Functional Dyspepsia - Case Study Gastroenterology

Functional Dyspepsia - Case Study
by Dr Maryam Iqbal
Sahiwal Teaching Hospital

1. Functional dyspepsia  Dr. Maryam Iqbal PG II - Internal medicine  Sahiwal teaching hospital

2. disclosure Sami Pharmaceuticals is conducting an exciting and intellectually stimulating presentation competition exclusively for doctors on the topic of functional dyspepsia.  This competition aims to foster knowledge exchange, encourage innovative thinking, and advance the understanding and treatment of functional dyspepsia within the medical community.

3. patient history Patient Name: Azira Bano Age: 25 Occupation: Student  Chief Complaint:  Abdominal bloating for 1 year with others symptoms including epigastric pain, eructations , flatulence and straining with stool.  The patient’s bloating worsened postprandially and improved with defecation.  Patient reported 2 bowel movements per day, each of which took up to 45 minutes to complete and were characterized by excessive straining with occasional bright red blood  An additional leading diagnostic consideration for this patient was constipation-predominant irritable bowel syndrome (IBS-C). Per the Rome IV criteria.

4.   Examination The epigastric pain was intermittent, rated as a 5/10 in intensity, and was unaffected by defecation.  Vital signs were within normal limits and her body mass index was 19.5.  Physical examination was positive for epigastric pain, hyperactive bowel sounds in the epigastric area, and a geographic tongue.  Patients oropharynx was otherwise clear and moist, with no evidence of halitosis.  No guarding or rebound tenderness in the abdomen and Murphy sign was negative.  Capillary refill was > 2 seconds and palpebral conjunctival pallor was absent. Physical exam was otherwise unremarkable. The patient fulfilled some of the IBS-C criteria, but the pain etiology, relationship to stool frequency/appearance, and Bristol stool scale types were uncertain. Patient had used digestive enzymes in the past with no effect on her symptoms.

5.       causes Onset of symptoms occurred after Azira's transition to graduate school, resulting in a more workload, time-pressured eating habits, and a dearth of whole food consumption. Dietary habits lacked diversity and consisted of refined carbohydrates, lactose-free yogurt, protein shakes, chicken, and eggs, with few vegetables or whole grains Azira's diet relied on prepared, packaged, convenience foods to accommodate her lifestyle.  Azira reported a moderately high amount of stress and difficulty adapting to her new lifestyle, having moved from another city and being burdened by workload   All symptoms were aggravated by the consumption of refined carbohydrates, dairy, gluten, and protein shakes.

6. management Dietary Modifications (Less processed/packaged food) Stress Management Excercise   Simethicone for Bloating Lifestyle Modification Antacids as needed

7. Treatment therapy  Lifestyle modifications were suggested first and included a trial elimination of gluten and dairy for 4 to 6 weeks Encouraged to consume fermented foods to deliver live bacterial cultures such as  Bifidobacterium  and  Lactobacillus — for healthy gut flora and regulate intestinal physiology Instructed to consume apple cider vinegar (ACV) before meals and fresh ginger root after meals. Amino acid L-glutamine supplement were recommended to support normal GI physiology.   Ultradilute tinctureconsisting of UNDA #4 and  Nux vomica  in the 9th and 12th centesimal (C) potencies with prescribed dosage of 5 drops, 3 times per day, taken 10 to 20 minutes away from food.

8. Follow up The patient was called 7 days after her initial office visit. Azira reported full compliance with the treatment protocol,  Reported difficulty in implementing the mindful eating practices Overall, the intensity and frequency of her presenting symptoms had significantly decreased.  Significant improvements in postprandial bloating were noted as mild, postprandial eructations and reflux had decreased in frequency, and epigastric pain had diminished to 3/10 from 5/10 intensity.  She also reported that defecation time decreased about 15 percent, and sleep quality improved, which was reported as the subjective feeling of deeper sleep. S

9. Follow up One month after her initial office visit, the patient reported that all of her presenting symptoms had resolved. Patient denied the presence of bloating, eructations , flatulence, reflux, and epigastric pain.  Abdominal exam showed normal bowel sounds and the absence of epigastric pain. Given that the presenting symptoms resolved, the visit focus shifted toward improvement of bowel transit time and reduction of straining with stool.  Was advised continuation of the existing treatment protocol, with a focus on mindful eating, increased hydration, and dietary fiber.

10. Thank you