Functional Dyspepsia

Functional dyspepsia is a disorder of gut–brain interaction running with recurrent or long-lasting fullness after meals, early satiety, and stomach or epigastric pain or burning in the upper abdomen.

The word “functional” does not mean the patient’s complaints are unimportant or psychological. It means that on assessment no ulcer, tumour or other structural disease has been found that would adequately explain them.

Is functional dyspepsia common?

Yes. It is one of the commoner gastrointestinal problems in the population. The symptoms can disappear and come back from time to time, and in some patients they can carry on for a long while.

What are the commonest symptoms?

Four complaints matter most:

• Fullness after meals: feeling the stomach is excessively full for a long time after eating
• Early satiety: feeling full before finishing a normal meal
• Epigastric pain: pain in the upper middle part of the abdomen
• Epigastric burning: a burning sensation in the same area

Bloating, nausea and belching can accompany them.

Are functional dyspepsia and reflux the same thing?

No.

In reflux, burning behind the breastbone and the stomach contents coming back up into the mouth are typically to the fore.

In functional dyspepsia the complaints are more in the stomach area, particularly meal-related fullness and early satiety, or epigastric pain and burning.

Both can be present in the same person.

Why does it happen?

Functional dyspepsia has no single cause. More than one mechanism can play a part together.

Among them:

Impaired accommodation of the stomach to food → hypersensitivity of the stomach and duodenum → changes in gastric emptying → certain changes in the duodenum → differences in gut–brain communication

can be counted.

In some people it begins after a gastrointestinal infection.

Is it related to stress?

Stress and emotional states can affect the severity of the symptoms through gut–brain communication.

But explaining functional dyspepsia simply as “it comes from stress” is not accurate. The condition has biological mechanisms and the symptoms are real.

Are there types of functional dyspepsia?

Yes. Two main clinical groups are defined according to which symptoms predominate.

Postprandial Distress Syndrome (PDS)

Fullness after meals + early satiety are particularly to the fore.

The patient may describe it as “I eat a little and I am full straight away”, “my stomach stays full for hours after a meal”.

Epigastric Pain Syndrome (EPS)

Pain and/or burning in the upper abdomen is particularly to the fore.

The two pictures can be present together in the same patient.

Is it the same as gastroparesis?

No.

In gastroparesis, gastric emptying is objectively shown to be delayed in the absence of a mechanical obstruction.

Functional dyspepsia and gastroparesis can produce some similar symptoms; but they are not the same condition.

How is the diagnosis made?

The characteristics of the patient’s complaints and how long they have lasted matter in the diagnosis. Standard symptom criteria are used today.

Depending on the patient’s age, complaints, medication and alarm findings, blood tests, testing for H. pylori, gastroscopy or other investigations may be needed.

The same tests do not have to be done in every patient.

If the gastroscopy is normal, how can the complaints carry on?

This is one of the questions these patients ask most often.

Gastroscopy is very valuable for assessing structural changes in the stomach and duodenum. But functions such as the sensitivity of the organs, their accommodation to food, and gut–brain communication are not seen at a standard gastroscopy.

So:

“My endoscopy is normal = there is nothing wrong with me”

does not follow.

Is there a link with Helicobacter pylori?

H. pylori can be looked for in suitable patients with dyspeptic complaints.

Where an active H. pylori infection is found, eradication treatment may be appropriate. In some patients, clearing the bacterium can bring a long-term improvement in the dyspeptic symptoms.

Which symptoms call for more care?

Where there are findings such as:

• New or progressive difficulty swallowing
• Gastrointestinal bleeding
• Black, tarry stools
• Unexplained iron deficiency anaemia
• Unintentional weight loss
• Persistent or repeated marked vomiting

the patient needs to be assessed separately.

Their presence does not necessarily mean there is a serious disease.

How is functional dyspepsia treated?

Treatment should be individualised according to the patient’s predominant complaint.

As appropriate, treatment can use:

• Adjustments to eating habits
• Eradication of H. pylori where it is present
• Acid-suppressing medicines
• In selected patients, medicines that affect gastric motility
• Low-dose neuromodulatory medicines that modulate gut–brain interaction
• In suitable patients, psychological / gut–brain focused approaches

How should I eat?

There is no single “functional dyspepsia diet” that can be applied to everyone.

Generally, choosing smaller portions rather than very large meals, and cutting down the foods that clearly increase the complaints in that person, can help.

Very fatty meals in particular can increase fullness after eating and other symptoms in some patients.

Unnecessary and excessive food restriction should be avoided.

Does functional dyspepsia turn into cancer?

No. Functional dyspepsia is not cancer and is not regarded as a condition that turns into cancer.

But an earlier diagnosis of functional dyspepsia does not mean that new or different alarm symptoms appearing years later should be attributed to the same condition.

Does functional dyspepsia go away completely?

Its course varies from person to person. The symptoms can increase in some periods, ease off in others, or disappear for a long time.

With a correct diagnosis, identification of the patient’s predominant complaint and treatment suited to it, the symptoms can be brought under substantial control.

In brief

The most typical picture in functional dyspepsia is:

Eating → early satiety / long-lasting fullness

and/or

Pain / burning in the upper abdomen

It is not an ulcer → it is not cancer → it does not mean “it is all psychological”.

Functional dyspepsia is a real clinical condition, related to changes in the functions and sensitivity of the stomach and duodenum and in gut–brain interaction.

Note: This information is provided for general patient education. Where there are newly started or steadily increasing complaints, gastrointestinal bleeding, difficulty swallowing, unexplained weight loss, iron deficiency anaemia or persistent vomiting, medical assessment should not be delayed.