Functional Dyspepsia

A 45 year old obese female presented to OPD with complaints of regurgitation, foreign body sensation throat and had been to several doctors for the same She has been taking PPI, syrups for a long long time I had advised her for UGI-E which was completely normal Can we label this as a case of functional dyspepsia?? What would be best to start her on? TCAs at bedtime or SSRI like Sertraline or so? Kindly suggest? Meanwhile, I have advised for all the lifestyle changes along with weight loss and relaxation techniques



Yes obesity is cause for her ailments She is leading passive lifestyle unless she accepts active lifestyle with regular exercise and fractional diet with weight loss she can not be relieved GERD is one such ailment in morbid obesity and now a days bariatic surgeons are finding this as indication for bariatric surgery to improve Yes SSRI can be added with rest Some alternative formulations can also be tried

Thanx dr Asra Atiya Siraj

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Dear Dr.Ajitsingji. I always like your post.. I advice Tab Esopprenozole Magnesium 40 mg + Domperedone.30 mg 1 tab OD on empty stomach. I tell you why I recommend than other PPIs.. It is hardly discussed that PPIs in long term cause HYPOMAGNESEMIA...!!! AND Esaprenezole it self is a magnesium salt.. But it has some limitation of drug interactions.. For example you just cannot give SUCRAFATE liquid with Esolrenazole ...Other PPI can be given with Sucrafate !!. Though I being 73+ ,am an old generation academician, but love new generation PGs like you with so decent curiosities.

Most important reason why acid peptic disease and reflux disease patient do not respond to proton pump inhibitors, is that they have decreased motility of stomach Addition of GI motility agent will alleviate their symptoms and it will make their miserable life much more happier Once such a patient becomes alright, it will fetch you lot of fame and many more patients will follow to with you Adv Capsule Esomeprazole 40 mg + Domperidone 30 ---- sustained release capsule once daily in morning before breakfast In Addition Tablet Itopride 50mg one tablet three times a day before food

Gastroesophageal reflux disease ama pachana should be ensured. after that use of sringa bhasma, sankha bhasma and pravala bhasma, kalyanakshara. also guduchi satwa,pushkara moola effective in GERD

She is most probably suffering with a condition called GLOBUS HYSTERICUS. U can suggest Tab Sertraline 25mg to start with, for 6 days followed by 50mg daily for at least 4-6 Months; Tablet Pantodac-DSR ODAC in the morning, Tablet Lorfast-AM Or Loridin AM to be taken at evening 7pm for 2 weeks, Tablet Clonazepam 0.25mg BD 0-----1-----1 for at least 6 weeks & then taper it to stop.

Levosulpiride� 25 mg is effective and well tolerated in patients with�functional dyspepsia�accompanied by delayed gastric emptying. Its efficacy may be related to its action on the gastric motor�function�by improving the delayed gastric emptying. Levosulpiride is the levo-enantiomer of sulpiride, a well-known antiemetic, antidyspeptic and antipsychotic drug.

As she is obese that might have lead to repeated regurgitations... can be associated with H.pylori over colonization in the intestine... go for the markers of H.pylori ...that might give an idea

Needs detailed history to rule out stressor, if any, Accordingly Management may be planned. Anxiolytics n relaxation exercises recommended

In my opinion she should be given gastrokinetics such as Itopride/cinitapride only (not with PPI orH2antagonists primarily.).Anti flatulents like simethicone can be considered if required.

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