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Functional Dyspepsia

WHAT IS FUNCTIONAL DYSPEPSIA?

Functional dyspepsia is a condition when there is pain or discomfort in the epigastric area with no known cause. The epigastric area is the upper part of your stomach area, just below your chest.

Symptoms can greatly affect your quality of life and activities of daily living. The pain may be severe enough to cause you to take time away from work or to change how you eat.

SYMPTOMS OF DYSPEPSIA

Common symptoms of functional dyspepsia include:

  • Epigastric pain

  • Epigastric fullness

  • Epigastric burning

 

You may also experience:

  • Nausea

  • Belching/burping

  • Heartburn

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RISK FACTORS

  • female sex

  • increasing age

  • smoking

  • previous or current stomach infection called H. pylori

  • nonsteroidal anti-inflammatory (NSAID) drug use (examples: ibuprofen, aspirin)

ALARM FEATURES

Vomiting, excessive and unintended weight loss, signs and symptoms of bleeding, and difficulty swallowing are not common symptoms of functional dyspepsia.  See your healthcare provider for further assessment.

DIAGNOSIS

Your healthcare provider will do a detailed review of your health and symptoms. Depending on your age and health history, your doctor may arrange for you to have a gastroscopy or upper endoscopy. This is a procedure where a long flexible camera is inserted into your mouth and passed down into your esophagus (food pipe) and stomach. The doctor will check if there is a cause for your dyspepsia. A gastroscopy will show a normal esophagus and stomach in functional dyspepsia.

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Functional dyspepsia is diagnosed based on one or more of the following symptoms that started at least 6 months ago:

  1. Bothersome fullness after a meal

  2. Bothersome early fullness when eating a meal

  3. Bothersome epigastric pain

  4. Bothersome epigastric burning

POTENTIAL CAUSES

The digestive system is lined with a network of nerves that send signals to the brain called the brain-gut axis.  The nerves surrounding the stomach send signals to the brain when food is about to enter the stomach. This causes the walls of the stomach to relax so food can enter. When the nerves do not communicate appropriately, it disturbs the way the stomach muscles relax and tighten. This can cause a sensation of and you may feel like the food is not going down into your stomach. The nerves lining the stomach can also be sensitive to stomach expansion and acidity. This can cause symptoms of functional dyspepsia.
 

A stomach bacterial infection called H. pylori has been linked with dyspepsia. Clearing the infection can help with symptoms of dyspepsia.
 
Long term use of medications called nonsteroidal anti-inflammatory drugs (NSAIDs) may cause dyspepsia since they can irritate the stomach.

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Chronic stress and/or a history of depression, and anxiety have also been linked with functional dyspepsia. Various stressors can cause or worsen dyspepsia symptoms.

TREATMENT

There are medications to treat dyspepsia but lifestyle changes also play a big role in managing symptoms. It is important to work closely with your healthcare provider to determine which therapy or combination of treatments will best manage your symptoms.

 

Small frequent meals are recommended to help ease dyspepsia symptoms. High fat foods should be avoided because they take longer to digest and can worsen symptoms. Avoiding or decreasing intake of alcohol, caffeine, and smoking can also help improve symptoms.

 

If you take nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen) on a daily basis, check with your healthcare provider to see if this is necessary or if another option can be considered.

 

A test to check for H. pylori can be ordered by your healthcare provider. This test can be done during the gastroscopy or through a breath test. If the results are positive, the infection will need to be treated and this may eliminate dyspepsia symptoms. You will need to retest for H. pylori infection about 8 weeks after completing treatment to ensure it has been cleared.

 

If symptoms don’t improve after treatment, your healthcare provider may consider starting you on medications for dyspepsia. One group of medication is called proton pump inhibitors (PPI) and works by lowering the amount of acid your stomach makes.

 

Low doses of neuromodulators have shown to improve gut pain from dyspepsia. These medications decrease the sensitivity of the nerves surrounding the gut which can decreases pain. Other neuromodulators have also shown to help with stomach relaxation, allowing food to easily enter the stomach.

 

Working with a psychologist trained in cognitive behavioural therapy (CBT) or mindfulness based therapy (MBT) has shown to be helpful. Stress can worsen dyspepsia symptoms and the techniques in CBT and MBT focus on symptom control and can teach you how to develop coping strategies.

 

It is important to have regular follow-up with your healthcare provider to see what treatments work for you. It may require a few tries to see which one or combination of treatments is effective in managing your symptoms.

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