Functional Dyspepsia

Overview

What is functional dyspepsia?

Dyspepsia is another word for indigestion. People with chronic indigestion often report feelings of stomach pain, over-fullness and bloating during and after eating. Other common symptoms include acid reflux, heartburn and excessive burping. These symptoms resemble peptic ulcer disease, but when tested, only 1/3 of people will have an ulcer — the other 2/3 will have functional dyspepsia.

A functional disorder is an ongoing problem with your bodily functions that can’t be explained by physical causes. You have symptoms, and doctors can observe those symptoms, but they can’t find any mechanical reason for them. Gastrointestinal diseases are often “functional” rather than structural. Doctors don’t always understand why they occur. It may be that the brain and nerves are involved.

If you have frequent symptoms of indigestion, your healthcare providers will look to see if they can find anything wrong with your GI tract — such as an ulcer or structural problem. If they can’t, they’ll diagnose your condition as simply functional dyspepsia (FD). Sometimes FD is also described as nervous dyspepsia, non-ulcer dyspepsia or pseudo-ulcer syndrome.

How common is functional dyspepsia?

Functional dyspepsia is considered one of the most common functional disorders. Estimates say 10% to 20% of people who seek healthcare for their symptoms may have functional dyspepsia. But because many people never seek healthcare for their symptoms, the number of those who have it might be much higher than we know.

Symptoms and Causes

What are the symptoms of functional dyspepsia?

Dyspepsia symptoms are sporadic: They come and go without clear reasons, and it’s hard to tell if anything in particular makes them better or worse. While functional dyspepsia is chronic — ongoing over a long period of time — it may disappear for a while and then return for unknown reasons. To be diagnosed, you must have had symptoms within the last three months and persistently for at least six months. You’ll also have more than one of the following symptoms:

  • Epigastric pain. This is pain in the upper abdomen under the ribcage. This region, called the epigastrium, is home to your stomach, small intestine, pancreas and liver.
  • Bloated stomach. Feelings of uncomfortable pressure or fullness in your belly, especially after eating.
  • Early satiety or loss of appetite. Feeling “full” very quickly after or during eating.
  • Heartburn. This is a burning pain in the region between the stomach and the esophagus, usually due to acid reflux.
  • Acid reflux. Stomach acid comes up from your stomach through your esophagus, leading to a burning sensation and often a sour taste in your mouth.
  • Nausea and vomiting. In severe cases, fullness and loss of appetite may develop into actual nausea or vomiting.

Are there different types of functional dyspepsia?

Some healthcare specialists classify functional dyspepsia symptoms into two categories:

  • Epigastric pain syndrome (EPS) refers to only those symptoms associated with upper abdominal pain and burning.
  • Postprandial distress syndrome (PDS) refers to only those symptoms that occur after eating, such as early fullness, bloating and nausea.

Not everyone’s symptoms fall neatly into these two categories, but when they do, it helps healthcare specialists focus on treating those symptoms as a group.

How do I tell if I have functional dyspepsia vs. gastritis?

Gastritis and dyspepsia share many symptoms, and you can have both. Gastritis, which is inflammation of the stomach lining, usually has a traceable cause. It might be a bacterial infection, overuse of certain pain medications that erode the stomach lining (NSAIDs), or too much stomach acid. These things can be tested for and treated. If you have functional dyspepsia, gastritis may be part of the equation, but not all of it. You may discover and treat the cause of your gastritis and experience some relief from those symptoms, but not total relief.

How do I tell if I have functional dyspepsia vs. GERD?

GERD can also be a factor in functional dyspepsia. Heartburn, belching and the sour taste that sometimes comes with acid reflux are all among the symptoms of functional dyspepsia. If you have GERD, it’s not hard for healthcare providers to recognize. Chronic acid reflux does visible damage to your esophagus over time. GERD is also relatively easy to treat with medications that reduce stomach acid. If you’ve treated your GERD, but you still have symptoms of indigestion, you might be diagnosed with functional dyspepsia.

How do I tell if I have functional dyspepsia vs. IBS?

IBS (irritable bowel syndrome) is another functional disorder, like functional dyspepsia. They even have similar nicknames. Functional dyspepsia has been called “irritable stomach syndrome,” and IBS has been called “nervous stomach”. However, IBS is really concerned with the bowels, especially the large intestine or colon. Functional dyspepsia symptoms are more involved with the stomach and the upper small intestine. FD pain is more of a burning sensation in the upper GI tract, while IBS pain is more like cramping in the bowels due to constipation or diarrhea.

What causes functional dyspepsia?

The term “indigestion” assumes that something is going wrong with your digestive process. But this could be a lot of things. Doctors don’t have clear answers for what causes functional dyspepsia, but they have some suggestions. Some of these include:

  • Impaired stomach accommodation / emptying. Normally, the stomach is supposed to relax and expand to accommodate food, but in some people, this function might be impaired, leading to a constant full feeling. The signals that tell the stomach to empty food into the small intestine may also be impaired. This can cause food to back up, gas to build up, and bacteria to breed too much while food sits too long in the stomach.
  • Food allergies. If you have an undiagnosed food allergy, it could be producing an inflammatory response in your gut. Some people with FD have higher white blood cell counts, which suggests the gut immune system is activated. Some also self-report food sensitivities, particularly to wheat. An allergic response could explain symptoms of nausea, gas and inflammation. Inflammation could be the cause of bloating and pain.
  • H. pylori. This common bacterial infection can cause chronic inflammation (gastritis) in some people, as well as erode the mucous lining that protects the stomach against gastric acid. H. pylori infection can have a variety of side effects, so healthcare providers will test for it when your gastrointestinal symptoms are unexplained. Some people with FD do improve after being treated for H. pylori.
  • Visceral hypersensitivity / psychological factors. Some people’s nervous systems are extra sensitive. These people might have a physical response to stress and emotional factors, such as tightening and restriction of the digestive organs. Some of these people may also have visceral hypersensitivity, which means that the regular expansion and contraction of the digestive organs feels excessive or uncomfortable to them.

What risk factors contribute to functional dyspepsia?

You may be more likely to experience functional dyspepsia if you:

  • Have a history of anxiety or depression.
  • Have a history of abuse.
  • Have a history of H. pylori infection.
  • Use NSAIDs.
  • Smoke or use tobacco products.
  • Were assigned "female" at birth.

Diagnosis and Tests

How is functional dyspepsia diagnosed?

When you explain your symptoms to your healthcare provider, they will test you for common causes. Tests may include:

  • Blood tests to check for common infections and diseases that might explain your symptoms.
  • Upper endoscopy, an imaging test to look inside your organs for any structural problems.
  • Breath tests to screen for abnormal bacteria in your gut. The urea breath test can detect H. pylori infection, while the hydrogen breath test can detect SIBO.
  • Gastric emptying studies to see how fast your stomach empties into your small intestine.

If there’s no evidence of a structural or biochemical disease, and your symptoms have been persistent for three months or more, you’ll be diagnosed with FD.

Management and Treatment

How do you treat functional dyspepsia?

If you’ve tested positive for a bacterial infection, you’ll be treated with antibiotics for the infection first. But if functional dyspepsia persists, and no other direct cause can be found, the remaining treatment options are focused on managing symptoms. This is a trial-and-error process. Medication might include:

  • Acid reduction: Healthcare providers will often begin by prescribing a short-term course of medication to repress or neutralize stomach acid. This will give your stomach lining a chance to rest and repair and reduce the symptoms of acid reflux. Common prescription medications include proton pump inhibitors (PPIs) and H2 receptor blockers. These will usually be prescribed for two or three months and then reevaluated. You may also try over-the-counter antacids to manage your symptoms, but consult your healthcare provider if you are using them regularly for more than a few weeks.
  • Prokinetic agents: If something is slowing or impairing your motility, the process of moving food through your digestive system, prokinetic agents can help. These drugs help encourage your stomach to empty food into your small intestine without holding onto it too long, and they reduce the tendency to send food or fluids back up through the esophagus.
  • Phytotherapy: Combined herbal preparations have been successful in treating some people’s symptoms. The multi-targeted approach of using different plant extracts together to treat different symptoms appears to work better than one alone. A fixed combination of peppermint and caraway oil is one of the most commonly prescribed formulas for stimulating motility while also calming and sedating the digestive system. A commercial compound called Iberogast®, which lists nine different ingredients, has also done well in clinical trials.
  • Low-dose antidepressants: Some people whose symptoms seem to be related to the nervous system benefit from a category of medicines known as tricyclic antidepressants (TCAs). These medicines, given in much lower doses than they are given to treat depression, may help to subdue the perception of pain and discomfort as well as modulate psychological triggers. Some also help the stomach relax during digestion, allowing it to expand more to accommodate food.

These medications may help if they happen to target the factors contributing to your symptoms. But functional dyspepsia is often more complicated than that, and medications overall have only a moderate success rate in treating FD.

Some other therapies that people use to manage their symptoms include:

  • Acupuncture: Results are mixed, but some studies and people report improvement following a several-week course of consistent acupuncture treatments.
  • Behavioral therapy: Certain mind-body techniques may help improve symptoms that aren’t improved by medication alone. Relaxation techniques, biofeedback, and psychotherapy may all contribute to a more regulated nervous system and digestive system.
  • Diet changes: While diet alone isn’t a major factor in functional dyspepsia, everyone can benefit from paying attention to which foods seem to trigger their symptoms and avoiding those foods. This can be a very individual thing. You might want to consider keeping a food journal to track how your body responds to different meals, or try an elimination diet to systematically test different categories of foods. Eating smaller meals and chewing more thoroughly can also help.
  • Lifestyle changes: Some people find that losing weight, getting more exercise, getting adequate sleep and reducing stress factors in their lives improves their digestive symptoms.

Outlook / Prognosis

Does functional dyspepsia ever go away?

Among those who seek medical care for their functional dyspepsia, only 20% report permanent relief. How long does functional dyspepsia last? For most people, it’s a chronic condition that comes and goes indefinitely, depending on many factors. The best thing you can do is to try and manage your symptoms as they arise, and try to develop an awareness of the foods, stress triggers and lifestyle habits that affect your symptoms. The good news is that FD is not a dangerous or progressive condition. It should get better at least at times, and it shouldn’t get worse.

Living With

How do I live with functional dyspepsia?

Functional disorders like FD are complex. They often involve the brain and nervous system, diet and lifestyle factors as well as organic causes in your digestive system. That’s what makes them so tricky for both patients and healthcare providers to manage. Medical testing can help rule things out, but often can’t tell you exactly what’s going on. In the end, you are the one in the best position to notice what makes your symptoms better or worse. As you try out different therapies and work to reduce your triggers, you’ll find your own way to live with functional dyspepsia.

When should I see my healthcare provider?

Seek medical attention if:

  • You haven't been tested for gastrointestinal diseases.
  • Your symptoms change or get noticeably worse.
  • You are unintentionally losing weight.

A note from Cleveland Clinic

Functional dyspepsia can be a frustrating diagnosis for people who experience it and are looking for solutions. On one hand, it’s a benign condition that won’t endanger your life. But on the other hand, there is no definitive cause or cure. Even so, medical testing can help put you on the path to relief. It can identify or rule out certain contributing factors and give your healthcare provider important information about your condition. Your provider will use the evidence they find to prescribe the best medication they can to help you. And if the first prescription doesn’t work, that will tell them what to suggest next.

Last reviewed by a Cleveland Clinic medical professional on 01/10/2022.

References

  • Canadian Society of Intestinal Research. Functional Dyspepsia. (https://badgut.org/information-centre/a-z-digestive-topics/functional-dyspepsia/) Accessed 01/10/2022.
  • Madisch A, Andresen V, Enck P, Labenz J, Frieling T, Schemann M. The Diagnosis and Treatment of Functional Dyspepsia. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938438/) Dtsch Arztebl Int. 2018;115(13):222-232. Accessed 01/10/2022.
  • Pryor J, Burns GL, Duncanson K, Horvat JC, Walker MM, Talley NJ, Keely S. Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders. (https://pubmed.ncbi.nlm.nih.gov/32797313/) Curr Gastroenterol Rep. 2020 Aug 14;22(10):51. Accessed 01/10/2022.
  • Kim HJ. The Gastric and Duodenal Eosinophilia in Functional Dyspepsia. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930292/) J Neurogastroenterol Motil. 2016;22(3):353-354. Accessed 01/10/2022.
  • Rösch W, Liebregts T, Gundermann KJ, Vinson B, Holtmann G. Phytotherapy for functional dyspepsia: a review of the clinical evidence for the herbal preparation STW 5. (https://pubmed.ncbi.nlm.nih.gov/16978851/) Phytomedicine. 2006;13 Suppl 5:114-21. Accessed 01/10/2022.
  • Lu Y, Chen M, Huang Z, Tang C. Antidepressants in the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911162/) PLoS One. 2016;11(6):e0157798. Accessed 01/10/2022.

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