Scope of repertories in the management of functional dyspepsia

Dr Ananya Balakrishna

ABSTRACT:
In today’s modern world, with the increase in the work load, stress, lack of sleep, altered lifestyle habits, there is a rampant increase in the cases of functional dyspepsia even in young adults. Functional dyspepsia is a chronic upper gastro intestinal disorder which comprises of a constellation of symptoms like postprandial fullness, early satiety, epigastric pain, epigastric burning or any other digestive symptoms like heartburn, nausea, regurgitation affecting young adults to old age. This article is an attempt to correlate the rubrics from various repertories with the symptoms of functional dyspepsia which can be applied in clinical practice.

KEYWORDS: Functional dyspepsia, lifestyle habits, upper gastro intestinal disorder

INTRODUCTION:
ICD-10 code K30 for Functional dyspepsia is a medical classification as listed by WHO under the range – Diseases of the digestive system. Functional Dyspepsia is a chronic gastrointestinal disorder which includes a constellation of complaints such as postprandial fullness, early satiety, epigastric pain, epigastric burning or any other digestive symptoms like heartburn, nausea, regurgitation affecting young adults to old age.¹

The disorder is defined by Rome IV criteria and subclassified into postprandial distress syndrome and epigastric pain syndrome. Of patients with functional dyspepsia, approximately 38% are classified with postprandial distress syndrome, 27% are classified with epigastric pain syndrome, and 35% meet criteria for both. Dyspepsia patients often report a range of upper gastrointestinal symptoms.

EPIDEMIOLOGY/PREVALENCE
Functional dyspepsia is a global health problem with prevalence rates of 23-25.8% seen in the US and 30.4% in India. Global Burden of Functional Gastro Intestinal Disorders (FGIDs) states that more than 40% of persons worldwide have FGIDs. Among them Functional dyspepsia was the most prevalent gastroduodenal disorder.²

ETIOLOGY

Etiological factors for functional dyspepsia have been shown to include

• Environmental or lifestyle habits such as poor socio-economic status,
• Intake of spicy, oily or highly seasoned food
• Smoking, alcohol intake
• Increased caffeine intake
• Drugs like:
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Glucocorticoids
• Iron and potassium supplements
• Digoxin
• Stress
• Lack of sleep
• Psychological factors (anxiety, depression)

It is clear that dyspepsia and functional dyspepsia in particular are common conditions globally, affecting most populations, regardless of location.

SYMPTOMS

• An unpleasant sensation like prolonged persistence of food in the stomach.
• Inability to eat full meal or feeling full after only a small amount of food.
• Epigastric pain
• Epigastric burning
• Eructation
• Abdominal discomfort
• Nausea
• Occasional vomiting

ALARM FEATURES IN DYSPEPSIA

• Weight loss
• Anaemia
• Vomiting (continuous or projectile)
• Haematemesis and or melaena
• Dysphagia
• Palpable abdominal mass³

DIAGNOSTIC CRITERIA:

Rome IV diagnostic criteria for adults:

FUNCTIONAL DYSPEPSIA

Must fulfil the criteria for B1a. Postprandial distress syndrome (PDS) or B1b. Epigastric pain syndrome (EPS) below:

B1a. Postprandial Distress Syndrome

Must fulfil at least one of the following at least 3 days a week for the past 3 months:

1.Bothersome postprandial fullness (i.e., severe enough to impact on usual activities)

2.Bothersome early satiation (i.e., severe enough to prevent finishing a regular size meal)

No evidence of structural disease that can account for the symptoms. Symptom onset at least 6 months prior to diagnosis. It can be associated with any other digestive symptoms.

B1b. Epigastric Pain Syndrome

Must fulfil the following criteria at least 1 day a week for the past 3 months:

1.Bothersome epigastric pain (i.e., severe enough to impact on usual activities) OR

2.Bothersome epigastric burning (i.e., severe enough to impact on usual activities)

No evidence of structural disease that can account for the symptoms. Symptom onset at least 6 months prior to the diagnosis. It can be associated with any other digestive symptoms

REPERTORIAL APPROACH

1. Some of the rubrics related to Functional dyspepsia from Boenninghausen’s Therapeutic Pocket Book (BTPB)⁴

SECTION	CHAPTER	RUBRIC	SUB RUBRIC	PAGE NUMBER
Parts of the body and organs	Eructations	Belching		75
Parts of the body and organs	Eructations	Eructations in general		76
Parts of the body and organs	Eructations	Heartburn		76
Parts of the body and organs	Nausea and vomiting	Nausea in general		77
Parts of the body and organs	Nausea and vomiting	Nausea in throat	-stomach	78
Parts of the body and organs	Nausea and vomiting	Nausea in throat	-Abdomen	78
Parts of the body and organs	Nausea and vomiting	Nausea in throat	-chest	78
Parts of the body and organs	Nausea and vomiting	Qualmishness		78
Parts of the body and organs	Nausea and vomiting	Retching		79
Sensations and complaints	Sensations	Pressing (simple pain)	-internally	186

Some of the rubrics related to functional dyspepsia from Kent’s “Repertory of the Homoeopathic Materia Medica” are as follows⁵:

CHAPTER	RUBRIC	SUB RUBRIC	PAGE NUMBER
Stomach	Satiety (see appetite) Appetite	Easy satiety	476
Stomach	Distention		487
Stomach	Distention	Eating after	487
Stomach	Eructations		489
Stomach	Eructations	Ameliorate	490
Stomach	Eructations	Eating -after	491
Stomach	Fullness sensation of		498
Stomach	Fullness sensation of	Eating after	498
Stomach	Heartburn		499
Stomach	Heartburn	Eating after	500
Stomach	Heaviness, weight oppression (see fullness)		501
Stomach	Heaviness, weight oppression (see fullness)	Eating after	501
Stomach	Nausea		504
Stomach	Nausea	Eating after	507
Stomach	Nausea	Eating after – amel	507
Stomach	Pain		511
Stomach	Pain	Eating while -after	513
Stomach	Pain	Burning	515
Stomach	Pain, burning	Eating after	516
Stomach	Pain, pressing	Eating after	521
Stomach	Retching		525
Stomach	Retching	Eating after	526

Some of the rubrics related to functional dyspepsia from “Boger Boenninghausen’s characteristics and repertory” are as follows⁶:

CHAPTER	RUBRIC	SUBRUBRIC	PAGE NUMBER
EPIGASTRIUM	Burning		522
EPIGASTRIUM	Pressure		524
EPIGASTRIUM	Swelled, distended	sensation	525
EPIGASTRIUM -Aggravation	Eating	before	527
EPIGASTRIUM -Aggravation	Eating	while	527
EPIGASTRIUM -Aggravation	Eating	after	527
STOMACH	Burning	Cardiac orifice, in	515
STOMACH	Distended		517
STOMACH	Fulness		518
STOMACH	Pain, simple painfulness		519
NAUSEA AND VOMITING	Nausea	Epigastrium in the	500
NAUSEA AND VOMITING	Nausea	Stomach in the	501
NAUSEA AND VOMITING	Retching and gagging		501
NAUSEA AND VOMITING	Squeamishness (qualmishness,weak stomach etc)		502
NAUSEA AND VOMITING -Aggravation	Eating	Before While After -immediately -a long time after
WATERBRASH & HEARTBURN	Burning extending upwards in throat (compare rising) Risings in throat (gulping up)	Feeling of sensation of Sour Sweet warm	495   496
WATERBRASH & HEARTBURN -Aggravation	Eating after	while	497
ERUCTATION	Eructations in general		490
ERUCTATION	Amelioration from		491
ERUCTATION	Burning		491
ERUCTATION	Empty(tasteless)		491

Some of the rubrics related to Functional dyspepsia from “Murphy’s Homoeopathic Medical Repertory” are as follows⁷:

CHAPTER	RUBRIC	SUB RUBRIC	PAGE NUMBER
STOMACH	Appetite (see food chapter, appetite)		1723
FOOD	Appetite, general	Easy satiety	725
STOMACH	Belching,general (see heartburn)		1723
STOMACH	Belching, general	Aggravated from	1724
STOMACH	Belching, general	Ameliorated from	1724
STOMACH	Belching, general	Burning (see heartburn)	1725
STOMACH	Belching, general	Eating after	1725
STOMACH	Burning, pain (see heartburn)		1731
STOMACH	Burning, pain	Burning, esophagus	1732
STOMACH	Distention		1737
STOMACH	Distention	Eating, while -after -amel	1737
STOMACH	Fullness, sensation		1740
STOMACH	Fullness, sensation	Eating, after	1740
STOMACH	Heartburn, general (see belching)		1742
STOMACH	Heartburn, general	Eating, after	1742
STOMACH	Nausea, general		1748
STOMACH	Nausea, general	Eating, while After agg After amel Before agg	1750
STOMACH	Pressing, pain		1761
STOMACH	Pressing, pain	Eating while After -after a little – amel	1762
STOMACH	Retching, general		1764
STOMACH	Retching, general	Eating after	1765

Some of the rubrics related to functional dyspepsia from “Synthesis 1.3 Android application” created by Archibel SA based on synthesis repertory version 2009,

Editor: Dr.Frederick Schroyens.⁸

• STOMACH – Appetite – easy satiety
• STOMACH – Belching (Cross reference – Eructations)
• STOMACH – Eructations
• STOMACH – Eructations – eating – after
• STOMACH- Eructations – eating – while
• STOMACH – Eructations – eating – before
• STOMACH – Distention
• STOMACH – Distention- Epigastrium
• STOMACH – Distention – pit of the stomach
• STOMACH – Distention – eating- after
• STOMACH -Distention – eating – impossible
• STOMACH – Distention – eating – while
• STOMACH – Distention – eructations – amel
• STOMACH – Distention – eructations – not amel
• STOMACH – Distention- sensation of
• STOMACH -Pain – epigastrium
• STOMACH – Pain – Cardiac opening
• STOMACH – Pain -Cardiac opening – burning
• STOMACH – Pain- epigastrium – eating – after
• STOMACH – Pain – epigastrium – eating – amel
• STOMACH – Pain – epigastrium – pressing pain
• STOMACH – Pain- Burning
• STOMACH – Heartburn
• STOMACH – Heartburn – eating – after
• STOMACH – Heartburn – eating – before
• STOMACH – Heartburn – eating – while
• STOMACH – Fullness – sensation of
• STOMACH – Fullness, sensation of – epigastrium
• STOMACH – Fullness, sensation of – eating -after
• STOMACH – Fullness, sensation of – eating before
• STOMACH – Fullness, sensation of – eating while
• STOMACH – Heaviness
• STOMACH – Heaviness – epigastrium
• STOMACH – Heaviness – eating – after
• STOMACH – Heaviness – eating – amel
• STOMACH – Heaviness – eating – while
• STOMACH – Nausea
• STOMACH – Nausea -Epigastrium in
• STOMACH -Nausea – eating – after
• STOMACH -Nausea – eating -amel
• STOMACH -Nausea – eating – before

Some of the rubrics related to Functional dyspepsia taken from S.R Phatak’s “A concise repertory of homoeopathic medicines” are as follows⁹:

HEARTBURN

-Dinner after

-Sweets, agg

ERUCTATIONS,

ERUCTATIONS

-Aggravation

– Amelioration

-Empty

-Ingesta, tasting of

-Loud, noisy

-Relief, without

-Sour

DISTENTION, feeling of

NAUSEA

NAUSEA

-Eating -while

-Eating – amel

PAIN

-Aching

-Burning, (see burning)

BURNING (See heat)

-Internal

-Painful

Some of the rubrics related to Functional dyspepsia taken from “Pocket manual of Homoeopathic Materia Medica and Repertory” by William Boericke, are as follows¹⁰:

• STOMACH

-Indigestion – Dyspepsia- Remedies in general

• CAUSE – Abuse of drugs

– Acids

– Aged

-Fat food

• HYPERACIDITY (hyperchlorhydria)
• SYMPTOMS AND CONDITIONS – Acidity
• Digestion, weak, slow (bradypepsia)
• Eructations, belching
• Eructations, odorless, tasteless, empty
• Eructations relieve temporarily
• Erctations, sour, burning acid, bitter
• Eructations, tasting of ingesta
• Eructations, rancid, putrid food
• Flatulent distention of stomach drumlike
• Heartburn, pyrosis
• Nausea, vomiting
• Pain
• Pain, immediately after eating
• Pressure as from a stone
• Pulsation in epigastrium
• Regurgitation of food
• NAUSEA- (qualmishness)

CONCLUSION:
Thus, various repertories like Boenninghausen’s Therapeutic Pocket Book (BTPB), Boger Boenninghausen’s characteristics and repertory, Murphy’s repertory, Kent’s repertory, Boericke’s repertory, Phatak’s repertory contains numerous rubrics related to functional dyspepsia. The above-mentioned rubrics emphasizes the role and scope of repertories in managing functional dyspepsia.

REFERENCES:

1. Kumar A, Pate J, Sawant P. Epidemiology of functional dyspepsia. J Assoc Physicians India. 2012 Mar 1;60(6):9-12. Available from https://www.researchgate.net/profile/Prabha-Sawant/publication/233533351 [Accessed on 25 June 2023]
2. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology. 2021 Jan 1;160(1):99-114.Available from: https://www.sciencedirect.com/science/article/pii/S001650852030487X [Accessed on 25 June 2023]

3. Ralston SH, Penman ID, Strachan MWJ, Hobson RP, editors. Gastroentrology. In: Davidson’s Principles and Practice of Medicine.23/e. Elsevier Health Sciences.
4. Roberts, H.A., Wilson, A.C. and von, B.C.M.F. (1999) The principles and practicability of Boenninghausen’s therapeutic pocket book for Homoeopathic physicians: To use at the beside and in the study of the Materia Medica. B. Jain Publishers (P) LTD, New Delhi.
5. Kent JT. Repertory of the Homoeopathic Materia Medica. Enriched Indian ed. New Delhi. B Jain Publishers; 2017
6. Boger CM. Boger Boenninghausen’s Characteristics Repertory with corrected Abbreviations and word index. USA. B. Jain publication; 2015.
7. Murphy R. Homeopathic medical repertory.3/e. B. Jain Publishers; New Delhi:
8. Archibel SA. Synthesis 1.3 Android app based on Synthesis Repertory Dr Frederick Schroyens; 2009.
9. Phatak S. Materia Medica of Homoeopathic Medicines: Revised Edition: 2/e. B. Jain Publishers, New Delhi, 2018.
10. Boericke William, Pocket manual of Homoeopathic Materia Medica and repertory, 9/e, B. Jain Publishers, New Delhi, 2012,

Dr. Ananya Balakrishna
PG Scholar, MD(HOM) Part 1
Department of Case Taking and Repertory
Government homoeopathic medical college and hospital, Bengaluru.

UNDER THE GUIDANCE OF: Dr. Praveen Kumar MD(Hom)
Associate Professor and PG guide
Department of Case Taking and Repertory
Government homoeopathic medical college and hospital, Bengaluru.