First of all, we should consider whether children eat too much at a time, and the food they eat contains too many things from protein, such as meat, eggs, or seafood. Eating too much food from protein will make it difficult for children to digest.
In addition, the arrangement of children's diet should be rationalized, that is, there should be vegetables, fruits and foods containing crude fiber every day; In addition, meat and protein should be properly matched to ensure the regularity of children's three meals a day and reduce the intake of snacks.
Regular defecation every day, appropriately increasing children's exercise, is conducive to the digestion and absorption of food and defecation. Such as gastrointestinal motility disorder, visceral hypersensitivity, abnormal gastric acid secretion, Hp infection and psychological factors. The pathogenesis of functional dyspepsia is still unclear. Changes in mucosal immune and inflammatory functions, as well as changes in the regulatory functions of central nervous system (CNS), brain-gut axis and intestinal nerve (ENS).
clinical picture
The common symptoms of FD include epigastric pain, abdominal distension, flatulence, early satiety, belching, nausea, vomiting, and burning sensation in the upper abdomen. These symptoms persist or recur, but lack characteristics, and rarely all of them appear at the same time, only one or more of them appear. These symptoms affect children's eating, leading to long-term insufficient nutrition intake, high incidence of malnutrition in children, and possible growth retardation. Many children have mental and psychological symptoms such as neurosis and anxiety.
cheque
FD is a functional lesion, and there is usually no positive finding in various laboratory tests, radiology and endoscopy. In recent years, with the development and application of electrogastrogram and gastric motility test, many new advances have been made in its auxiliary diagnosis methods.
1. body surface electrogastrogram examination
This is an effective non-invasive method to evaluate the myoelectric activity of children with gastric upset. The complex wave of gastric antrum movement can be measured by body surface electrogastrogram, Fourier transform and spectrum analysis. Studies have shown that the activity of gastric antrum moving motor complex in some FD children is obviously reduced. Bradycardia is more common in children with FD, and hyperactivity of gastric antrum is more common in children with anorexia, which shows that electrogastrogram examination can prompt dyskinesia (hyperactivity or deceleration) of gastric smooth muscle, which is of auxiliary diagnostic significance for children with FD.
2. Gastric motility test
Gastric motility disorder is one of the pathogenesis of FD, and most children have abnormal gastric motility. Gastric motility test can understand gastric emptying by ultrasound, observe the frequency and amplitude of gastric antrum contraction, provide objective basis for clinical diagnosis of FD, and evaluate the curative effect during follow-up. This detection method has the advantages of painless, non-invasive, economical, simple, avoiding radiation exposure and so on, which is easy for children and parents to accept. But the exam needs the cooperation of children.
3. Others
Water load test is helpful to diagnose FD with high specificity but low sensitivity, so it has not been widely used in clinic. Many FD children are accompanied by psychological factors such as anxiety, tension and depression. Through simple psychological tests, we can understand the mental health of children and further understand their illness, thus assisting diagnosis and treatment. [ 1]
diagnose
Diagnostic criteria of FD in children: dyspeptic symptoms for at least 2 months, at least 1 time per week, meeting the following three conditions:
(1) Persistent or recurrent epigastric pain or discomfort, early satiety, belching, nausea, vomiting and acid reflux.
(2) Symptoms cannot be relieved after defecation, or the onset of symptoms has nothing to do with the change of defecation times or fecal characteristics (except irritable bowel syndrome).
(3) There is no evidence of inflammation, anatomy, metabolism or tumor diseases to explain children's symptoms.
differential diagnosis
Attention should be paid to the differentiation from gastroesophageal reflux and irritable bowel syndrome.
treat cordially
1. General therapy
Help parents of children understand and understand their illness, guide them to improve their lifestyle, adjust their diet structure and habits, remove pathogenic factors that may be related to symptoms, and improve their ability to relieve symptoms. Non-drug therapy includes cognitive therapy, adjusting diet and changing defecation habits. Mental factors such as insomnia, anxiety and depression are important causes of FD in children, and children have poor tolerance for recurrent abdominal pain, bloating and other upper abdominal symptoms, which in turn may promote and aggravate children's mental symptoms. In recent years, cognitive behavioral therapy has been paid more and more attention in the treatment of FD children.
2. Drug therapy
According to the clinical manifestations of children and their relationship with diet, prokinetic drugs, antacids and antacids can be selected, and the general course of treatment is 2 ~ 4 weeks. For specific drug selection principles, please refer to "Procedures for Diagnosis and Treatment of FD in Children". If the treatment is ineffective, the course of treatment can be appropriately extended, and further examination and diagnosis can be made before treatment. People infected with Hp need treatment to eradicate Hp.
(1) Drugs for promoting gastric motility At present, commonly used drugs for promoting gastric emptying are: ① Dopamine receptor antagonist: metoclopramide, which has a strong central antiemetic effect and can enhance gastric motility. However, because it can cause extrapyramidal reaction, it is not suitable for infants and long-term high-dose use. Domperidone is a selective D2 receptor antagonist of peripheral dopamine, which does not penetrate the blood-brain barrier and has no extrapyramidal side effects. It can increase the movement of gastric antrum and duodenum, promote gastric emptying, and obviously improve the symptoms of postprandial fullness and early satiety in FD children. However, long-term use can lead to the increase of prolactin, and some patients have breast pain or lactation. ② Mosapride citrate, a 5-hydroxytryptamine 4(5-HT4) receptor agonist, can obviously improve the early saturated abdominal distension in FD patients.
(2) antacids and antacids have been widely used to treat dyspepsia. At present, commonly used antacids in clinic include aluminum magnesium carbonate, compound aluminum hydroxide and calcium carbonate oral suspension, which can relieve symptoms. Antacids include H2 receptor antagonists (H2RA), such as cimetidine, ranitidine and famotidine. And proton pump inhibitors (PPI), such as omeprazole. These drugs have obvious effects on relieving abdominal pain, acid reflux, heartburn and other symptoms.
(3) Eradication of Hp infection Although the relationship between the onset and symptoms of Hp and FD is uncertain, it is still recommended to eradicate Hp for FD children infected with Hp. Studies have shown that for FD patients with Hp positive, the symptoms of some patients can be improved for a long time after Hp eradication with omeprazole and antibiotics. More effective than omeprazole alone.
3. Application of intestinal probiotics
Intestinal probiotics such as lactic acid bacteria not only inhibit the growth of intestinal pathogenic bacteria and enhance immune function, but also participate in the digestion and decomposition of endogenous substances, and promote digestive function by enhancing or reducing the activity of digestive enzymes or producing various digestive enzymes.
4. Chinese medicine treatment
It is an important treatment for functional gastrointestinal diseases. The mechanism of action of traditional Chinese medicine is not completely clear. However, there is evidence that they can stimulate the secretion of stomach and digestive glands through the taste system, vagus nerve and intestinal nervous system, and strengthen the feedback stimulation of digestive tract to the central nervous system through the intestinal nervous system, thus enhancing the intestinal function. Large doses of traditional Chinese medicine can even directly act on gastrointestinal mucosa. Chinese herbal medicine often contains aromatic oil, which has spasmolytic, cathartic and local analgesic effects. In recent years, many Chinese herbal medicine preparations (such as coriander oil, peppermint oil, ginger and turmeric extract, etc.) have been compared and studied. It shows that Chinese herbal medicine is better than placebo in the treatment of functional gastrointestinal diseases, but the effect is the same as gastrointestinal motility drugs.
5. Mental and psychological adjustment
More and more attention has been paid to the psychological factors of FD. Doctors should have enough compassion and patience. Given certain behavioral therapy, cognitive therapy or psychological intervention, some placebos can be used in combination, and most symptoms will improve over time. For patients with obvious mental and psychological disorders who are ineffective in acid suppression and prokinetic therapy, a psychologist can be asked to assist in diagnosis and treatment, and appropriate anti-anxiety and antidepressant drugs can be given to improve symptoms. [2-3]
prognosis
Most of them have a good prognosis after correct diagnosis. However, other organic diseases should be excluded in the process of disease diagnosis.
nurse
1. Adjust the diet structure and eat less meat, cold drinks, carbonated drinks and snacks. Attention should be paid to avoid eating foods that induce symptoms, such as coffee, wine and high-fat foods.
2. Develop good eating habits, don't be too full, eat on time, and eat more fruits and vegetables is a good way to regulate digestive function. Educating children to develop good defecation habits and normalize defecation may help to improve dyspeptic symptoms.
3. Ensure the time for outdoor activities.
4. Appropriate psychotherapy plays an important role in disease recovery and can improve symptoms. [ 1-3]