functional dyspepsia

Introduction

At least 3 months of pain or discomfort centered in the upper abdomen, without clinical, endoscopic, or ultrasonographic evidence of known organic disease likely to explain the symptoms.

Etiology

(differential diagnosis)

• gastroesophageal reflux disease (GERD)*
• irritable bowel syndrome (IBS)*
• peptic ulcer disease (PUD) is an uncommon cause
• gallstones

* 75% of cases are due to GERD &/or IBS

Pathology

• dysfunctional gastric acid secretion
• gastrointestinal dysmotility -> gastroparesis*
• psychosocial factors

* essentially the same disorder as gastroparesis

Clinical manifestations

• ulcer-like dyspepsia
  • epigastric pain
  • relieved by food
  • relieved by antacids or H2 receptor antagonists
  • occurs before meals or when hungry
  • awakens patients from sleep
  • periodic: weeks to months with pain with intermittent remissions of weeks without pain
• dysmotility-like dyspepsia
  • abdominal discomfort (pain is infrequent)
  • early satiety
  • postprandial fullness
  • nausea
  • recurrent wretching or vomiting
  • bloating in the upper abdomen, not accompanied by visible distension
  • upper abdominal discomfort often aggravated by food
  • gastroparesis*

* essentially the same disorder as gastroparesis

Diagnostic criteria

• bothersome postprandial symptoms
• early satiety
• epigastric pain &/or burning
• symptoms for past 3 months
• symptom onset at least 6 months previously
• no evidence of structural disease to explain symptoms

Laboratory

• endoscopy
• 24 hours esophageal pH monitoring
• serology for Helicobacter pylori

Management

• diet & lifestyle modification
• benefit proton pump inhibitor short-lived
  • benefit at 4 weeks, but not at 8 weeks
• low-dose tricyclic antidepressant if poor response to once daily proton pump inhibitor
• cognitive behavioral therapy
• probiotics Bacillus subtilis & Bacillus coagulans may be of benefit

More general terms

• dyspepsia (indigestion)

Additional terms

• cholelithiasis (gallstones)
• gastroesophageal reflux disease (GERD)
• gastroparesis
• Helicobacter pylori
• irritable bowel syndrome (IBS)
• peptic ulcer disease (PUD)