Functional Dyspepsia (Non-Ulcer Stomach Symptoms)

If you have repeated bouts of indigestion and stomach pain, have gone through a battery of tests and its all come up clear yet your symptoms persist then you could have what is known as functional dyspepsia. it is a relatively common problem yet it is not widely known. The exact cause is still unknown and there is no known cure or definitive preventative measures.

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What is functional dyspepsia?

Functional dyspepsia is a condition where there are stomach symptoms like pain and bloating but it is not related to any identifiable stomach disease. In other words there may be no underlying cause like gastritis or peptic ulcers, hence the term non-ulcer dyspepsia. The term dyspepsia is also used interchangeably with indigestion. It is a common condition and estimates are that 1 out of 4 adults will experience functional dyspepsia at least once a year.

There are many different types of functional disorders like irritable bowel syndrome. A functional disorder does not mean that it is an ‘imaginary’ or psychogenic in nature. Instead there is no clearly identifiable pathology (disease mechanism) to explain the symptoms yet it does exist and affects a person’s quality of life. Although we usually associate indigestion with short term discomfort, some cases of functional dyspepsia can be long lasting.

Causes of Functional Dyspepsia

Gastritis and peptic ulcers are two of the common stomach conditions that lead to symptoms like pain, bloating, fullness after eating a few bites, excessive belching and nausea. However, in non-ulcer or functional dyspepsia these symptoms can still be present despite the lack of gastritis, peptic ulcer disease or other stomach-related conditions. The exact reason for functional dyspepsia is unclear but is not related to any disease. Hence it is a functional disorder.

As with certain other functional gastrointestinal disorders, it is believed to be due to disordered physiological activities like abnormal movement of food through the stomach, increased pain perception by the stomach nerves (visceral hypersensitivity) and alterations in gastrointestinal activity asĀ  result of psychological responses. This complex interplay of factors is also seen in conditions like irritable bowel syndrome (IBS).

Risk Factors

There are certain factors that may contribute to functional dyspepsia. However, it is important to note that these factors do not cause the condition but may simply aggravate it. Risk factors associated functional dyspepsia include:

  • Tobacco smoking
  • Excess intake of alcohol
  • Excess consumption of caffeinated drinks
  • Certain medication such as aspirin and ibuprofen.

It is important to note that many of these factors also play a role in other functional gastrointestinal conditions like irritable syndrome. Similarly it also tends to aggravate gastritis and peptic ulcers. The role of psychological stress is still unclear but does seem to contribute to an exacerbation of symptoms in some cases.

Signs and Symptoms

The symptoms of functional dyspepsia include:

  • Burning sensation or discomfort in the upper abdomen or lower chest.
  • Excessive belching.
  • Abdominal bloating.
  • Feeling of fullness when eating.
  • Nausea.

These symptoms are similar to a host of other gastrointestinal conditions and it is often difficult to differentiate between conditions. While it may arise with trigger factors like excessive eating or certain foods and drinks, in functional dyspepsia these symptoms can also arise on its own and persist for long periods of time that does not correlate with dietary or lifestyle triggers.

Abdominal cramps

Diagnosis of Functional Dyspepsia

A number of different tests need to be conducted before functional dyspepsia is confirmed. The purpose of these tests are to identify underlying pathology that may be the cause of the symptoms. Investigations include:

  • Blood tests
  • Breath test for H.pylori infection
  • Stool tests
  • Upper gastrointestinal endoscopy and sometimes a biopsy

Once these investigations exclude known pathologies, then functional dyspepsia is diagnosed. It is important to note that diagnosing functional dyspepsia without conducting these tests may be an inaccurate diagnosis as various pathologies may be missed within these investigations.

The presence of bloody vomit and dark tarry stools (melena) indicates bleeding with the upper digestive tract and not due to functional dyspepsia. It needs to be immediately investigated and treated.

Treatment of Functional Dyspepsia

As with most functional disorders, there is no known cure and treatments may not always yield lasting results as the exact cause is unknown. Many people find that there symptoms ease with antacids raising the concern about conditions like gastritis and peptic ulcers that also ease with antacids. However, in functional dyspepsia it is believed that the stomach lining is hypersensitive to the presence of acid without the inflammation seen in gastritis or open sores (ulcers) seen in peptic ulcer disease.

Medication for functional dyspepsia includes:

  • Antacids that neutralize the stomach acid.
  • Proton pump inhibitors and H-2 receptor blockers to reduce gastric acid production.
  • Simethicone to relieve gas in the digestive tract.
  • Prokinetic agents like metoclopramide to speed up gastric emptying.
  • Tricyclic antidepressants to ease pain associated with increased nerve activity.

As mentioned, psychological stress may exacerbate symptoms although its exact role is unclear. Therefore treatment may include behavior therapy and counseling to learn relaxation techniques and better coping skills to deal with stress.

Prevention and Diet

There is no specific diet that can be used for all cases of functional dyspepsia in order to provide relief. However, the following measures may prove helpful.

  • Stop tobacco smoking, reduce alcohol intake or stop it altogether and minimize the intake of foods and beverages containing caffeine.
  • Keep a food diary to identify trigger foods which can vary among individuals. These trigger foods should then be avoided or minimized.
  • Ensure regular meals that are small in size. It is usually better to eat many small meals than a few large meals in a day. Do not skip meals.
  • Eat slowly and chew food thoroughly. This will prevent excessive air swallowing (aerophagia) and pronounced distension of the stomach which can lead to symptoms like excessive belching and bloating respectively.
  • Take a walk after eating. This can assist with gastric emptying and may also help with symptoms of reflux which some people experience.
  • Manage stress effectively with relaxation techniques that prove to be helpful. Physical activity like sports may have multiple benefits when it comes to functional dyspepsia.

References:

  1. www.mayoclinic.org/diseases-conditions/stomach-pain/basics/definition/con-20027306
  2. www.medscape.com/viewarticle/444547

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