How Do I Deal With Indigestion Pain?

The incidence of functional dyspepsia (FD) in pediatric patients in China has not been standardized, but it has become a common cause of treatment in pediatric digestive clinics. Because many pediatric clinicians lack sufficient knowledge of functional dyspepsia, they cannot make correct diagnosis and treatment in a timely manner, delay the physical and mental recovery of children, and affect the quality of learning and life.

Basic Information

Visiting department: Pediatrics, Gastroenterology, Psychological Medicine
Multiple groups: Children
Common locations: Gastrointestinal
Common causes: Related to gastrointestinal motor dysfunction, visceral hypersensitivity, psychopsychological factors, etc.

Common symptoms: Epigastric pain, bloating, early satiety, belching, nausea, vomiting, burning sensation in the abdomen, etc.
Contagious: no

Pediatric indigestion classification

For older children (4 years) who have a clear complaint, they can refer to the Rome III standard and divide FD into post-prandial discomfort syndrome (expressed as post-prandial fullness or early satiety) and epigastric pain according to the main symptoms. Signs (expressed as epigastric pain or burning sensation) in two subtypes.

Causes of dyspepsia in children

At present, it is considered to be the result of a combination of factors, such as gastrointestinal motor dysfunction, visceral hypersensitivity, abnormal gastric acid secretion, Hp infection, and psychological factors. The pathogenesis of functional dyspepsia is unclear. Changes in mucosal immune and inflammatory functions, as well as changes in the central nervous system (CNS), brain-gut axis, and enteric nerve (ENS) regulatory function.

Clinical manifestations of dyspepsia in children

Common symptoms of FD include epigastric pain, bloating, flatulence, early satiety, belching, nausea, vomiting, and burning sensation in the abdomen. These symptoms persist or recur, but they are not characteristic and rarely all occur simultaneously. Only one or more of them appear. These symptoms affect children's eating, leading to chronic nutritional insufficiency, a high incidence of malnutrition in children, and growth retardation may also occur. Many children have psychotic symptoms such as neurosis and anxiety.

Pediatric indigestion test

FD is a functional disease, and various laboratory tests, radiology, and endoscopy are often not found positive. In recent years, with the development and application of electrogastrograms and gastric motility tests, there have been many new advances in its auxiliary diagnostic methods.

Body surface electrogastrogram

This is an effective method for non-invasive assessment of adverse gastric electromyography in children. Gastric antrum mobility motor complex wave (MMC) can be measured by applying surface gastric electricity, Fourier transform and spectral analysis methods. Studies have shown that gastric antral mobile motor complex wave activity is significantly reduced in some children with FD. Gastric bradycardia is more common in children with FD, and hyperactivity of gastric antrum is more common in children with decreased appetite, which indicates that electrogram examination can indicate poor movement (hypermotility or slowing) of gastric smooth muscle, which is helpful for children with FD Diagnostic significance.

2. Gastric motility test

Gastric sensorimotor dysfunction is one of the pathogenesis of FD, and most children have abnormal gastric motility. Gastric motility test uses ultrasound to understand gastric emptying, observes the frequency and amplitude of gastric antrum contraction, provides an objective basis for clinical diagnosis of FD, and can evaluate the efficacy during follow-up. This test method has the advantages of painlessness, non-invasiveness, economy, simplicity, and avoiding radiation exposure, which is easy for children and parents to accept. However, the examination requires the cooperation of children. Children <3 years of age have insufficient cognitive ability and are difficult to perform.

3. Other

Water loading test assists in the diagnosis of FD. It has high specificity but low sensitivity, and has not been widely used in clinical practice. Many children with FD are accompanied by psychological factors such as anxiety, tension, depression, etc. Through simple psychological tests, you can understand the mental health of the children and further understand the condition of the children to assist diagnosis and treatment. ^[1]

Diagnosis of dyspepsia in children

FD diagnostic criteria for children: have dyspepsia for at least 2 months, appear at least once a week, and meet the following 3 conditions:

(1) Suffering or recurrent upper abdomen (upper umbilical) pain or discomfort, early satiety, belching, nausea, vomiting, acid reflux.

(2) Symptoms cannot be relieved after defecation, or the onset of symptoms has nothing to do with the frequency of defecation or changes in stool characteristics (ie, irritable bowel syndrome is excluded).

(3) No evidence of inflammatory, anatomical, metabolic, or neoplastic disease can explain the symptoms of the child.

Differential diagnosis of dyspepsia in children

Attention should be paid to the identification of gastroesophageal reflux and irritable bowel syndrome.

Pediatric Indigestion Treatment

General treatment

Help parents of children to understand and understand the condition, guide them to improve the children's lifestyle, adjust the dietary structure and habits, remove possible factors related to symptoms, and improve the ability to relieve symptoms. Non-drug treatments include cognitive therapy, diet adjustment, and changes in bowel habits. Insomnia, anxiety, depression and other mental factors are an important cause of FD in children, and children are not well tolerant of repeated abdominal pain, bloating and other symptoms of upper abdominal discomfort, which may in turn trigger and aggravate the mental symptoms of children. In recent years, the treatment of children with FD by cognitive behavioral therapy has received more and more attention.

2. Drug treatment

According to the clinical manifestations of children and their relationship with meals, prokinetic drugs, antacids and acid suppressants can be selected. The general course of treatment is 2 to 4 weeks. Specific drug selection principles are detailed in the diagnosis and treatment process of children with FD. Those who fail to treat can appropriately extend the course of treatment, and can be further checked and treated after a clear diagnosis. People with Hp infection need H. pylori eradication treatment.

(1) Promoting drugs At present, the drugs commonly used to promote gastric emptying are: dopamine receptor antagonist: metoclopramide, which has a strong central antiemetic effect and can enhance gastric motility. But because it can cause extrapyramidal reactions, it is not suitable for infants and young children and long-term high-dose use. Domperidone is a selective peripheral dopamine D2 receptor antagonist. It does not penetrate the blood-brain barrier and has no extrapyramidal adverse reactions. It can increase motility of the gastric antrum and duodenum, promote gastric emptying, and significantly improve postprandial satiety in children with FD. Swelling, early satiety and other symptoms are old. But long-term use can cause blood prolactin to rise, and individual patients have breast tenderness or lactation. Serotonin 4 (5-HT ₄ ) receptor agonist: Mosapride citrate can significantly improve early satiety and abdominal distension in patients with FD.

(2) Antacids and acid suppressants have been widely used in the treatment of indigestion. At present, clinically used antacids include aluminum magnesium carbonate, compound aluminum hydroxide, calcium carbonate oral suspension, etc., which can relieve symptoms. Antacids include H ₂ receptor antagonists (H2RA), such as: cimetidine, ranitidine, famotidine, and the like; and proton pump inhibitors (PPI), such as omeprazole. These drugs have a more obvious effect on the relief of abdominal pain, acid reflux, heartburn and other symptoms.

(3) H. pylori eradication Although the relationship between H. pylori and the incidence and symptoms of FD is uncertain, it is still recommended to treat H. pylori eradication in children with H. pylori infection. Studies have shown that for patients with Hp-positive FD, the use of omeprazole and antibiotics to eradicate Hp can improve the symptoms of some patients for a long time. Better than omeprazole alone.

3. Application of intestinal probiotics

In addition to the effects of intestinal probiotics such as lactobacillus, which can inhibit the growth of intestinal pathogens and enhance the body's immune function, they also participate in the digestion and decomposition of endogenous substances, by enhancing or reducing the activity of digestive tract enzymes, or generating various digestions Enzymes promote digestive function.

4. Chinese medicine treatment

Is an important treatment for functional gastrointestinal diseases. The mechanism of action of Chinese medicine is not completely clear. However, there is evidence that they can stimulate the secretion of the stomach and digestive glands through the taste system, vagus nerve, and intestinal nervous system even at very low concentrations, and strengthen the feedback stimulation of the central nervous system by the digestive tract through the intestinal nervous system. , So that intestinal function is enhanced. Large doses of traditional Chinese medicine can even directly affect the gastrointestinal mucosa. Chinese herbal medicines often contain aromatic oils, which have antispasmodic, ventilatory and diarrhea-relieving functions and local analgesics. In recent years, many comparative studies on Chinese herbal medicine preparations (such as coriander oil, peppermint oil, ginger, and turmeric extract, etc.) have shown that Chinese herbal medicine is better than placebo in the treatment of functional gastrointestinal diseases, The effect is the same.

5. Psychological adjustment

The psychological factors of FD have been paid more and more attention. Doctors should be compassionate and patient. Giving certain behavioral therapy, cognitive therapy or psychological intervention can be combined with some placebo, most of the symptoms will improve over time. For patients who are not effective in acid suppression and prokinetic therapy, and who have significant mental and psychological disorders, they can ask a psychiatrist to assist in diagnosis and treatment. Appropriate anti-anxiety and antidepressant drugs can improve symptoms. ^[2-3]

Prognosis of dyspepsia in children

The prognosis is good after most correct diagnosis. However, care must be taken to exclude other organic diseases during the diagnosis of the disease.

Pediatric indigestion

1. Adjust diet structure, eat less meat, cold drinks, carbonated drinks, snacks. Care should be taken to avoid foods that induce symptoms, such as coffee, alcohol, and high-fat foods.

2. Develop good eating habits, do not overeat, eat on time, and eat more vegetables and fruits is a good way to adjust digestive function. Educating children to develop good bowel habits and normalizing bowel movements may help improve symptoms of indigestion.

3. Guarantee the time of outdoor activities.

4. Appropriate psychological treatment has an important effect on disease recovery and can improve symptoms. ^[1-3]