Functional Dyspepsia

What is functional dyspepsia?

Functional dyspepsia is chronic indigestion with no identifiable cause. “Dyspepsia” is another word for indigestion — a pattern of symptoms that occur together after eating and while you’re digesting. “Functional” means that your dyspepsia symptoms can’t be explained by the usual physical causes.

Typical symptoms of dyspepsia include burning stomach pain, over-fullness and bloating. These symptoms resemble peptic ulcer disease or GERD. But after testing, only a fraction of people with dyspepsia are diagnosed with these conditions. The rest are diagnosed with functional dyspepsia.

Types of functional dyspepsia

Dyspepsia is more of a syndrome than a condition — it’s a pattern of symptoms that occur together. But different people can have different combinations of symptoms with it. Healthcare providers have identified two distinct ways that people can experience functional dyspepsia. They classify these as:

• Epigastric pain syndrome. This type is characterized by upper abdominal pain and burning, such as heartburn. It resembles symptoms of GERD and it doesn’t necessarily occur at mealtimes.
• Postprandial distress syndrome. This type is characterized by early satiety and fullness, bloating and stomach pain after eating (“postprandial”). It resembles symptoms of peptic ulcer disease.

Not everyone fits these into profiles. Some people experience both types or a mix.

Symptoms of functional dyspepsia

Functional dyspepsia symptoms typically include:

• Upper abdominal pain. Pain in your upper abdomen is called epigastric pain. This region (your epigastrium) is home to digestive organs like your stomach, pancreas, duodenum and liver.
• Bloated stomach. You may feel uncomfortable pressure or fullness in your belly after eating. Bloating is closely connected to gas and gas pain and a feeling of stretching or distension.
• Fullness and loss of appetite. You may feel full very quickly during or after eating (early satiety), even when you haven’t eaten a lot. In some cases, you may lose your appetite before eating.
• A burning sensation. Heartburn, a burning pain in your chest, is common with indigestion. It’s usually related to acid reflux in your esophagus. You may also feel burning in your stomach.

Additional or related symptoms may include:

• Excessive belching
• Nausea or gagging
• IBS symptoms (urgent or delayed pooping)
• Stress or emotional disturbances

What causes functional dyspepsia?

Healthcare providers diagnose “functional” gastrointestinal disorders when they can’t find a direct cause for your symptoms. This might happen because of the close connection between your gut and brain. Functional disorders seem to involve your nervous system and how you perceive pain or discomfort.

While there’s no single cause of functional dyspepsia, several factors might be involved. These include:

• Visceral hypersensitivity. If your nervous system is extra sensitive, you might be more likely to have a physical response to stress. You might unconsciously clench your muscles or halt your digestion in order to attend to your stress. You might also be hypersensitive to sensations in your organs. This could make digestion feel uncomfortable even when it’s working normally.
• Motility disorders. Motility disorders affect how your GI tract moves food along through the digestive process. This is another way that communication between your brain and digestive system can go awry. The nerves in your GI tract may fail to activate the muscles in your organs correctly. Your organs may hold on to food too long, or may not relax enough to let food in.
• Gut dysbiosis. Dysbiosis in your gut microbiome — an imbalance of microbes in your gut — may cause symptoms of functional dyspepsia in various ways. For example, some bacteria, like H. pylori, can eat into your stomach lining, causing inflammation and making it more sensitive to acid. Bacterial overgrowth in your small intestine can cause gas and difficulties digesting fats.
• Eosinophilic duodenitis. Some people with functional dyspepsia have an excess of white blood cells (called eosinophils) in the top of the small intestine (duodenum). This can cause chronic inflammation (duodenitis). Eosinophils come from your immune system to defend you from infections and allergens. A previous infection or food allergy might have triggered them.

Risk factors

Additional risk factors for functional dyspepsia include:

• Psychological factors like anxiety and mood disorders or a history of trauma or abuse
• A family history of nervous disorders or other functional GI disorders, like IBS
• Food sensitivities (such as FODMAPs) or intolerances (such as lactose intolerance)
• Having a lot of allergic conditions or atopy

How do doctors diagnose functional dyspepsia?

Healthcare providers diagnose functional dyspepsia by confirming your symptoms and ruling out other causes. These include chronic acid reflux (GERD) and peptic ulcer disease. In some cases, you may already have one of these diagnoses. But treating the condition hasn’t relieved your symptoms.

Functional dyspepsia symptoms can be sporadic. Providers only diagnose it if they:

• Have been persistent for at least three months
• Originally appeared at least six months ago
• Aren’t relieved by burping, passing gas or pooping
• Don’t meet the criteria for biliary colic or gallbladder pain

Once they’ve confirmed you have dyspepsia, they’ll look to rule out structural causes.

Tests might include:

• Blood tests to check for common infections and diseases that might explain your symptoms
• Breath tests (urea and hydrogen) to screen for abnormal bacteria in your GI tract
• Gastric emptying studies to see how fast or slow your stomach empties into your intestine
• Upper endoscopy to look inside your digestive organs for structural issues, or to take a biopsy

What treatment is available for functional dyspepsia?

If tests reveal any underlying factors, like bacterial overgrowth or a motility disorder, your provider will treat those first. But usually, treating these isn’t enough to relieve functional dyspepsia. Your provider will suggest other treatment options to relieve your symptoms. It usually takes a combination of these.

Medications for functional dyspepsia might include:

• Antibiotics to treat a bacterial infection
• Prokinetics to encourage movement in your GI tract
• Acid blockers like proton pump inhibitors (PPIs) or H2 blockers
• Tricyclic antidepressants in low doses to calm your nervous system

Complementary medicine for functional dyspepsia might include:

• Plant-based formulas, like peppermint and caraway oil, or a blend called Iberogast®
• Mind-body relaxation therapies, like meditation and yoga, biofeedback or psychotherapy
• Elimination diet to identify food triggers, followed by a revised regular diet
• Acupuncture, which has shown some benefits in some studies

What can I expect if I have functional dyspepsia?

For most people, functional dyspepsia is a chronic condition that comes and goes throughout their lives. It may take some trial and error to figure out which therapies and habits improve your symptoms. While you may find some relief, it may never go away completely. But it doesn’t cause serious harm.

When should I see my healthcare provider?

See your provider if:

• You haven’t been tested for gastrointestinal diseases
• Your symptoms change or get noticeably worse
• You’re vomiting often
• You’re losing weight unintentionally