Dyspepsia pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The pathophysiology of dyspepsia is as follows:<ref name="pmid26535514">{{cite journal |vauthors=Talley NJ, Ford AC |title=Functional Dyspepsia |journal=N. Engl. J. Med. |volume=373 |issue=19 |pages=1853–63 |year=2015 |pmid=26535514 |doi=10.1056/NEJMra1501505 |url=}}</ref><ref name="pmid26901578">{{cite journal |vauthors=Napthali K, Koloski N, Walker MM, Talley NJ |title=Women and functional dyspepsia |journal=Womens Health (Lond) |volume=12 |issue=2 |pages=241–50 |year=2016 |pmid=26901578 |pmc=5375052 |doi=10.2217/whe.15.88 |url=}}</ref><ref name="pmid27048251">{{cite journal |vauthors=Talley NJ |title=Functional dyspepsia: new insights into pathogenesis and therapy |journal=Korean J. Intern. Med. |volume=31 |issue=3 |pages=444–56 |year=2016 |pmid=27048251 |pmc=4855108 |doi=10.3904/kjim.2016.091 |url=}}</ref><ref name="pmid24716560">{{cite journal |vauthors=Ganesh M, Nurko S |title=Functional dyspepsia in children |journal=Pediatr Ann |volume=43 |issue=4 |pages=e101–5 |year=2014 |pmid=24716560 |doi=10.3928/00904481-20140325-12 |url=}}</ref><ref name="pmid21443707">{{cite journal |vauthors=Fock KM |title=Functional dyspepsia, H. pylori and post infectious FD |journal=J. Gastroenterol. Hepatol. |volume=26 Suppl 3 |issue= |pages=39–41 |year=2011 |pmid=21443707 |doi=10.1111/j.1440-1746.2011.06649.x |url=}}</ref><ref name="pmid22327302">{{cite journal |vauthors=Oustamanolakis P, Tack J |title=Dyspepsia: organic versus functional |journal=J. Clin. Gastroenterol. |volume=46 |issue=3 |pages=175–90 |year=2012 |pmid=22327302 |doi=10.1097/MCG.0b013e318241b335 |url=}}</ref><ref name="pmid19663903">{{cite journal |vauthors=Kindt S, Dubois D, Van Oudenhove L, Caenepeel P, Arts J, Bisschops R, Tack J |title=Relationship between symptom pattern, assessed by the PAGI-SYM questionnaire, and gastric sensorimotor dysfunction in functional dyspepsia |journal=Neurogastroenterol. Motil. |volume=21 |issue=11 |pages=1183–e105 |year=2009 |pmid=19663903 |doi=10.1111/j.1365-2982.2009.01374.x |url=}}</ref> | The pathophysiology of dyspepsia is as follows:<ref name="pmid26535514">{{cite journal |vauthors=Talley NJ, Ford AC |title=Functional Dyspepsia |journal=N. Engl. J. Med. |volume=373 |issue=19 |pages=1853–63 |year=2015 |pmid=26535514 |doi=10.1056/NEJMra1501505 |url=}}</ref><ref name="pmid26901578">{{cite journal |vauthors=Napthali K, Koloski N, Walker MM, Talley NJ |title=Women and functional dyspepsia |journal=Womens Health (Lond) |volume=12 |issue=2 |pages=241–50 |year=2016 |pmid=26901578 |pmc=5375052 |doi=10.2217/whe.15.88 |url=}}</ref><ref name="pmid27048251">{{cite journal |vauthors=Talley NJ |title=Functional dyspepsia: new insights into pathogenesis and therapy |journal=Korean J. Intern. Med. |volume=31 |issue=3 |pages=444–56 |year=2016 |pmid=27048251 |pmc=4855108 |doi=10.3904/kjim.2016.091 |url=}}</ref><ref name="pmid24716560">{{cite journal |vauthors=Ganesh M, Nurko S |title=Functional dyspepsia in children |journal=Pediatr Ann |volume=43 |issue=4 |pages=e101–5 |year=2014 |pmid=24716560 |doi=10.3928/00904481-20140325-12 |url=}}</ref><ref name="pmid21443707">{{cite journal |vauthors=Fock KM |title=Functional dyspepsia, H. pylori and post infectious FD |journal=J. Gastroenterol. Hepatol. |volume=26 Suppl 3 |issue= |pages=39–41 |year=2011 |pmid=21443707 |doi=10.1111/j.1440-1746.2011.06649.x |url=}}</ref><ref name="pmid22327302">{{cite journal |vauthors=Oustamanolakis P, Tack J |title=Dyspepsia: organic versus functional |journal=J. Clin. Gastroenterol. |volume=46 |issue=3 |pages=175–90 |year=2012 |pmid=22327302 |doi=10.1097/MCG.0b013e318241b335 |url=}}</ref><ref name="pmid19663903">{{cite journal |vauthors=Kindt S, Dubois D, Van Oudenhove L, Caenepeel P, Arts J, Bisschops R, Tack J |title=Relationship between symptom pattern, assessed by the PAGI-SYM questionnaire, and gastric sensorimotor dysfunction in functional dyspepsia |journal=Neurogastroenterol. Motil. |volume=21 |issue=11 |pages=1183–e105 |year=2009 |pmid=19663903 |doi=10.1111/j.1365-2982.2009.01374.x |url=}}</ref> | ||
=== Physiology of | === Physiology of digestion === | ||
* In humans, digestion begins in the [[mouth]] where food is chewed. | * In humans, [[digestion]] begins in the [[mouth]] where food is chewed. | ||
* [[Salivary amylase]] aids in the chemical breakdown of [[polysaccharides]] such as starch into [[Disaccharide|disaccharides]] such as [[maltose]]. | * [[Salivary amylase]] aids in the chemical breakdown of [[polysaccharides]] such as [[starch]] into [[Disaccharide|disaccharides]] such as [[maltose]]. | ||
* The chewed food is pushed down the esophagus | * The chewed food is pushed down the [[esophagus]] into the [[stomach]] through [[peristaltic]] [[contraction]] of these [[Muscle|muscles]]. | ||
* Food enters the [[stomach]] where it is further broken | * Food enters the [[stomach]] where it is further broken down and thoroughly mixed with [[gastric acid]], [[pepsin]], and other digestive enzymes to break down [[proteins]], [[fats]] and [[carbohydrates]]. | ||
* After consumption of food, digestive "[[tonic]]" and [[Peristalsis|peristaltic]] contractions begin, which helps break down the food and move it through. Gastric emptying is the release of food from the stomach into the [[duodenum]]. | * After consumption of food, digestive "[[tonic]]" and [[Peristalsis|peristaltic]] [[contractions]] begin, which helps break down the food and move it through the [[gastrointestinal tract]]. Gastric emptying is the release of food from the [[Stomach cancer|stomach]] into the [[duodenum]]. | ||
* | * Gastric emptying has attracted medical interest as rapid gastric emptying is related to [[obesity]] and [[delayed gastric emptying]] syndrome is associated with [[diabetes mellitus]], [[aging]], [[gastroparesis]] and [[gastroesophageal reflux]]. | ||
* After being processed in the stomach, food is passed to the [[small intestine]]. The majority of [[digestion]] and [[absorption]] occurs here after the milky chyme enters the [[duodenum]]. Here it is further mixed with three different | * After being processed in the [[stomach]], food is passed to the [[small intestine]]. The majority of [[digestion]] and [[absorption]] occurs here after the milky [[chyme]] enters the [[duodenum]]. Here it is further mixed with three different [[digestive]] juices: | ||
** [[Bile]] which is produced by the [[liver]] and stored in the [[gallbladder]] [[emulsifies]] fats and neutralizes the [[chyme]]. | ** [[Bile]] which is produced by the [[liver]] and stored in the [[gallbladder]] [[emulsifies]] [[fats]] and neutralizes the [[chyme]]. | ||
** [[Pancreatic juice]] made by the [[pancreas]]. It secrete enzymes such as [[pancreatic amylase]], [[pancreatic lipase]], and [[trypsinogen]]. | ** [[Pancreatic juice]] made by the [[pancreas]]. It secrete [[enzymes]] such as [[pancreatic amylase]], [[pancreatic lipase]], and [[trypsinogen]]. | ||
**Intestinal juice secreted by the [[intestinal]] [[glands]] in the [[small intestine]]. It contains [[enzymes]] such as [[enteropeptidase]], [[erepsin]], [[trypsin]], [[chymotrypsin]], [[maltase]], [[lactase]], and [[sucrase]]. | **Intestinal juice secreted by the [[intestinal]] [[glands]] in the [[small intestine]]. It contains [[enzymes]] such as [[enteropeptidase]], [[erepsin]], [[trypsin]], [[chymotrypsin]], [[maltase]], [[lactase]], and [[sucrase]]. | ||
=== Pathophysiology of | === Pathophysiology of functional dyspepsia === | ||
* The symptoms of functional dyspepsia are directly caused by two major [[physiological]] abnormalities | * The [[symptoms]] of functional dyspepsia (FD) are directly caused by two major [[physiological]] abnormalities | ||
** '''Abnormal gastric motility''' | ** '''Abnormal gastric motility''' | ||
** '''Visceral hypersensitivity''' | ** '''Visceral hypersensitivity''' | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
The symptoms of functional dyspepsia are directly caused by two major pathophysiological abnormalities in gastric motility and visceral sensitivity. These mechanisms occur in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes. The process may be modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle.
Pathophysiology
The pathophysiology of dyspepsia is as follows:[1][2][3][4][5][6][7]
Physiology of digestion
- In humans, digestion begins in the mouth where food is chewed.
- Salivary amylase aids in the chemical breakdown of polysaccharides such as starch into disaccharides such as maltose.
- The chewed food is pushed down the esophagus into the stomach through peristaltic contraction of these muscles.
- Food enters the stomach where it is further broken down and thoroughly mixed with gastric acid, pepsin, and other digestive enzymes to break down proteins, fats and carbohydrates.
- After consumption of food, digestive "tonic" and peristaltic contractions begin, which helps break down the food and move it through the gastrointestinal tract. Gastric emptying is the release of food from the stomach into the duodenum.
- Gastric emptying has attracted medical interest as rapid gastric emptying is related to obesity and delayed gastric emptying syndrome is associated with diabetes mellitus, aging, gastroparesis and gastroesophageal reflux.
- After being processed in the stomach, food is passed to the small intestine. The majority of digestion and absorption occurs here after the milky chyme enters the duodenum. Here it is further mixed with three different digestive juices:
- Bile which is produced by the liver and stored in the gallbladder emulsifies fats and neutralizes the chyme.
- Pancreatic juice made by the pancreas. It secrete enzymes such as pancreatic amylase, pancreatic lipase, and trypsinogen.
- Intestinal juice secreted by the intestinal glands in the small intestine. It contains enzymes such as enteropeptidase, erepsin, trypsin, chymotrypsin, maltase, lactase, and sucrase.
Pathophysiology of functional dyspepsia
- The symptoms of functional dyspepsia (FD) are directly caused by two major physiological abnormalities
- Abnormal gastric motility
- Visceral hypersensitivity
- These mechanisms occur in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle.
- If the basis of this model of FD pathogenesis is excessive responsiveness of gastrointestinal function to stress and external stimuli, psychosomatic approaches to alter stress perception could be important treatment options.[8]
References
- ↑ Talley NJ, Ford AC (2015). "Functional Dyspepsia". N. Engl. J. Med. 373 (19): 1853–63. doi:10.1056/NEJMra1501505. PMID 26535514.
- ↑ Napthali K, Koloski N, Walker MM, Talley NJ (2016). "Women and functional dyspepsia". Womens Health (Lond). 12 (2): 241–50. doi:10.2217/whe.15.88. PMC 5375052. PMID 26901578.
- ↑ Talley NJ (2016). "Functional dyspepsia: new insights into pathogenesis and therapy". Korean J. Intern. Med. 31 (3): 444–56. doi:10.3904/kjim.2016.091. PMC 4855108. PMID 27048251.
- ↑ Ganesh M, Nurko S (2014). "Functional dyspepsia in children". Pediatr Ann. 43 (4): e101–5. doi:10.3928/00904481-20140325-12. PMID 24716560.
- ↑ Fock KM (2011). "Functional dyspepsia, H. pylori and post infectious FD". J. Gastroenterol. Hepatol. 26 Suppl 3: 39–41. doi:10.1111/j.1440-1746.2011.06649.x. PMID 21443707.
- ↑ Oustamanolakis P, Tack J (2012). "Dyspepsia: organic versus functional". J. Clin. Gastroenterol. 46 (3): 175–90. doi:10.1097/MCG.0b013e318241b335. PMID 22327302.
- ↑ Kindt S, Dubois D, Van Oudenhove L, Caenepeel P, Arts J, Bisschops R, Tack J (2009). "Relationship between symptom pattern, assessed by the PAGI-SYM questionnaire, and gastric sensorimotor dysfunction in functional dyspepsia". Neurogastroenterol. Motil. 21 (11): 1183–e105. doi:10.1111/j.1365-2982.2009.01374.x. PMID 19663903.
- ↑ Miwa H (2012). "Why dyspepsia can occur without organic disease: pathogenesis and management of functional dyspepsia". J Gastroenterol. doi:10.1007/s00535-012-0625-9. PMID 22766746. Unknown parameter
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