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 age8,9,10. 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
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.
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 dyspepsia16,17
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 indications18,19,20,21,22
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.
|
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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