What is Functional Dyspepsia?
Functional dyspepsia, also known as indigestion, is a common stomach disorder affecting over 20% of people. It can be broken down into three types – epigastric pain syndrome, postprandial distress syndrome (PDS), and a combination of both. Each of these types comes about through different causes. This ailment is diagnosed based on the Rome IV criteria, which is a set of symptoms that include stomach pain, burning feeling, early feeling of fullness after eating, and feeling overly full after eating. To diagnose functional dyspepsia, other physical diseases need to be ruled out through imaging or endoscopy. In some cases, these symptoms can be severe enough to disrupt daily activities. Some people may also experience less common symptoms like nausea, vomiting, or heartburn.
If suitable, patients should be tested and treated for a type of bacteria called Helicobacter pylori. This bacteria can sometimes be the cause of the condition. Additional treatment is focused on managing the symptoms and can involve medications like proton pump inhibitors (PPIs), H2-receptor antagonists (H2RAs), drugs that assist with digestion (prokinetic agents), and antidepressants. If a person experiences more severe symptoms, like weight loss, trouble swallowing (dysphagia), or vomiting, they should undergo an endoscopy which is a procedure where a doctor uses a flexible tube with a camera to examine the digestive tract.
What Causes Functional Dyspepsia?
Functional dyspepsia, or recurring indigestion, can be caused by a variety of factors. This can include problems with the stomach’s movement, like an inability for the upper part of the stomach to expand properly, or delayed emptying of the stomach. It could also be due to a heightened sensitivity to gas and bloating.
Inflammation in the stomach and duodenum (the first part of the small intestine) might also lead to symptoms. There’s a possibility that the indigestion could be inherited, but it’s not as clear-cut as with other similar conditions like irritable bowel syndrome (IBS).
Mental health conditions and psychological states might also play a role in functional dyspepsia. However, it’s important to note that these are not unique to this condition, and generally play a smaller role compared to IBS.
Risk Factors and Frequency for Functional Dyspepsia
Functional gastrointestinal disorders are a common issue affecting nearly 40% of people all around the world. Functional dyspepsia is one type of these disorders, and its prevalence varies based on geographic location.
- In Western countries, including the United States, around 10% to 40% of people experience this condition.
- Globally, functional dyspepsia affects 5% to 11% of people.
- In Asian countries, the prevalence rate varies between 5% and 30%.
- It’s important to note that functional dyspepsia is more common in women than in men. This might be due to differences in hormone functions, pain signaling, and healthcare upkeep between the sexes.
Signs and Symptoms of Functional Dyspepsia
Functional dyspepsia is identified by specific symptoms that impact a person’s quality of life. The symptoms can range from mild to severe, be short or long-term, and can be classified into three types: epigastric pain syndrome, postprandial distress syndrome (PDS), or a combination of the two. Doctors use these symptoms to diagnose the condition, especially if the symptoms continue for three or more months starting at least six months before the diagnosis and no structural disease is present.
The recognized symptoms for a functional dyspepsia diagnosis according to Rome IV Criteria include:
- Feeling of fullness after eating
- Pain in the upper abdomen
- Burning sensation in the upper abdomen
- Feeling of fullness too soon while eating
Functional dyspepsia is then divided into two classifications: epigastric pain syndrome and PDS. Epigastric pain syndrome involves pain or a burning sensation in the upper abdomen. In contrast, PDS usually comes on after eating and includes feelings of fullness after meals and feeling satisfied too soon.
To diagnose epigastric pain syndrome, at least one of these symptoms must be severe enough to interfere with daily activities, occur at least once per week for three or more months, and start at least six months before diagnosis:
- Burning sensation in the upper abdomen
- Pain in the upper abdomen
Extra symptoms may include:
- Bloating, nausea, and burping after meals
- Pain that doesn’t qualify as gallbladder pain
- Pain that can be triggered or relieved by eating and may also occur when fasting
- Heartburn
PDS is diagnosed when at least one of these symptoms is severe enough to disrupt daily activities, happens at least three days per week for three or more months, and start at least six months before diagnosis:
- Feeling overly full after eating, which affects quality of life
- Feeling satisfied too quickly, preventing the completion of a typical-sized meal
Supporting symptoms may also include:
- Loss of appetite
- Nausea
- Dry heaving
- Persistently vomiting (though this may suggest another condition)
- Pain or burning in the upper abdomen after eating, similar to heartburn
- Upper abdominal bloating
- Excessive burping
- Heartburn
- Symptoms of irritable bowel syndrome (IBS) may also be present
However, it’s important to note that symptoms such as relief from passing gas or bowel movements are not typically considered as part of dyspepsia. Persistent vomiting could suggest another condition.
Testing for Functional Dyspepsia
Getting checked for health issues often begins with some general laboratory tests. These can include a blood count to see if you have the right number of cells, a comprehensive metabolic panel to test your organ function and blood chemicals, checking your thyroid function, screening for celiac disease (a condition where your body can’t process a protein called gluten), and looking for general signs of inflammation in your body. Because a type of bacterial infection called Helicobacter pylori (or H pylori for short) is pretty common – it’s found in roughly 1 in 10 people – doctors often recommend testing for this as well.
To get a closer look at things, doctors might do some examinations. These can include an esophagogastroduodenoscopy (EGD for short, a type of endoscopy where a small camera on a flexible tube is inserted through your mouth to look at your esophagus, stomach, and the start of your small intestine) as well as an ultrasound of your abdomen. The American College of Gastroenterology says that it’s a good idea for anyone over 60 to get an EGD, even if they don’t have any particular symptoms that might worry doctors. People under 60 might get an EGD if they have what doctors call “alarm symptoms”.
These are specific signs that could suggest a serious condition. They include losing weight without trying, having trouble swallowing, pain when swallowing, being constantly low on iron despite seemingly healthy diet and lifestyle, throwing up a lot, having a lump or swollen lymph nodes, or having a family history of certain types of gut cancer.
If the usual treatments aren’t working, doctors might order more specialized tests that are specifically tailored to the symptoms you’re having. In some cases, a condition known as functional dyspepsia (a type of digestion problem) is diagnosed, not just based on specific tests, but by taking a close look at your medical history and ruling out other conditions that might present the same way.
Treatment Options for Functional Dyspepsia
Treating functional dyspepsia, a condition characterized by chronic or recurrent pain or discomfort centered in the upper abdomen, can be challenging. The main goal of treatment is to alleviate symptoms. The first step in managing this condition is to educate the patient about their diagnosis and discussing what to expect from the treatment process.
H pylori, a type of bacteria that can infect the stomach, affects more than half of the world’s population and has been linked to conditions like chronic gastritis, peptic ulcers, stomach cancer, GERD, and functional dyspepsia. Getting rid of H pylori is therefore often recommended as the first course of treatment for functional dyspepsia. Treatments aimed at eradicating H pylori have been shown to provide some benefit in reducing symptoms. Checking for H pylori is commonly done during a procedure called an upper endoscopy. However, if an endoscopy was not done, then the existence of H pylori can be confirmed with a stool antigen test or a urea breath test. It’s important that the patient hasn’t taken any antibiotics for 4 weeks, and not used proton pump inhibitors (PPIs) for 1 to 2 weeks prior to the stool antigen test, to ensure accurate results.
There are various treatments used to get rid of H pylori, including:
Bismuth quadruple therapy, which includes the combined administration of different antibiotics and a PPI. Clarithromycin-based therapy involves different combinations of antibiotics and a PPI. Hybrid therapy involves a mix of antibiotics and a PPI. There’s also Levofloxacin-based therapy, which is recommended when it is confirmed that H pylori is sensitive to this antibiotic. Additionally, Vonoprazan-based regimens are a possible treatment approach.
If the initial H pylori treatment doesn’t work, other therapies may be used. A successful eradication of H pylori from the body may lead to reduced symptoms. After H pylori has been eradicated, treatment continues in two steps: first, a PPI or H2RA (drugs that reduce stomach acid) for at least 4 weeks, and then, if symptoms persist, possibly a tricyclic antidepressant or a prokinetic agent, which helps to speed up the movement of food through the stomach.
Patients who initially test negative for H pylori, and those with symptoms that persist 4 weeks after H pylori has been eradicated, are recommended to use PPIs for 4 to 8 weeks. In patients who find improvement with PPIs, therapy should be paused every 6 to 12 months to avoid long-term risks.
Further research is needed to determine the efficacy of H2RA treatment compared to PPI therapy, but several studies have shown it to be more effective than no treatment at all, showing a 23% reduction in symptoms.
Patients whose symptoms do not improve after the initial 8 weeks of PPI therapy may be considered for treatment with a low-dose tricyclic antidepressant. Additionally, prokinetic agents can be prescribed after other treatments have failed or when symptoms recur. These medicines are designed to help with gastric emptying and can reduce symptoms, but some patients may experience side effects that lead to discontinuation of therapy.
Finally, other therapies, such as psychotherapy, buspirone, dietary modifications or lifestyle changes, might be effective for some patients with Functional dyspepsia, although more data is needed to confirm their effectiveness.
What else can Functional Dyspepsia be?
When dealing with potential stomach or digestive problems, the doctor might consider the following conditions to arrive at the correct diagnosis:
- GERD (Gastroesophageal reflux disease)
- H pylori infection
- Gastritis
- Peptic ulcer disease
- Celiac disease
- IBS (Irritable bowel syndrome)
- Small intestinal bacterial overgrowth
- Chronic pancreatitis
- Gastroparesis (Slow stomach emptying)
- Acute cholecystitis (Gallbladder inflammation)
- Gastric carcinoma (Stomach cancer)
- Chronic abdominal pain
- Biliary pain (Pain from bile ducts)
- Hepatocellular carcinoma (Liver cancer)
- Mesenteric ischemia (Reduced blood supply to intestines)
- Giardiasis (Parasitic infection)
- Strongyloidiasis (Another type of parasitic infection)
- Sarcoidosis (Inflammatory disease affecting various organs)
What to expect with Functional Dyspepsia
Functional dyspepsia is a condition that involves recurring bouts of stomach discomfort or issues with digestion. These episodes can come and go, with periods where the symptoms are less severe mixed with times when they flare up. Some common methods of management include changes in lifestyle, taking medication, and at times, going through psychotherapy, which is a form of therapy targeted at the mind.
These techniques can help some people find substantial relief, but there are those who might continue to experience symptoms over a long time. Research shows that about half of the people diagnosed with functional dyspepsia still have symptoms a year after their diagnosis.
In one study, it was found that patients who have functional dyspepsia reported a similar quality of life as those who have peptic ulcer disease, a condition characterized by painful sores or ulcers developing on the lining of the stomach. However, their overall well-being was significantly worse than individuals without any stomach-related ailments.
Possible Complications When Diagnosed with Functional Dyspepsia
Functional dyspepsia, while not life-threatening, can cause considerable physical discomfort and emotional suffering, interfering with a person’s life quality. It’s been noted that patients dealing with functional dyspepsia often showcase signs of anxiety, depression, and somatization, as seen in psychometric tests.
Interestingly, about 10% to 25% of these patients feel that dyspepsia affects their social life to such an extent that they seek medical help. As a result, these patients tend to visit healthcare facilities more often. They also go through significant health deterioration and a reduction in their overall wellbeing and life quality.
Major Issues Faced by Patients:
- Physical discomfort
- Emotional distress
- Anxiety symptoms
- Depression symptoms
- Somatization symptoms
- Increased healthcare visits
- Significant health impairment
- Reduced quality of life
Preventing Functional Dyspepsia
It’s important to let patients know that this condition is not life-threatening and to set realistic expectations for ongoing care and treatment. Patients need to be aware of the need to report alarming symptoms at once, such as unexpected weight loss, continuous vomiting, or difficulty swallowing. They also need to understand that these symptoms may require further medical examination.
