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General practice Terapia 2018, 7 ( 366 ) :  12  -  15

Disturbances of gastrointestinal motility in the GP’s practice

Summary: The paper presents problems related to the most frequent disturbances of gastrointestinal motility in the practice of a GP, such as constipation, dyspepsia and gastroparesis. These diseases are the cause of a significant percentage of visits and consultations with family doctors and in specialist clinics. Their diagnosis and treatment involves a wide range of clinical knowledge, often at the interface of gastroenterology, psychiatry, psychology, neurology and dietetics. For these reasons, the diagnosis and treatment of these diseases is often problematic. The paper draws attention to the recognition of functional constipation and dyspepsia based on the Roman Criteria IV. The role of carefully collected interviews, which include the number, frequency and duration of symptoms, has been emphasized. It is important to remember about so-called alarm symptoms that may suggest cancer, such as weight loss, anemia, overt or latent gastrointestinal bleeding and a change in the rhythm of defecation. A physical examination is an important and necessary stage of diagnostics, allowing us to notice organic changes in the patient, for example. The most common causes of constipation have idiopathic and medicament-related backgrounds. The most important role in treatment is played by a high-fiber diet, fluid supply, lifestyle changes, and sometimes also modification of medication. The role of new-generation prokinetics (itopride) in pharmacological treatment is important. Functional dysfunction includes two types of disorders: B1a postprandial distress syndrome (PDS) and B1b epigastric pain syndrome (EPS). Treatment includes the modification of lifestyle and diet. In postprandial disorders, the drugs which are used are prokinetics, while in the epigastric pain syndrome -¬ proton pump blockers (PPI) and H2-blockers. Good results in clinical trials have been obtained for Iberogast, a herbal preparation. Another mentioned disorder is gastroparesis , i.e. delayed gastric emptying. Among the causes, the most common is the idiopathic background and diabetes, especially perennial and decomposed. In its diagnosis, apart from an interview, the most important role is played by the scintigraphic examination of the stomach. Treatment includes normal control of the underlying disease, dietary management and prokinetics. In the diagnosis and treatment of all discussed disorders it is very important to build a good relationship with the patient. A friendly, calm atmosphere during the visit facilitates conversation for the often embarrassed patient.
Keywords: obstipation, functional dyspepsia [FD], postprandial distress syndrome [PDS], epigastric pain syndrome [EPS], gastroparesis

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