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What is Functional Dyspepsia?

Functional dyspepsia (FD) is *kind of* like IBS for the upper gut, but with a few important differences!⁠⁠ ⁠⁠ I see a LOT of patients that have functional dyspepsia diagnosed with IBS. Not all functional gut disorders ARE IBS – and the distinction is important!⁠ Why?⁠⁠ Because management is different.. How do we manage it? Luckily – there is a LOT we CAN do, when we have the right diagnosis, with a lot of ‘tools in our toolkit’ including...

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 Why Is Functional Dyspepsia the New Hot Topic?

The situation is different for the counterpart of IBS in the upper gastrointestinal tract, functional dyspepsia (FD). The term is poorly recognized outside of the gastroenterology specialty, rarely used in communications with patients and virtually absent in the lay press. Lack of clear and stable symptom-based identity and lack of successful drug development have contributed to this orphan status, and this has been worsened by the ill-founded assumption, especially in the U.S.A., that upper gastrointestinal symptoms are mainly attributable to acid peptic disease and, in the absence of response to anti-secretory therapy, that the patient is likely to have gastroparesis.

Articles of Interest

Functional dyspepsia: How to manage the burn and the bloat

The pathophysiology of functional dyspepsia, like that of all disorders of gut-brain interaction, is poorly understood. However, there are clear associations with visceral hypersensitivity, disruptions of normal gastro duodenal motility, or both.

Diagnosis and Treatment of Functional Dyspepsia

Functional dyspepsia is a diagnosis of exclusion. Symptoms must be present for at least six months, and must include one of the following: early satiety, epigastric burning, and postprandial fullness. Two variants of functional dyspepsia are postprandial distress syndrome and epigastric pain syndrome.

Functional dyspepsia

Despite its strange-sounding name, functional dyspepsia is a common digestive disorder. Characteristic symptoms include stomach pain or heartburn, the feeling of an overfull stomach, discomfort, and nausea. Although not life-threatening, quality of life is affected by this disorder, in which the gut microbiota appears to be involved. Symptoms can be relieved by changing our diet or, potentially, by modifying the gut flora using probiotics.

Functional dyspepsia and gastroparesis: are they distinct disorders, a spectrum of diseases or one disease?

Functional dyspepsia (FD) and gastroparesis (GP) are clinically managed as distinct upper gastrointestinal conditions but present with symptoms that are often indistinguishable. FD is a common disorder of gut–brain interaction that negatively impacts quality of life, while GP is considered a rare disease exclusively defined by delayed gastric emptying and symptoms. The degree of overlap between these disorders makes them hard to differentiate in clinical practice, thereby impacting treatment decisions.

Functional Dyspepsia: A Review of the Symptoms, Evaluation, and Treatment Options

The diagnosis and treatment of functional dyspepsia is often clinically challenging due to factors such as the heterogeneity of upper gastrointestinal symptoms and the generalized poor response to currently available treatment options.

Functional Dyspepsia: Advances in Diagnosis and Therapy

Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux.

Functional dyspepsia: Causes, treatments, and new directions

Functional dyspepsia (FD) is a common condition, loosely defined by some physicians as a stomach ache without a clear cause. More specifically, it is characterized by the feeling of fullness during or after a meal, or a burning sensation in the mid-upper abdomen, just below the rib cage (not necessarily associated with meals). The symptoms can be severe enough to interfere with finishing meals or participating in regular daily activities. Those with FD often go through multiple tests like upper endoscopy, CT scan, and gastric emptying study. But despite often-severe symptoms, no clear cause (such as cancer, ulcer disease, or other inflammation) is identified.

Functional Dyspepsia: Current Understanding and Future Perspective

FD is a disorder of gut-brain interaction involving diverse pathophysiological mechanisms. Individualized treatment based on symptoms and responses to interventions is crucial. Further research is needed to improve the understanding of FD and advance the development of effective therapies.

Functional Dyspepsia: Evaluation and Management

Functional dyspepsia is defined as at least one month of epigastric discomfort without evidence of organic disease found during an upper endoscopy, and it accounts for 70% of dyspepsia. Symptoms of functional dyspepsia include postprandial fullness, early satiety, and epigastric pain or burning. Functional dyspepsia is a diagnosis of exclusion...

Low FODMAP diet improves symptoms in functional dyspepsia

“Functional dyspepsia is very prevalent with a prevalence of 7.2% worldwide and is divided into PDS, postprandial distress syndrome, and EPS, epigastric pain syndrome. Current treatment options for functional dyspepsia are based on initial therapy with acid suppressive drugs for EPS and prokinetic drugs for PDS, although the overall efficacy of treatment options is often very limited,” Karen Van den Houte, PhD, researcher at KU Leuven...

Overprescribing, functional dyspepsia and PPWhy’s?

Sometimes (often), it feels like us GP's can't do anything right. Whether that’s not seeing everyone in the whole world within two weeks, or hiding behind a telephone, now we’re also being told we’re vastly overprescribing our trusty friend the proton pump inhibitor (PPI), including long term for functional dyspepsia. So where does this latest charge come from, is it justified, and what should we be doing differently? What’s more, am I the only who’s not entirely sure what function dyspepsia actually is? Luckily, new research from the BJGP and long overdue guidance from the British Society of Gastroenterology are here to shed some light.

Prokinetics for functional dyspepsia

Due to low, or very low, quality of evidence, we are unable to say whether prokinetics are effective for the treatment of functional dyspepsia . We are uncertain which of the individual prokinetic drugs is the most effective as well as whether prokinetics can improve quality of life. Apart from cisapride, prokinetics are well‐tolerated. Good quality RCTs are needed to verify the efficacy of prokinetics.

Studying the Painful Story of Functional Dyspepsia

The food was ready. The aroma was mind-blowing. However, you couldn’t take a single bite because of stomach pain.

The Role of Diet in Functional Dyspepsia Management

Food is clearly a triggering factor for dyspeptic symptoms in the majority of patients. However, the relationships between nutrients, except for fat, or other specific foods and the onset or intensity of dyspeptic symptoms have been poorly evaluated, and there is a lack of high-quality evidence to guide dietary therapies in functional dyspepsia.

Treating Functional Dyspepsia: What Are Your Options?

While the definition of FD has changed somewhat over the years, the disorder is generally regarded as a group of symptoms thought to originate in the upper digestive tract (stomach and upper small intestine) in the absence of any structural or metabolic disease likely to explain the symptoms. Frustratingly, symptoms of FD do not reliably guide therapy.

What Causes Your Bloating?

Interestingly, a series of studies over the past few years have been working on figuring out the CAUSE of distension, and it may not be what you think! Bloating from fermentation happens (or should happen) in the colon, where the majority of your bacteria live. Those bacteria break down what we can’t – fermentable carbohydrates! This creates gas, bloating and distension, and if the expansion is enough or you have IBS, can also trigger pain. This type of bloating typically takes place ~2-8 hours after you’ve eaten, depending on what you’ve eaten. However, I frequently see in my practice, patients that complain of ‘instant’ bloating – within 15 minutes of eating, and usually not from consuming fermentable carbohydrates. Many times I see patients jump RIGHT to #SIBO as the culprit. BUT! Research suggests that is less likely to be the case. In fact, in a new 2019 study, they were able to show that those that experience frequent bloating and distension have bloating not from food, but uncoordinated abdominal wall muscles.

Resources

Australian Prescriber

Functional dyspepsia is characterised by troublesome early satiety, fullness, or epigastric pain or burning. It can easily be overlooked as the symptoms overlap with gastro-oesophageal reflux disease and irritable bowel syndrome. Diagnosis is clinical, however it requires exclusion of structural gastrointestinal disease. The presence of red flags, such as weight loss or anaemia, should prompt investigation including gastroscopy.

GI Society

Functional dyspepsia is a common, long-recognized condition with a number of upper abdominal symptoms. Although diagnosing this condition can sometimes be challenging, due to the variable nature of symptoms, the prognosis for functional dyspepsia is good. There is no evidence that it leads to cancer or other serious disease. Theories as to its cause are multiple but a minor muscle motility disturbance is most likely. Typically, successful therapy involves dietary discretion and short courses of medication.

GutsUK

Functional dyspepsia, the most common cause of dyspepsia symptoms, is ultimately diagnosed in 8 out of 10 cases of indigestion. Around the world, 7 in every 100 people have functional dyspepsia. There are more women than men living with functional dyspepsia in the UK. There are a slightly higher number of adults diagnosed between the ages of 18 to 39 years, compared with older age groups.

National Library of Medicine

Functional (previously nonulcer) dyspepsia (FD) is the focus of this review, and usually indicates abdominal discomfort or pain with no obvious organic cause that could be identified by endoscopy.

Squarespace

Functional dyspepsia is a condition that causes discomfort in the epigastric (stomach) area. This can include stomach pain, nausea, vomiting, bloating, or feeling full quickly after eating. People with functional dyspepsia have usually had a normal endoscopy and normal testing for infections (like H. pylori). This is because functional dyspepsia is a disorder of gut sensation or motility, not a problem with the lining of the stomach.

StatPearls

Functional dyspepsia is a common and benign gastrointestinal disorder that presents similarly to other conditions, making it difficult to diagnose. This condition is characterized by symptoms such as epigastric pain or burning, early satiety, and postprandial fullness, without any structural abnormalities detected via imaging or endoscopy. Functional dyspepsia affects over 20% of the population and is diagnosed based on symptom-based Rome IV Criteria.