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Functional gastric disturbances — disturbances of secretory and motive function of a stomach with a symptom complex of gastric dyspepsia and a pain syndrome without accurately defined structural changes of a mucous membrane. It is heterogeneous group of diseases in which it is accepted to include functional gastric disturbances as an independent nosological form and secondary disturbances of secretory and motor activity of a stomach at other diseases. Besides, allocate special types of functional gastric disturbances: acute gastrectasia, aerophagia, usual vomiting.
Functional gastric disturbances as the independent nosological form meets at men of young age more often, making from 1,5 to 58,8% among duodenogastric pathology at persons of young age. Discrepancy of the functional gastric disturbances given about frequency reflects different views of authors on essence of a disease, and also level of the conducted examination which is not allowing to differentiate functional gastric disturbances from other diseases of gastroduodenal system (chronic gastritis, a duodenitis). Disturbances of various functions of a stomach can be found practically in each patient with hard proceeding extra gastric diseases, however they seldom proceed independently and usually are not diagnosed. Special types of functional gastric disturbances (an aerophagia, usual vomiting) are more characteristic of women with isteroidny type of mentality.
Etiology and pathogeny
The major etiological factors of functional gastric disturbances as independent disease are food disturbances (food with no drink, the use of rough and spicy food, unbalanced food, irregular meal, a bad chewing at fast food), a neuroemotional pressure, professional harm and addictions (alcohol intake, smoking, the frequent use of coffee).
Functional activity of a stomach is regulated by three interacting systems:
1) central and vegetative (sympathetic and parasympathetic) nervous system;
2) own enteroendocrine device including endocrine cells and the hormones and gormonopodobny substances produced by them (gastrin, a histamine, bombeein, serotonin, somatostatin, enkephalins, etc.);
3) fabric substances which kinina, prostaglandins, metabolism products are among (adenosine, etc.).
These three regulatory systems control several cell populations and structures with various functional purpose:
1) stem undifferentiated cells (intermediate cells of an isthmus of gastric glands), being ancestors of all epithelial elements of a stomach;
2) the covering (obkladochny) cells cosecreting NSL;
3) the zimogenny (main) cells developing a pepsinogen;
4) cells of a cover epithelium. The receptors tied with an adenilattsiklazny (ATs) complex first of all participate in implementation of functional answers of a cell (ATs — цАМФ — a protein kinase). Increase of intracellular maintenance of tsAMF leads to stimulation of synthesis of HCI and pepsinogen.
Influence of adverse factors can lead to failure of the adaptation and compensatory mechanism in any link of this system that is shown by various disturbances of secretory and motor activity of a stomach.
Secondary functional gastric disturbances develop against diseases of other bodies and systems of an organism. The pathogeny of these frustration is difficult, disturbances of neuroendocrinal regulation, toxic influences, insufficiency of local blood circulation and some other the factors leading to dystrophic changes of the ferruterous device and a cover epithelium participate in it.
There is no standard classification of functional gastric disturbances. Most G. I. Dorofeyev and V. M. Uspensky's classification (1984) was widely adopted.
For practical use the following option of this classification is offered.
Classification of functional gastric disturbances
I. On origins
1. Independent disease (primary functional gastric disturbances)
2. Manifestations or effects of a basic disease (secondary functional gastric disturbances)
II. On dysfunction types:
III. In a form (on clinical manifestations):
IV. Special forms:
1) acute gastrectasia,
3) usual vomiting
Approximate formulation of the diagnosis:
1. Functional gastric disturbance of hypersthenic type, painful form.
2. Chronic post-dysenteric colitis. Functional gastric disturbance of hyposthenic type, dispepsichesky form.
3. Hysteria. Aerophagia.
According to review MKB IX functional gastric disturbances belong to a heading 536, except for the functional gastric disturbances specified as psychogenic (an aerophagia, usual vomiting) — a heading 306.
Clinical picture, preliminary diagnosis
At the patient with functional gastric disturbances it is necessary to think of an opportunity at emergence of pain in epigastriums and dispepsichesky disturbances.
The clinical symptomatology of functional gastric disturbances differs in variety, not specificity and therefore cannot serve as reliable diagnostic criterion. Patients usually complain of heartburn, nausea, an eructation, vomiting and pain in upper parts of a stomach without accurate localization. Mainly functional nature of these manifestations is indicated by abundance of complaints, their quite often emotional coloring, inconstancy of symptoms. Have crucial importance of the complaint at diagnosis of special forms of functional gastric disturbances, for example a loud eructation air, the typical for an aerophagia, easily arising vomiting without the previous nausea — for usual vomiting.
With functional gastric disturbances often find signs of neurovegetative instability (irritability, a psychoemotional neuravnoyeshennost, lability of pulse and the ABP etc.) in the patient. At a palpation of a stomach morbidity in epigastriums can be defined.
The short gastroenterological anamnesis which usually does not exceed 1 — 2 flying is considered important criterion of diagnosis of functional gastric disturbances.