Functional Dyspepsia

 

Functional dyspepsia (FD) is a condition characterized by chronic indigestion symptoms such as stomach pain, fullness, and bloating that cannot be explained by an underlying medical condition. Treatment options for FD include dietary changes, medication, and lifestyle modifications, however, the effectiveness of these treatments can vary among individuals.

Overview

What is functional dyspepsia?

Indigestion, also known as dyspepsia, is a common condition characterized by stomach discomfort, fullness, bloating, and other symptoms such as acid reflux, heartburn, and excessive burping. While these symptoms may be similar to those of peptic ulcer disease, only a third of people with chronic indigestion actually have a stomach ulcer. The majority of people with these symptoms have a condition called functional dyspepsia.

Functional disorders are a type of medical condition in which an individual experiences ongoing issues with their bodily functions, despite the absence of any observable physical causes. These disorders are characterized by symptoms that are present, but cannot be explained by any structural or mechanical issues. Gastrointestinal diseases are a common example of functional disorders, as they often occur without a clear understanding of why. It is believed that the brain and nerves may play a role in the development of these types of disorders.

If you experience recurrent indigestion symptoms, your healthcare providers will examine your gastrointestinal tract for potential issues such as ulcers or structural abnormalities. If no underlying cause is found, you will be diagnosed with functional dyspepsia (FD). FD is also referred to as nervous dyspepsia, non-ulcer dyspepsia, or pseudo-ulcer syndrome.

How common is functional dyspepsia? 

Functional dyspepsia, a common functional disorder, is thought to affect a large portion of the population, with estimates suggesting that anywhere from 10-20% of individuals who seek medical attention for related symptoms may have the condition. However, it is important to note that many individuals may never seek medical attention for their symptoms, meaning that the actual number of individuals with functional dyspepsia may be much higher than currently reported.

SYMPTOMS AND CAUSES

What are the symptoms of functional dyspepsia?

Dyspepsia symptoms are unpredictable and can fluctuate without clear cause. It can be difficult to determine what triggers them or what improves them. Although functional dyspepsia is a long-term condition, it may temporarily disappear and then reappear unexpectedly. In order to be diagnosed, an individual must have experienced symptoms within the past three months and consistently for at least six months. Additionally, the individual must 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 are two conditions that have many similar symptoms. It is possible to have both at the same time. Gastritis is an inflammation of the stomach lining, and it typically has a specific cause, such as a bacterial infection, excessive use of certain pain medications, or excessive stomach acid. These causes can be identified through testing and treated accordingly. On the other hand, functional dyspepsia may be a contributing factor in gastritis, but it is not the only cause. Even if the cause of gastritis is treated, it may not fully alleviate symptoms associated with functional dyspepsia.

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

Functional dyspepsia, a condition characterized by symptoms such as heartburn, belching, and a sour taste in the mouth, can also be caused by Gastroesophageal Reflux Disease (GERD). GERD is easily recognizable by healthcare providers due to its visible damage on the esophagus over time and its ability to be treated with medications that decrease stomach acid. However, if an individual has treated their GERD but continues to experience symptoms of indigestion, they may be diagnosed with functional dyspepsia.

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

Irritable bowel syndrome (IBS) and functional dyspepsia are functional disorders that share similarities in their nicknames. While functional dyspepsia is often referred to as "irritable stomach syndrome," IBS is commonly referred to as "nervous stomach." Despite these similarities, IBS primarily affects the large intestine or colon, causing cramping and discomfort as a result of constipation or diarrhea. On the other hand, functional dyspepsia primarily affects the stomach and upper small intestine, leading to burning sensations in the upper gastrointestinal tract.

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?

Functional dyspepsia is a functional gastrointestinal disorder characterized by chronic or recurrent symptoms of upper abdominal pain or discomfort that is not caused by a structural or metabolic disorder. Some risk factors that have been associated with functional dyspepsia include:

• Psychological factors, such as stress and anxiety
• Gastroesophageal reflux disease (GERD)
• H. pylori infection
• Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Smoking and alcohol consumption
• Obesity
• Genetics
• Eating habits, such as eating too quickly or too much, or eating spicy or fatty foods.

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?

Functional dyspepsia, is a chronic condition that affects the stomach and can cause discomfort and discomfort. While 20% of people report permanent relief, for most individuals, the condition comes and goes indefinitely. Managing symptoms as they arise and being aware of triggers such as certain foods, stress, and lifestyle habits can help alleviate symptoms. It is important to note that FD is not a dangerous or progressive condition and should improve at least at times and not worsen.

LIVING WITH

How do I live with functional dyspepsia?

Functional dyspepsia,  is a complex disorder that affects the functioning of the digestive system. It is characterized by symptoms such as stomach pain, nausea, and bloating, and can be caused by a variety of factors including the brain and nervous system, diet, lifestyle, and organic issues within the digestive system. Due to the complexity of this disorder, it can be challenging for both patients and healthcare providers to effectively manage it. While medical testing can help eliminate potential causes, it is often unable to provide a specific diagnosis. Ultimately, it is up to the individual to pay close attention to their symptoms and determine what triggers them and what methods of treatment are most effective. With a combination of different therapies and a reduction of triggers, it is possible 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.

References:-

• Canadian Society of Intestinal Research. Functional Dyspepsia. 

• Madisch A, Andresen V, Enck P, Labenz J, Frieling T, Schemann M. The Diagnosis and Treatment of Functional Dyspepsia.

• Pryor J, Burns GL, Duncanson K, Horvat JC, Walker MM, Talley NJ, Keely S. Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders.

• Kim HJ. The Gastric and Duodenal Eosinophilia in Functional Dyspepsia.

• 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 

• Lu Y, Chen M, Huang Z, Tang C. Antidepressants in the Treatment of Functional Dyspepsia: A Systematic Review and Meta-Analysis.