dyspepsia, diabetic gastropathy. 

Andersen LP, Hoick S, Janulaityte-Gunther D et al (2005) Gastric inflammatory markers and interleukins in patients with functional dyspepsia, with and without Helicobacter pylori infection. FEMS Immunol Med Microbiol 44(2) 233-238... 

While the 5-HT3 receptor is the most important in control of nausea and vomiting, others are also involved. 5-HT4 agonists have prokinetic properties in nauseated patients with gastroparesis and functional dyspepsia. The 5-HTlD-receptor agonists, such as sumatripan, are used in treatment of migraine and reduce emesis both in this condition and also in the cyclic vomiting syndrome, most likely via action on CNS sites. 

Parsley possesses carminative, antispasmodic, diuretic, emmenagogue, expectorant, antirheumatic, and antimicrobial properties. Traditionally, it is used for flatulent dyspepsia, colic, cystitis, dysuria, bronchitic cough in elderly people, dysmenorrhea, functional amenorrhea, myalgia, and specifically for flatulent dyspepsia with intestinal colic. 

Capsicum, also known as chili or paprika, is the fruit of various Capsicum species. It is widely used as a spice and, traditionally, it has been used internally for colic, flatulent dyspepsia, chronic laryngitis, insufficiency of peripheral circulation, and externally for neuralgia. Capsaicin (the active pungent ingredient) has been used extensively as a probe to elucidate the function of sensory neurons in various organs and systems (including the stomach), because of its ability to excite and later defunctionalize a subset of primary afferent neurons. 

Three common side-effects are (a) first-dose hypotension, (b) persistent dry cough and (c) hyperkalaemia. Other side-effects include gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhoea, altered liver function tests, blood disorders, angioedema, rash, loss of sense of smell (more likely if also on potassium-sparing agents or potassium supplements). 

The adverse effects of sulfasalazine 2-3 g/day and mesalazine 1.2-2.4 g/day in 685 patients have been reviewed for a median follow-up period of 7 and 5 years respectively (18). Adverse effects were observed overall in 20% of patients taking sulfasalazine and 6.5% of those taking mesalazine. The commonest adverse effects due to sulfasalazine (reported by more than 10% of patients) were dyspepsia, rash, and headache, while the commonest due to mesalazine were rash, diarrhea, headache, fever, abdominal pain, impaired renal function, dyspepsia, and edema. Fertility was affected in aU 42 male patients taking sulfasalazine who were assessed, but improved when they changed to mesalazine. 

Nephrotoxicity has been described during treatment with olsalazine (SEDA-21, 364). To assess the effects of 9 months of treatment with oral mesalazine 1.2 g/day and olsalazine 1 g/day on renal function, a randomized trial has been performed in 40 patients with ulcerative colitis in complete remission (91). Neither drug had a significant effect on glomerular filtration rate. Adverse effects (all mild to moderate) were more common in the mesalazine group they included abdominal pain and distension, dyspepsia, nausea, and diarrhea. 

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