- Functional dyspepsia is a common gastrointestinal disorder characterized by chronic or recurrent upper abdominal discomfort or pain without any identifiable structural or biochemical abnormalities on routine testing. It is considered a type of functional gastrointestinal disorder, meaning that the symptoms arise from altered motility or sensitivity of the gastrointestinal tract rather than from a visible disease or damage. Functional dyspepsia can significantly affect a person’s quality of life, often causing distress, anxiety, and disruptions in daily activities.
- The symptoms of functional dyspepsia include early satiety (feeling full after eating a small amount), postprandial fullness (a prolonged sense of stomach fullness after meals), upper abdominal bloating, epigastric pain or burning, nausea, and belching. These symptoms often overlap with those of other digestive disorders, making diagnosis a process of exclusion. Unlike peptic ulcer disease or gastritis, no ulcers, erosions, or inflammation are found on endoscopy in patients with functional dyspepsia.
- Although the exact cause of functional dyspepsia is not fully understood, several contributing factors have been identified. These include abnormal gastric motility, visceral hypersensitivity (increased sensitivity of the stomach to distension), delayed gastric emptying, and disturbances in the gut-brain interaction. Psychological factors such as stress, anxiety, and depression also appear to play a role in symptom development and severity. In some cases, functional dyspepsia may follow an episode of acute gastrointestinal infection, a condition referred to as post-infectious dyspepsia.
- Diagnosis of functional dyspepsia is made based on symptom criteria, such as the Rome IV criteria, and the exclusion of organic diseases through investigations like upper gastrointestinal endoscopy, blood tests, and imaging if necessary. The Rome IV criteria require that symptoms be present for at least three months, with onset at least six months prior to diagnosis, and without evidence of structural disease.
- Treatment of functional dyspepsia involves a combination of lifestyle changes, pharmacologic therapy, and psychological support. Patients are encouraged to eat smaller, more frequent meals, avoid fatty and spicy foods, reduce caffeine and alcohol intake, and manage stress. Medications commonly used include proton pump inhibitors (PPIs), H2-receptor antagonists, prokinetic agents (to improve gastric emptying), and occasionally antidepressants, particularly low-dose tricyclic antidepressants or SSRIs, which can help modulate visceral sensitivity. In cases where psychological stress is a prominent factor, psychological interventions such as cognitive-behavioral therapy (CBT) or relaxation techniques may be beneficial.
- Although functional dyspepsia does not lead to serious complications or structural damage to the gastrointestinal tract, it can be a chronic and relapsing condition. Management focuses on improving symptom control and enhancing the patient’s quality of life. A supportive doctor-patient relationship and a comprehensive, individualized approach are essential for successful long-term management.
