Functional dyspepsia & homoeopathy

Functional dyspepsia – its modern understanding and homoeopathic approach

Gastric symptoms like abdominal discomfort, stomach pain, bloating, fullness, tenderness and allied symptoms are very common in day to day practice.  These abdominal symptoms have been in existence since the beginning of human history. But the term dyspepsia covering these symptoms was first recorded in the mid 18th century and since then the term has been widely used. Dyspepsia may be acute or chronic. While acute dyspepsia is a kind of indisposition which may go on its own by diet modifications, chronic dyspepsia may recur again and again. Modern pathologists tried to found out organic cause for the recurrent type but failed to identify one in many cases and termed it as functional dyspepsia (FD). Because of the absence of a clear understanding of the mechanism/s, conventional system without having effective drug mostly depend on the dietary recommendations, lifestyle modifications and psychological intervention.  The scope and success of homoeopathy in functional dyspepsia as in other functional disorders are known both in acute episodes as well as in giving stable recovery in chronic cases. This article tries to update the readers on the possible modern understanding of the disease, its miasmatic approach and drugs to manage the condition.

How prevalent is this condition?

Recent epidemiological studies indicate that functional dyspepsia is a very common condition with a high prevalence throughout the world.¹ In western counties it affects about 15% of the general population²; in some countries like Canada it is estimated that 20-45% people suffer from this problem³. There are studies from different parts of India that upto 49% of the Indian population report dyspeptic symptoms⁴. In daily practice general practitioners encounter these cases frequently.⁵

Factors influencing the condition

In studies from Asia, functional dyspepsia seem to be more common in younger age group.⁶ While a study from urban Mumbai, India found that dyspepsia was more prevalent in adults > 40 years⁷, studies from Britain, Taiwan and Denmark show a decreasing trend of functional dyspepsia with age^8,9,10. In the latter survey, there was a significantly lower prevalence of uninvestigated dyspepsia in adults > 70 years (10%) compared to those < 60 years (18.4%).¹⁰ Majority of population-based studies do not show any gender difference in dyspepsia prevalence but few studies from different populations, have noted a consistent female preponderance with dyspepsia.⁶ Two studies from Malaysia on about 2000 patients on applying Rome II diagnostic criteria showed a prevalence of dyspepsia in different ethnicity of Malaysian, Chinese and Indian populations is 231 (14.6%), 30 (19.7%) and 28 (11.2%) respectively.^11,12 While some studies have shown link between some prior infections like salmonella gastroenteritis and origin of the condition¹³, others have shown a relationship of non-vegetarian diet, spicy food, smoking, coffee, alcohol and non-steroidal anti-inflammatory drugs (NSAIDs) with different forms of dyspepsia.^6,7

How is it diagnosed?¹

As per records the term functional dyspepsia has been in use since the last 5-6 decades.¹⁴ It is considered as a very common condition with a high prevalence throughout the world. Though the cases are high, there were no definite diagnostic criteria till recently. Physicians often confused this with simple heartburn, gastro-oesophageal reflux disease, drug induced gastritis, cholelithiasis, etc. Understanding the need for definite diagnostic criteria, in 1994 the Rome Diagnostic Criteria, now widely accepted criteria for functional gastrointestinal disorders, were developed. The criteria were subsequently modified in 2000 and 2006 as Rome II & Rome III respectively. Diagnostic criteria based on the most recent 2006 Rome III criteria is given below.

Diagnostic criteria of functional dyspepsia must include one or more of: (a) bothersome postprandial fullness, (b) early satiation, (c) epigastric pain and (d) epigastric burning; and there should not be any evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms. Criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis.

Functional dyspepsia has been further sub-divided in to: (i) postprandial distress syndrome and (ii) epigastric pain syndrome. In postprandial distress syndrome, the diagnostic criteria must include one or both of the (a) bothersome postprandial fullness, occurring after ordinary-sized meals, at least several times per week and (b) early satiation that prevents finishing a regular meal, at least several times per week.  In this subtype too, the criteria must be fulfilled for the last 3months, with symptom onset at least 6 onths prior to diagnosis. The supportive criteria include the presence of upper abdominal bloating or postprandial nausea or excessive belching, and coexistence of epigastric pain syndrome.

In epigastric pain syndrome, the diagnostic criteria must include all of the (a) pain or burning localized to the epigastrium of at least moderate severity, at least once per week, (b) the pain is intermittent, (c) not generalized or localized to other abdominal or chest regions, (d) not relieved by defecation or passage of flatus, and (e) not fulfilling criteria for gallbladder and sphincter of Oddi disorders. Here too the criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months prior to diagnosis. The supportive criteria include (a) the pain may be of a burning quality, but without a retrosternal component, (b) the pain is commonly induced or relieved by ingestion of a meal, but may occur while fasting, and (e) postprandial distress syndrome may coexist.

Clinical features¹⁵

As per the above diagnostic criteria if one or more of the mentioned symptoms at least for three months with onset at least six months previously without any structural disease is considered as functional dyspepsia. Now let us examine each symptom with its clinical presentation. Postprandial fullness is an unpleasant sensation perceived as the prolonged persistence of food in the stomach. Early satiation is a feeling that the stomach is overfilled soon after starting to eat, out of proportion to the size of the meal being eaten and such that the meal cannot be finished. Epigastric pain refers to a subjective unpleasant sensation and epigastric burning is referred to as an unpleasant subjective sensation of heat.

The subdivision of functional dyspepsia into two groups is on the distinction of meal related and meal unrelated symptoms. Post prandial distress syndrome is meal related dyspeptic symptoms characterized by post prandial fullness and early satiety. Epigastric pain syndrome is meal unrelated dyspeptic symptoms characterized by epigastric pain and burning.

Miasmatic approach of functional dyspepsia^16,17

The symptoms of functional dyspepsia are functional and as such mainly psora. Pathological abnormalities and hyper activity/growth indicative of syphilitic and sycotic miasms often mingled with functional disturbances. These cases should be separately dealt as syphilitic or psychotic miasms, when the clinical presentation is more towards them. Dyspeptic and other gastric symptoms like fullness and distension of abdomen, rumbling and gurgling sound after eating; constrictive feeling around the abdomen; nausea and vomiting aggravated by any motion; pain aggravated in the morning and ameliorated by heat application; alternate constipation and diarrhoea should remind to psoric medicines.

General manifestations of psoric miasm

Basic qualities of psoric miasm include hypersensitiveness and hyperactiveness, emotional state, anxiety and restlessness. In psoric people symptoms can normally be triggered by suppression of emotions, grief and excitement. Fatigue, malaise and uneasiness may lead to vertigo, which can be aggravated by any motion. General modalities of psora are worse in the morning, new moon, before menses and odours and better by rest. Sour, sweet and bitter tastes in the mouth are especially in the morning. Yellow coating on tongue is one of the key symptoms in hepatic cases of psora. Craving for sour acids, sweets and pickles. One has to keep these in mind while taking the case. Other general symptoms like generalised itching and skin rashes, burning following itching and scratching, which aggravates at evening and midnight; dry, rough, dirty and unhealthy skin; amenorrhoea or bland/scanty/too-short menses, joint pains worse by motion and better by warmth and joint pain with constant feeling of coldness in the extremities are also indicative of psora.

General manifestations of syphilitic miasm

In syphilis, the changes would be from functional to structural disorders. Mentally they are dull, introvertic, slow in understanding, with suicidal thoughts, anxious and depression. The intensity of pain would be very high and intolerable. Complaints aggravate during and after rest, extremes of heat and cold, and at night; better by constant motion and cold application. There is always metallic or coppery taste in the mouth. Such inclination in functional dyspepsia indicates syphilitic miasm.

General manifestations of sycotic miasm

Slow recovery is the cardinal point. Sycotic people are suspicious and jealous. They quarrelsome, deceitful, cruel, cunning and have fixed ideas. They think suicide, but not daring to commit. General aggravating factors are damp weather, change of weather, daytime and meat. Feeling of weakness after sweating and other natural eliminations like stool and urine. Complaints generally relieved by slow motion, lying on abdomen, dry weather and return of suppressed normal discharges are normally found in sycotic miasm.

Commonly prescribed polychrests for functional dyspepsia and their grade of miasmatic affinity*

Ars alb – pso+++, syp+, syc+++; Bell – pso+;  Bry – syp++; Digit – pso++, syc+; Ferr m – pso++, syc++; Iod – pso+++, syp++, syc++; Kali c – pso++, syp++, syc++, Lach – pso+++, syp+++, syc++; Lyc – pso+++, syp++, syc+++; Merc s – pso++, syp+++, syc++, Nat m – pso+++, syc++; Nux v – pso++, syc+; Phos – pso++, syp++, syc++, Plum m – pso+, syp+; Puls – pso++, syc++; Rhus t – pso++, syc+, Sep – pso+++, syp+, syc+++; Sil – pso++, syp+, syc+++; Sulph – pso+++, syp++, syc++

*Note: +++ - More affinity, ++ - Moderate affinity, + - Less affinity

Specific drugs for functional dyspepsia and their indications^{18,19,20,21,22}

Acidum sulphuricum	It covers epigastric pain and sour eructations and useful in cases of pains either violent and contractive, or are of a dull, heavy, aching character with pyrosis and flatulence. Loss of appetite and great debility are also covered.
Argentum nitricum	It covers retarded gastric pain and diarrhoea resulting from eating sweets in persons fond of sugar.  Associated stool symptoms like watery, noisy, flatulent, green with mucus or turning green after remaining on diaper in children are also covered.  Nausea and vomiting of glairy mucous are indicated by this drug. Acidity is associated in many cases.
Arsenicum album	It is useful in functional dyspepsia aggravated from vegetable diet like melons, watery fruits, acid fruits, ice cream and ice water, etc. Nausea, vomiting, faintness, icy coldness and great exhaustion are also indicated.  It covers diarrhoea after eating or drinking.  It is indicated for weakness in such cases. It is also a remedy for periodic burning pain in the stomach at night or midnight with nausea and vomiting.  Adynamia (lack of vital power), anxiety, thirst and restlessness are characteristic of the drug. Other indications include weakness, loss of weight, paleness, nausea, vomiting soon after any intake, heartburn and regurgitation of acid matter.  Dyspepsia from vinegar or acids, ice creams, tobacco.  Associated symptoms are great thirst, drinks much, gastritis, gastroenteritis, gastric ulcers etc., but in small quantities at a time.
Belladonna	Distended abdomen, spasmodic or colic pain worsened by pressure, improved by bending backwards, greenish stool and shuddering during stool.
Bismuthum subnitricum	It covers pressure and burning in the region of stomach. Also indicated for digestive dysfunctions like lost and diminished appetite, much thirst, eructation after drinking water, slow digestion, with frequent bitter eructations and feeling of discomfort in the stomach, vomitting with convulsive pain.  Water is vomited as soon as it reaches the stomach.
Capsicum annum	It covers symptoms like burning in the stomach after eating, great flatulence from vegetables, flatulent colic, atonic dyspepsia and painless rumbling in the abdomen. Also used in hyperacidity with reduced appetite, vomiting, much thirst, dyspepsia, and heartburn.  Pressure, pain in the pit of stomach with nausea are also covered by this medicine.
Carbo vegetabilis	Used in symptom of functional dyspepsia, lowered vital power from loss of fluids, state of collapse in cholera, frequent involuntary stools followed by burning, irritation after eating and drinking.  Simple food distresses, belching, flatulence and abdominal discomfort are effectively taken care by this.
Chamomilla	More suitable for children who are irritable, frightful, impatient, hyper-sensitive, wants this or that and becomes angry when refused or when offered. Distension and flatulent colic which is improved by warmth.  Suits well in neuropathic or psychopathic children. Stool hot, green, watery, corroding and very offensive like rotten egg.  One cheek red and hot, the other pale and cold.
Chelidonium majus	It is a liver remedy, covering many of the dyspeptic symptoms. It is indicated in jaundice, enlarged liver, gall colic, distension and sluggish bowels due to hepatic disease or bilious complications. Cinchona officinalis: It covers flatulent colic, tympanitic abdomen, vomiting, slow digestion, stool frothy, yellow and painless.
Colocynthis	Suitable for irritable persons who easily angered; epigastric pain causing patient bend double, sometimes with nausea and vomiting, sometimes with diarrhoea, sometimes with passing great quantities of gas; pains often extend into chest and pelvis; sensation as if stones were being ground together in the abdomen
Cuprum aceticum	It covers violent spasmodic pains in stomach and abdomen, vomiting, diarrhoea, slimy brown stool and violent tenesmus.
Dioscorea villosa	It is especially for colic, flatulence and problems of tea drinkers, improves digestion, used in painful affections of abdominal and pelvic viscera.
Foeniculum vulgare	A commonly used Indian household cookery, it allays griping pain and is carminative.  It helps digestion, lowers flatulence and colic.
Hydrastis	It has a marked action on the liver, helps digestion smooth.
Ipecacuanha	It acts on persistent nausea and vomiting, cutting pain around the naval, tenesmus and liver sore. This drug is well suited for children and sensitive adults.  The action of the drug on nerves, responsible for persistent nausea and vomiting.
Iris versicolor	It is indicated for violent burning like fire of whole alimentary canal, nausea and vomiting of watery and very acidic substance; heartburn and profuse flow of saliva, acidity makes the teeth blunt.  In some cases appetite is deficient. Stress and headache are aggravated in such cases.
Lycopodium clavatum	Meteoritic tenseness, lack of digestive power, often with functional disturbance of liver. Child weeps all day.  Excessive accumulation of flatulence; abdomen is bloated, full with rolling of flatulence.  Appetite good, eats more than the average, but does not put on weight.
Mentha piperita	Flatulent colic, bilious colic, deranged digestion, accumulation of gas, respiratory catarrh, dry and spasmodic cough.
Momordica balsamina	Distension and rubbing in splenic flexure of colon.  Griping, colicky pains, starting from the back, spreading over whole abdomen are covered by this drug.
Natrum phosphoricum	It acts in the conditions of sour eructations after eating, sour vomiting, dyspepsia from fatty food, heaviness and pressure in epigastrium, flatulence, rumbling, symptoms worse after eating.
Nux Vomica	It is said to be the drug for many conditions incident to modern life.  It has a calming effect on digestive, portal and hypochondrial spheres.  Headache, vertigo, nausea, vomiting abdominal colics and symptoms due to over exertion, are covered by this medicine.
Okoubaka	It is a recently introduced remedy for indigestion as a consequence of food intolerance with gastro enteritis and food poisoning symptoms. It helps in the elimination of toxin. Dyspeptic and related symptoms like fullness of stomach with rumbling often accompanied by colic and/or diarrhoea, anorexia, flatulent dyspepsia, eructation, nausea, sometimes vomiting and vertigo occurs after changing diet are covered.
Petroleum	Considered to be useful in dyspeptic symptoms resulting from irritations involving the central nervous system and brain stem.  The drug is indicated for ailments aggravated from riding in cars, carriages, ship or air, fright and vexation.  Noise is unbearable; heartburn and nausea are other accompanying symptoms.
Phosphorus	It is an established medicine for eructations, vomiting of food or blood that is temporarily ameliorated by ice-cold drinks, but returns as the stomach becomes warm. Dyspepsia with excessive flatulence and white tongue.
Podophyllum	It is indicated for distended abdomen, feeling of heat and emptiness, sensation of weakness or sinking, painful liver region, jaundice, portal engorgement, gastro-enteritis-like symptoms.
Robinia pseudocacia	Helpful in conditions like constant eructations of a very sour fluid, heartburn and acidity especially at night, on lying down, distention of stomach and bowels, regurgitation of acid and bile, with a feeling that everything turns to acid. Gastric headache with acid vomiting, epigastric pain and retching are also covered by this medicine.
Tabacum	Indicated for epigastric pain, nausea, giddiness, pallor, vomiting, seasickness, prostration of entire muscular system, vertigo, sick headache and vomiting on least motion.  Pathogenesis covers migraine, neuralgias and gastrocardiac symptoms.
Tilia europaea	It covers bloated abdomen, pain around navel, flatulence, muscular pain and urticaria.

References

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Source: Dr. R. Valavan, Functional dyspepsia – its modern understanding and homoeopathic approach, Homoeopathy For All, Vol. 14 No. 03 (159) March 15 2013