Functional Dyspepsia: Symptoms, Causes, Treatment

What are the symptoms of functional dyspepsia?

Functional dyspepsia, also known as non-ulcer dyspepsia, is a chronic disorder of the upper digestive system that is characterized by recurring or persistent pain or discomfort centered in the upper abdomen. Symptoms of functional dyspepsia can vary but commonly include:

Pain or Discomfort: Persistent or recurrent pain or discomfort in the upper abdomen, often described as burning, gnawing, or aching.
Feeling Full Early: Sensation of fullness or bloating after eating a small amount of food (early satiety).
Bloating: Feeling bloated or gassy in the upper abdomen.
Nausea: Feeling nauseous or having an upset stomach.
Belching: Frequent belching or burping.
Heartburn: Some people with functional dyspepsia may experience symptoms similar to acid reflux, such as heartburn or a sour taste in the mouth.
Loss of Appetite: Some individuals may experience a reduced appetite or weight loss.

Symptoms of functional dyspepsia can be bothersome and may come and go over time. They can also be triggered or worsened by certain foods, stress, or other factors. If you experience persistent or recurrent symptoms of functional dyspepsia, it’s important to see a healthcare provider for an accurate diagnosis and appropriate management.

What are the causes of functional dyspepsia?

The exact cause of functional dyspepsia is not well understood, but it is believed to involve a combination of factors. Some possible causes and contributing factors to functional dyspepsia include:

Delayed Emptying of the Stomach (Gastroparesis): Some people with functional dyspepsia may have a delay in the emptying of food from the stomach into the small intestine, which can lead to symptoms of bloating, fullness, and discomfort.
Increased Sensitivity to Gastric Distension: Individuals with functional dyspepsia may have an increased sensitivity to stretching of the stomach, leading to discomfort or pain even with normal amounts of food.
Abnormalities in Gastric Motility: Dysfunctions in the contractions of the stomach muscles may contribute to symptoms of functional dyspepsia.
Helicobacter pylori Infection: While not always present, some studies suggest that infection with the bacterium Helicobacter pylori may play a role in functional dyspepsia, particularly in areas where the infection is common.
Inflammation of the Stomach Lining: In some cases, inflammation of the stomach lining (gastritis) may contribute to symptoms of functional dyspepsia.
Psychological Factors: Stress, anxiety, and other psychological factors can influence the perception of symptoms and may contribute to functional dyspepsia.
Dietary Factors: Certain foods and beverages, such as fatty foods, spicy foods, alcohol, and caffeine, may worsen symptoms of functional dyspepsia in some individuals.
Other Factors: Other factors such as smoking, certain medications, and underlying medical conditions may also play a role in the development of functional dyspepsia.

Functional dyspepsia is a complex condition, and the exact cause can vary from person to person. It is likely that a combination of factors contributes to the development of symptoms.

How is the diagnosis of functional dyspepsia made?

The diagnosis of functional dyspepsia is typically made based on a combination of clinical evaluation, medical history, and diagnostic tests. The following steps are usually followed:

Medical history: The patient’s symptoms, including the nature, frequency, and duration of their dyspeptic symptoms, are evaluated. The patient is asked about their eating habits, any triggers that may exacerbate symptoms, and any medications they are taking.
Physical examination: A physical examination is performed to check for any signs of organic disease, such as abdominal tenderness, masses, or jaundice.
Dyspepsia symptom questionnaire: The patient may be asked to complete a standardized questionnaire to assess the severity and impact of their symptoms.
Endoscopy: Endoscopy may be performed to rule out organic causes of dyspepsia, such as peptic ulcers, gastroesophageal reflux disease (GERD), or gastritis.
Upper gastrointestinal (UGI) series: A UGI series is a type of X-ray exam that uses a contrast agent to visualize the esophagus, stomach, and duodenum.
Blood tests: Blood tests may be ordered to check for Helicobacter pylori infection, liver function tests (LFTs), and electrolyte levels.
Breath tests: A breath test may be used to diagnose H. pylori infection or lactose intolerance.
Stress test: A stress test may be performed to evaluate the relationship between symptoms and stress.
Gastrointestinal motility testing: This may involve measurements of the time it takes for food to pass through the stomach (gastric emptying) or the movement of food through the small intestine (small intestine transit time).
Symptom-based criteria: The Rome IV criteria are used to diagnose functional dyspepsia based on symptom patterns:
- At least 12 weeks of recurrent episodes of upper abdominal pain or discomfort centered in the epigastric area that has lasted for at least 30 minutes.
- At least 25% of episodes are characterized by at least two of the following: postprandial fullness, early satiety, epigastric burning or discomfort.

If all these evaluations do not reveal an organic cause for the symptoms, a diagnosis of functional dyspepsia is made. The diagnosis is confirmed when other causes of dyspepsia have been ruled out and the patient’s symptoms meet the Rome IV criteria.

What is the treatment for functional dyspepsia?

Functional dyspepsia is a chronic disorder of sensation and movement (peristalsis) in the upper digestive tract. Treatment typically focuses on symptom management rather than curing the condition. Here are some common approaches:

Lifestyle Changes: Eating smaller, more frequent meals; avoiding foods that trigger symptoms (like fatty or spicy foods); reducing stress; and avoiding alcohol and tobacco.
Dietary Modifications: Some people find relief by avoiding carbonated beverages, caffeine, and foods that can trigger symptoms, such as citrus fruits, onions, garlic, and chocolate.
Medications: Over-the-counter antacids can help neutralize stomach acid and provide relief. Prescription medications such as proton pump inhibitors (PPIs), H2-receptor antagonists, or prokinetics may be recommended in some cases.
Psychological Therapies: Cognitive-behavioral therapy (CBT) or relaxation techniques can be helpful for managing stress and anxiety, which can exacerbate symptoms.
Herbal Remedies: Some people find relief from herbal remedies such as peppermint oil, ginger, or chamomile tea. However, these should be used with caution as they can interact with medications or exacerbate symptoms in some individuals.
Probiotics: There is some evidence to suggest that certain probiotics may help improve symptoms of functional dyspepsia, but more research is needed to confirm their effectiveness.

It’s important to consult with a healthcare professional before starting any new treatment regimen, as they can help determine the most appropriate approach based on individual symptoms and medical history.

What is a good diet for functional dyspepsia?

A good diet for functional dyspepsia focuses on reducing symptoms by avoiding foods that trigger discomfort and adopting habits that promote digestion. Here are some general dietary recommendations:

Eat Smaller, More Frequent Meals: Large meals can distend the stomach and increase pressure, leading to discomfort. Eating smaller meals more frequently can help reduce symptoms.
Avoid Trigger Foods: Common triggers include fatty or greasy foods, spicy foods, caffeine, alcohol, carbonated beverages, chocolate, and acidic foods like citrus fruits and tomatoes. It may be helpful to keep a food diary to identify personal triggers.
Choose Low-Fat Foods: High-fat foods can delay stomach emptying and worsen symptoms. Opt for lean proteins and limit added fats and oils.
Limit or Avoid Alcohol and Tobacco: Both can irritate the stomach lining and worsen symptoms.
Eat Slowly and Chew Thoroughly: This can help reduce the amount of air swallowed, which can contribute to bloating and discomfort.
Stay Hydrated: Drink plenty of water throughout the day, but avoid drinking large amounts of liquid with meals, as this can distend the stomach.
Consider Fiber: For some people, a high-fiber diet can help regulate bowel movements and improve digestion. However, others may find that fiber exacerbates symptoms.
Mindful Eating: Pay attention to your body’s signals of hunger and fullness, and stop eating when you’re satisfied but not overly full.
Consider Probiotics: Some studies suggest that probiotics may help alleviate symptoms of functional dyspepsia by promoting a healthy gut microbiome.
Manage Stress: Stress can worsen digestive symptoms. Incorporate stress-reducing techniques such as meditation, yoga, or deep breathing exercises into your daily routine.

It’s important to note that individual responses to foods can vary, so what works for one person may not work for another. Keeping a food diary can help you identify foods that trigger symptoms so you can avoid them in the future. If you have functional dyspepsia, it may be helpful to work with a healthcare provider or dietitian to develop a personalized diet plan.