EpistemisPostprandial epigastric fullness
Specialty: Gastrointestinal.
Why it occurs
- Functional dyspepsia (postprandial distress syndrome according to Rome IV) due to a disorder of gastric accommodation or hypersensitivity to distension
- Gastroparesis of diabetic, postviral or metabolic origin with slowing of the emptying of solids
- Chronic active gastritis with associated antral motor dysfunction
- Inadequate eating habits with excessive consumption of lipids or tobacco that physiologically slow down gastric transit.
Initial workup
Upper digestive endoscopy (EDA) to exclude structural or organic gastric lesions | Gastric emptying of solids scan (4-hour test of choice) | Abdominal ultrasound to evaluate concomitant cholelithiasis.
red flags
Involuntary weight loss, repeated vomiting of food eaten several hours before, severe early satiety, documented iron deficiency anemia or palpable mass in the epigastrium.
Standard management
- Prokinetics — itopride 50 mg three times a day, domperidone 10 mg three times a day or cinitapride 1 mg three times a day administered 15 to 30 minutes before main meals
- Reception of mirtazapine at low doses — 15 mg at night, useful for its 5-HT3 receptor antagonist effect to improve gastric accommodation and appetite
- Tricyclic antidepressants (amitriptyline 10 mg at night to modulate visceral gastric hypersensitivity).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gastrointestinal
- Listed causes
- 4
- Treatment options
- 3