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What is functional dyspepsia?
Functional dyspepsia (FD) is a chronic sensory and peristalsis problem of the digestive tract. Peristalsis is the normal downward pumping and squeezing of the esophagus, stomach, and duodenum. We call this disorder ‘functional’ because there are no observable or measurable structural abnormalities found to explain persistent symptoms. You might hear other terms used to describe this condition such as non-ulcer dyspepsia, pseudo-ulcer syndrome, pyloroduodenal irritability, nervous dyspepsia, or gastritis. Around 20-29% of Canadians have FD but only a small number will consult a doctor. FD does not lead to cancer or other serious illness.
What are the symptoms?
The disturbed motility present in FD leads to amplified sensation in the upper gut (visceral hyperalgesia). This is due to uncoordinated and even ineffectual emptying of the upper gut, with resulting symptoms of pain, fullness, and bloating, and an inability to finish meals. Other common symptoms of FD include heartburn, sour taste in mouth, excessive burping, nausea, and sometimes vomiting. Characteristically, these complaints are sporadic, poorly localized, and without consistent aggravating or relieving factors. The vast majority of patients experience more than one symptom. FD may come and go, and symptoms could present with increased severity for several weeks or months and then decrease or disappear entirely for some time.
In the past, some doctors would have diagnosed peptic ulcer disease in a patient complaining of epigastric (upper middle abdominal pain) and nausea. Now, using such investigative tools as detailed barium x-rays or endoscopy, physicians can quickly rule out an ulcer diagnosis. In fact, twice as many persons will not have an ulcer as will have one in this grouping of dyspeptic people.
What causes functional dyspepsia?
The cause of FD is unknown; however, several hypotheses exist to explain this condition. Excessive acid secretion, inflammations of the stomach or duodenum, food allergies, lifestyle and diet influences, psychological factors, medication side effects (from drugs such as non-steroidal anti-inflammatory drugs and aspirin), and Helicobacter pylori infection have all had their proponents. Unfortunately, none can be consistently associated.
How is functional dyspepsia diagnosed?
A physician forms a diagnosis of functional dyspepsia when there is no evidence of structural disease and when there has been at least three months, with onset at least six months previously, of one or more of the following:
bothersome post-meal (postprandial) fullness
early satiation
epigastric pain
epigastric burning
The role of investigations and testing in FD is often misunderstood. All conventional testing produces normal results because dysmotility is difficult to confirm with our current technology. Frequently, people conclude that a normal result on x-ray or endoscopy means that nothing is wrong, which can lead to anger or frustration because they continue to experience very real symptoms.
How is functional dyspepsia treated?
Diet & Lifestyle: The treatment of FD is variable. Although no evidence directly links specific foods to functional dyspepsia, it does make sense to limit or avoid foods where a symptom effect is obvious on an individual basis. Some patients have reported increased FD symptoms when consuming excessive amounts of milk, alcohol, caffeine, fatty or fried foods, mint, tomatoes, citrus fruits, and some spices. After meals, it may help to avoid lying down for at least two hours. When you do lie down, it would be best to raise the head of your bed by about six to eight inches. Regular eating times with avoidance of large meals and rapid eating are important to normalize upper gut motility.
Neutralize acid: Many people find that non-prescription antacids (which neutralize acid in the esophagus and stomach) can provide quick, temporary, and/or partial relief. Antacids are short acting and do not prevent heartburn. Over the counter antacid medication such as Maalox®, Tums®, Rolaids® and bismuth (Pepto-Bismol®) may help initially. If you find you use antacids for more than 3 weeks, then consult a physician.
Block acid production: If the above milder measures do not work for you, there are some other options. These two classes of medication block acid production:
Histamine receptor antagonists (H2RAs) work by blocking the effect of histamine, which stimulates certain cells in the stomach to produce acid. These include cimetidine (Tagamet®), ranitidine (Zantac®), famotidine (Pepcid®), and nizatidine (Axid®). H2RAs are all available as prescription medications and some are available in a lower dose, over-the-counter without a doctor’s prescription.
Proton pump inhibitors (PPIs) are a newer class of medication. They work by blocking an enzyme necessary for acid secretion. These include omeprazole (Losec®), lansoprazole (Prevacid®), pantoprazole (Pantoloc®), esomeprazole (Nexium®), and rabeprazole (Pariet™). In Canada, PPI medications are available only with a prescription.
Some therapies promote downward emptying of the esophagus and stomach and include metoclopramide and domperidone maleate (Motilium®).
Newer research shows some phyto-pharmaceuticals (plant medicine), such as Iberogast®, effective in treating functional dyspepsia.
Summary
Functional dyspepsia is a common long-recognized condition, leading to a variety of upper abdominal complaints, which has no clear, specific diagnostic feature. Although diagnosis can sometimes be challenging, due to the variable nature of symptoms, the prognosis for functional dyspepsia is good since it does not lead to cancer or other serious disease, and effective treatments exist. Theories as to its cause are multiple but a minor muscle motility disturbance is most likely. Therapy involves dietary discretion and short courses of medication.
Are you taking prescription medication for any of the following stomach problems/symptoms:
Stomach pain or discomfort
Heartburn
Sour taste in mouth/acid regurgitation
Excessive burping/belching
Increased abdominal bloating
Nausea
Early satiety
If you answer yes to any one of the symptoms listed above then take this test to see if your current medication is adequately controlling your stomach symptoms.
The PASS Test
PPI* Acid Symptom Suppression Test
*PPI is short for proton pump inhibitor, a class of medication used to suppress the acid in your stomach. These include Losec®, Nexium®, Pantoloc®, Pariet™, and Prevacid®.
