Functional dyspepsia

What is functional dyspepsia?

Functional dyspepsia is sometimes called non-ulcer dyspepsia. It is characterised by recurring or persistent pain or discomfort in the upper abdomen, often accompanied by symptoms such as bloating, feeling full quickly after eating, and nausea.

It means that no known cause can be found for the symptoms. That is, other causes for dyspepsia such as duodenal ulcer, stomach ulcer, acid reflux and oesophagitis, inflamed stomach (gastritis) and eosinophilic oesophagitis are not the cause.

How common is functional dyspepsia?

It is the most common cause of dyspepsia. It affects 7 in 100 people. About 6 in 10 people who have repeated (recurring) bouts of dyspepsia have functional dyspepsia.

Symptoms of functional dyspepsia

• Upper abdominal pain, which might feel like burning.

• Feeling sick (nausea).

• Feeling bloated.

• Feeling full after eating regular sized meals.

• Burping (belching).

What causes functional dyspepsia?

The symptoms seem to come from the upper gut but the cause is not known. If you have tests, nothing abnormal is found inside your gut. The lining inside your gut looks normal and is not inflamed. The amount of acid in the stomach is normal.

The following are some theories as to possible causes:

• Sensation in the stomach or the first part of the small intestine (the duodenum) may be altered in some way - an 'irritable stomach'. About one in three people with non-ulcer dyspepsia also have irritable bowel syndrome and have additional symptoms of lower tummy (abdominal) pains, erratic bowel movements, etc. The cause of irritable bowel syndrome is not known.

• A delay in emptying the stomach contents into the duodenum may be a factor in some cases. The muscles in the stomach wall may not work as well as they should.

• Infection with a germ (bacterium) called H. pylori may cause some cases.

• Some people feel that certain foods and drinks may cause the symptoms or make them worse. It is difficult to prove this and food is not thought to be a major factor in most cases. Those foods and drinks which have been suspected of causing symptoms or making symptoms worse in some people include:

  • Tomatoes.

  • Chocolate.

  • Spicy foods.

  • Fatty foods.

  • Hot drinks.

  • Coffee.

  • Alcoholic drinks.

• Anxiety, depression, or stress are thought to make symptoms worse in some cases.

• You are more likely to suffer from functional dyspepsia if you have a family history of it (if close relatives are also affected). There is likely to be a genetic cause in some people.

• A side-effect of some medicines can cause dyspepsia:

  • The most common culprits are anti-inflammatory medicines such as ibuprofen and aspirin.

  • There are various other medicines which sometimes cause dyspepsia, or make dyspepsia worse. These include antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines, and bisphosphonates. (Note: this is not an exhaustive list. Check with the leaflet that comes with your medication for a list of possible side-effects.)

  • If you suspect a prescribed medicine is causing the symptoms, or making them worse, speak with your doctor to discuss possible alternatives.

How is functional dyspepsia diagnosed?

Gastroscopy (endoscopy)

Strictly speaking, functional dyspepsia is a diagnosis that is made only when no other cause can be found for the symptoms (such as an ulcer). Therefore, prior to the diagnosis being made you may have had a gastroscopy (endoscopy).

In this test a doctor looks inside your stomach and the first part of your small intestine (the duodenum) by passing a thin, flexible telescope down your gullet (oesophagus). If you have non-ulcer dyspepsia, the inside of your gut looks normal. However, most people with dyspepsia do not have an endoscopy.

See the separate leaflet called Indigestion (Dyspepsia) for an overview of dyspepsia and when tests are advised.

Helicobacter Pylori test

A test to detect the Helicobacter pylori (H. Pylori) germ (bacterium) may be done. This test might be a stool test, blood test or breath test. If this bacteria is found then it may be causing the symptoms. See the separate leaflet called Helicobacter Pylori for more details about H. pylori and how it can be diagnosed and treated.

Other tests

Usually other tests are not necessary. But if you have other symptoms, your doctor might order further tests, such as an ultrasound scan or blood tests, or refer you to a specialist clinic. If you are referred to a specialist clinic other tests may include a CT scan, barium swallow or barium meal or a hydrogen breath test.

Treatment for functional dyspepsia

Reassurance and explanation

This is often helpful. Some people worry that they may have a serious disease such as stomach cancer. Worry and anxiety can make symptoms worse. It may be useful to know that you have functional dyspepsia and not some other disease. However, you will have to accept that pain, discomfort and other dyspeptic symptoms are likely to come and go.

Clearing Helicobacter. pylori infection

If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, infection with H. pylori is probably a coincidence rather than a cause in most cases of functional dyspepsia.

Acid-suppressing medicines

A one-month trial of medication that reduces stomach acid is often advised. This helps in some cases but not all. It may work because the lining of your stomach may be extra sensitive to the acid. See the separate leaflet called Indigestion Medication for more information.

Behavioural therapy

The symptoms of functional dyspepsia can be affected by psychological factors. Psychological treatments such as cognitive-behavioural therapy (CBT), gut-directed hypnotherapy and psychodynamic psychotherapy may be helpful. These treatments are not always available on the NHS.

Lifestyle changes

The National Institute for Health and Care Excellence (NICE) recommends the following lifestyle changes:

• Eat smaller meals and eat your evening meal 3-4 hours before going to bed.

• Lose weight, if you are obese.

• If you are a smoker, consider giving up.

• Don't drink too much alcohol.

What is the outlook for functional dyspepsia?

Most people's symptoms improve with treatment and become better over time. If you are on long term acid-suppressing medicine, you should have a review with your doctor once a year. A small number of people have long term dyspepsia. In cases where the symptoms do not settle, referral to a specialist clinic may be helpful.