Functional Dyspepsia

What functional dyspepsia means

Dyspepsia means indigestion: discomfort centered in the upper middle abdomen (epigastrium). When tests find a cause, such as a peptic ulcer, it is called organic dyspepsia. When no cause is found, it is functional dyspepsia, now classified as a disorder of gut-brain interaction. It is a real condition, not "all in your head".

Symptoms

• postprandial fullness: uncomfortable fullness after normal-sized meals
• early satiety: feeling full after a few bites, unable to finish a meal
• epigastric pain: pain in the upper middle belly
• epigastric burning: a burning feeling there, not behind the breastbone as in heartburn
• bloating in the upper abdomen, belching and nausea

Symptoms often overlap with GERD and irritable bowel syndrome.

Rome IV criteria

Functional dyspepsia is diagnosed when one or more of the four main symptoms is bothersome, for the last 3 months with onset at least 6 months earlier, and no structural disease explains them. Two subtypes:

Many people have both.

Causes

The exact cause varies, and usually several mechanisms combine:

• visceral hypersensitivity: stomach nerves sense normal stretching as discomfort
• impaired accommodation: the upper stomach does not relax properly to receive food, causing early fullness
• delayed stomach emptying in some people, overlapping with gastroparesis
• H. pylori infection in a minority
• after an infection: post-infectious dyspepsia can follow gastroenteritis
• low-grade inflammation in the duodenum, with immune cells such as eosinophils
• gut-brain factors: stress, anxiety and depression amplify symptoms

Smoking, alcohol, NSAIDs and fatty meals can worsen symptoms.

Diagnosis

• History and examination, with a review of medicines such as NSAIDs
• H. pylori test: a breath or stool antigen test for people under 60
• Upper endoscopy: recommended for people 60 and older with new dyspepsia, and for those with alarm features. Some guidelines suggest lower age thresholds in higher-risk populations
• Blood tests: blood count for anemia, celiac serology if suspected
• Other tests as needed: ultrasound for gallstones, gastric emptying study if vomiting is prominent

Treatment

Treatment is stepwise, and combining approaches often works best.

First steps

• Test and treat H. pylori: eradication relieves symptoms in a minority and is worth doing if positive.
• Proton pump inhibitor (PPI): a 4- to 8-week trial, especially for pain and burning. Stop if it does not help.
• Explanation and reassurance: understanding the condition itself reduces symptom-related worry.

If symptoms persist

• Low-dose tricyclic antidepressants (such as amitriptyline): used for their effect on gut nerve sensitivity, not as antidepressants. Good evidence supports them.
• Prokinetics: medicines that improve stomach movement, used for fullness and nausea in some cases.
• Other neuromodulators such as mirtazapine for early satiety and weight loss.
• Psychological therapies: CBT, gut-directed hypnotherapy and relaxation techniques have evidence for benefit.

Diet and lifestyle

• eat smaller meals more often, and eat slowly
• limit fatty, fried and spicy foods if they worsen symptoms
• avoid lying down within 2 to 3 hours of eating
• reduce alcohol, caffeine and carbonated drinks if they trigger symptoms
• stop smoking and avoid NSAIDs where possible
• regular physical activity
• keep a symptom diary to identify personal triggers

Outlook

Functional dyspepsia is a chronic, relapsing condition, but it does not cause cancer, ulcers or shorten life. Symptoms often fluctuate, and many people improve substantially with treatment.

Frequently asked questions

What is functional dyspepsia?

It is chronic indigestion, with upper belly pain, burning, fullness after meals or early satiety, where tests find no ulcer, cancer or other structural cause. It results from a sensitive stomach and altered gut-brain signaling.

What are the symptoms of functional dyspepsia?

The main symptoms are feeling uncomfortably full after meals, feeling full after a few bites, and pain or burning in the upper middle abdomen. Bloating, belching and nausea are also common.

How is functional dyspepsia treated?

Treatment includes testing and treating H. pylori, a trial of acid-reducing medicine, low-dose tricyclic antidepressants for persistent symptoms, prokinetics in some cases, dietary changes and psychological therapies such as CBT or hypnotherapy.

Is functional dyspepsia serious?

It is not dangerous and does not lead to cancer or ulcers, but it can significantly affect quality of life. New symptoms with alarm features, such as weight loss, vomiting, bleeding or swallowing problems, need prompt investigation.