Functional Dyspepsia with Dr. Scott Gabbard

Question 1 (Dr. Wardrop) – What is functional dyspepsia? (Dr. Gabbard)

Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, and/or pain in the center of the upper abdomen, without findings at upper endoscopy such as peptic ulcer disease to explain these symptoms. Functional dyspepsia is a common condition, affecting up to 30% of the global population; however, many patients go undiagnosed for years.

Case (Arjun) – 37-year-old female who presents with >10 years of epigastric fullness and bloating with meals. She denies heartburn/regurgitation, dysphagia, and weight loss. EGD was performed 5 years ago, with normal endoscopic appearance of the esophagus, stomach, and duodenum. Biopsies of the gastric antrum and body were negative for H-pylori, and biopsies of the duodenum were normal. She has tried two different proton pump inhibitors without improvement in her symptoms.

Question 2 (Arjun) – What is pathophysiology of Functional Dyspepsia? (Dr. Gabbard)

The pathophysiology of functional dyspepsia, like all disorders of gut-brain interaction (DGBI), is poorly understood. However, there are clear associations with visceral hypersensitivity and/or disruptions of normal gastroduodenal motility. Potential etiologies include:

Question 3 (Dr. Wardrop) – How do you diagnose Functional Dyspepsia? (Dr. Gabbard)

The Rome IV diagnostic criteria for Functional Dyspepsia is the following:

Patients must present with symptoms of postprandial fullness, epigastric burning, epigastric pain, and/or early satiation

Question 4 (Arjun) – What is prognosis of Functional Dyspepsia? (Dr. Gabbard)

It is important that patients understand that, although treatment can manage FD symptoms, FD is a lifelong medical condition which may wax and wane over time. Treatment aims to improve quality of life through decreasing or eliminating symptoms. Patients are often able to reduce dosage or even terminate the use of treatments upon symptom resolution. However, it is reasonable to expect symptom exacerbations throughout one’s lifetime, especially in response to stress or triggers, which may require patients to restart treatment regimens. Importantly, functional dyspepsia has not been shown to affect long-term survival in patients.

Question 5 (Arjun) – What treatment options are there for Functional Dyspepsia? (Dr. Gabbard)

Case follow up (Arjun) –

Going back to our case 37-year-old female who presents with >10 years of epigastric fullness and bloating with meals. EGD -ve, no H.pylori, no weight loss or heartburn/regurgitation. We dx her with functional dyspepsia (postprandial distress subtype) and educated on functional dyspepsia.The patient started buspirone 10mg 15-30 minutes before meals, with significant improvement in her postprandial bloating. PPI was then discontinued without worsening her FD symptoms. We plan to continue therapy for 12 months, then reassess the need for buspirone.

Intro/Outro music credit: Frank Gomez and Eden Bernstein, MD