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Functional Gastroduodenal Disorders (Rome III Diagnostic Criteria)
Discuss the diagnosis of Functional dyspepsia?
1. Functional dyspepsia (FD)
Diagnostic criteria* must include: One or more of the following:
AND
No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
PS- A gastric-emptying study (e.g., scintigraphy) is not currently recommended as a routine clinical test because the results uncommonly alter management. Recent studies have shown that less than 25% of patients with FD have delayed gastric emptying.
Postprandial distress syndrome and Epigastric pain syndrome are sub classified under functional dyspepsia
1a. Postprandial Distress Syndrome
Diagnostic criteria* must include one or both of the following:
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Supportive criteria
1b. Epigastric Pain Syndrome
Diagnostic criteria* must include all of the following:
Pain or burning localized to the epigastrium of at least moderate severity, at least once per week
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Discuss the treatment of FD disorders?
Discuss the diagnosis of functional belching disorders?
1a. Aerophagia
Diagnostic criteria* must include all of the following:
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
1b. Unspecified Excessive Belching
Diagnostic criteria* must include all of the following:
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
Discuss the treatment of belching disorders?
Dietary modification (avoiding sucking candies or chewing gum, eating slowly and encouraging small swallows, and avoiding carbonated beverages) is often recommended but has not been rigorously tested.
Behavioural therapy seems helpful in some cases, but clinical trials are lacking.
Discuss the diagnosis of functional nausea and vomiting disorders?
1a. Chronic Idiopathic Nausea
Diagnostic criteria* must include all of the following:
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
1b. Functional Vomiting
Diagnostic criteria* must include all of the following:
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
1c. Cyclic Vomiting Syndrome
Diagnostic criteria must include all of the following:
Supportive criterion
History or family history of migraine headaches
Although it is rare, adults may develop cyclical vomiting in middle age, and both men and women are affected. Only 1 in 4 adults had a history of migraine headaches. Adults have a mean of 4 cycles of vomiting per year, with a mean duration of 6 days (range, 1–21) and an average symptom-free interval of 3 months (range, 0.5–6). The mechanisms underlying functional and cyclic vomiting remain unknown.
The treatment of chronic idiopathic nausea is not defined. Anti nausea drugs provide limited benefit empirically. Low-dose tricyclic antidepressant therapy may be helpful anecdotally.
Discuss the diagnosis of rumination syndrome in Adults?
Diagnostic criteria must include both of the following:
Supportive criteria
Discuss rumination syndrome?
Although initially described in infants and the developmentally disabled, it is now widely recognized that rumination syndrome occurs in males and females of all ages and cognitive abilities. In general, rumination is more common in females than males.
Rumination syndrome is a probably underappreciated condition in adults who are often misdiagnosed as having vomiting secondary to gastroparesis or gastroesophageal
reflux or anorexia or bulimia nervosa.
Typical clinical features include the following:
Pathophysiological mechanisms involved in rumination syndrome remain somewhat unclear, although all observations suggest some adaptation of the belch reflex that overcomes the resistance to retrograde flow provided by the lower oesophageal sphincter.
Reassurance, explanation, and behavioural therapy are currently the mainstays of treatment in adolescents and adults of normal intelligence with rumination syndrome. The preferred behavioural treatment for rumination syndrome consists of habit reversal by using diaphragmatic breathing techniques to compete with the urge to regurgitate.
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