What Is Functional Dyspepsia? Symptoms, Causes, and How to Manage It

Not sure what functional dyspepsia is all about? You’re not alone—it can be confusing! Learn to identify the symptoms of this common disorder—and then learn how to manage it.

What is Functional Dyspepsia? 

Functional Gastrointestinal Disorders (FGID) are the most commonly diagnosed issues in gastroenterology. A health problem is considered “functional” when there is no identifiable cause or structural problem with the body. But that doesn’t mean it isn’t real! A functional issue disrupts body functions and can cause very real pain and discomfort. There are many FGIDs, and the term functional dyspepsia describes not a disease, but a collection of chronic symptoms that affects an estimated 20% of the global population, with rates being higher in Western countries. 

What Are The Symptoms of Functional Dyspepsia?

Dyspepsia is sometimes referred to as indigestion, which typically refers to discomfort or pain after eating, often due to a variety of different issues. However, there are distinct symptoms that can give your doctor an indication that an FGID may be the cause of the issue. A general diagnosis of functional dyspepsia may be made if one or more of the following symptoms are present for at least 3 months and quality of life is affected. Symptoms must also be found in the absence of structural disease detectable by imaging or endoscopy:

• Postprandial fullness 

• Epigastric pain

• Epigastric burning

• Early satiety

Functional dyspepsia is further classified into the following two categories:

1. Epigastric Pain Syndrome (at least one symptom occurs at least once a week) 

• Upper abdominal pain, bloating, belching, nausea

• Pain that does not meet biliary pain criteria

• Burning sensation that may feel like acid reflux

• Pain that may be triggered or relieved by eating a meal, and can also happen while fasting

2. Postprandial Distress Syndrome (at least one symptom occurs at least 3 times a week)

• Early satiety that prevents eating a normal-sized meal 

• Overfullness or bloating after eating

• Nausea, vomiting, retching

• Loss of appetite

• Symptoms of IBS

• Heartburn

Not everyone will experience all of these symptoms. In fact, women tend to be more likely to receive a diagnosis of functional dyspepsia. And research suggests that smokers and people who have H. pylori infections may also be more prone to the condition, although the associations are not strong. 

What Causes Functional Dyspepsia?

Functional dyspepsia is a complex condition, and unfortunately, it is not yet well understood. There appear to be physiological roots to the problem that include GERD, gastric motor dysfunctions (delayed or rapid gastric emptying, for example), and hypersensitivity to normal postprandial gastric distention. There are also what are called “microscopic physiologic mechanisms,” such as H. pylori infection or other issues with the gut microbiome, as well as inflammation or impaired integrity of the intestinal lining. Psychological factors such as anxiety, acute stress, or trauma may also be involved.

Getting To A Diagnosis

Due to its complexity, a diagnosis of functional dyspepsia generally involves several steps. Although physical abnormalities are not typically present in functional dyspepsia, this is often the first step in ruling out any obvious structural problems. Following that, testing for H.Pylori is typical, and can be conducted via non-invasive means like a stool or breath sample. Blood tests may also be done to help ensure that you don’t have another condition or disease that has similar symptoms, such as IBS. 

Sometimes, an upper endoscopy is scheduled, although it’s typically required only when there are alarming symptoms or an obvious need. An endoscopy allows the doctor to see the lining of the upper GI tract (esophagus and stomach). Beyond the physical, a frank discussion with your physician about your symptoms, the severity of your pain, and how frequently you experience these symptoms is essential to help reach a diagnosis. 

Managing Functional Dyspepsia

Living with dyspepsia likely means your physician will recommend a multi-pronged approach to managing your symptoms. Typically, this includes:

• Medications - Proton pump inhibitors (PPIs), which are available without a prescription, antibiotics to treat the H. pylori infection if you have it, and perhaps other medications to protect the lining of the stomach from acid. It’s common to take multiple medications together for functional dyspepsia, especially when H. pylori is involved.

• Diet changes - There is limited evidence that following a Low FODMAP diet improves functional dyspepsia. However, it may be suggested, especially if a diet history or diet tracking reveals any symptom trends that coincide with the consumption of FODMAP-containing foods. Other diet modifications to help with acid reflux-like symptoms may also be beneficial. Be sure to discuss these modifications with your doctor or ask for a referral to a Registered Dietitian who specializes in gut health or GI disorders.

• Psychological interventions - While the evidence that psychiatric counseling is effective for helping with functional dyspepsia is not strong (nor typically recommended), gut health is related to mental health, and there is evidence for that across several GI conditions. The gut-brain connection is real. If you have depression or anxiety, have experienced trauma, or endure chronic stress in your life, communicate that to your health provider and consider asking for a referral to a therapist to address it. 
  

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