Understanding & Diagnosing Functional Dyspepsia

Functional dyspepsia (FD) is a chronic symptom complex characterized by epigastric pain or burning, bothersome postprandial fullness, or early satiation without a definitive organic cause.¹ Many patients with FD also experience other troublesome symptoms, including nausea, bloating, belching, and heartburn.² FD has been subdivided into meal-related dyspepsia, or postprandial distress syndrome (PDS), and meal-unrelated dyspepsia, or epigastric pain syndrome (EPS); however, overlap between the two conditions has been reported.³

FD is one of the more common functional disorders, with a prevalence of 10-20% of the population.⁴

Since dyspepsia may present with a multitude of symptoms, FD is a diagnosis of exclusion. Clinicians are encouraged to look for red flags that are clinical indicators of a possible serious underlying condition.^1,5 Yet on diagnostic work-up, only 20-30% of patients with FD are found to have frank diseases that account for their symptoms.⁴ The pathogenesis of FD is unclear, but may be associated with:^6-8

• Socio-psychological factors such as stress, anxiety, depression, and stressful interpersonal relationships.
• Biological mechanisms such as gastroduodenal dysfunction and inflammation, impaired duodenal mucosal integrity, and visceral hypersensitivity.

Treatment strategies – modifiable lifestyle factors

The impaired quality of life of patients with this condition implies the need for a definitive diagnosis followed by treatment for the duration of the symptomatic interval. However, the causes of FD are varied and complex, resulting in nonstandard, limited, and potentially inefficient pharmaceutical-based therapeutic options.^3,7 Consideration of a patient’s lifestyle patterns and habits is critical for a successful treatment strategy. Sleep dysfunction and disorders are common in patients with FD,^2,6 which may exacerbate other symptoms and reduce quality of life. Psychiatric comorbidities such as depression and anxiety are another feature of functional gastrointestinal (GI) disorders like dyspepsia,⁹ and implementing either sleeping or psychological therapies may help reduce FD symptoms.⁶

Stress and social support

Research suggests that anxiety often precedes the onset of FD, specifically PDS rather than EPS,^2,10 and that FD may lead to an increase in anxiety levels, regardless of the type of disease. A 2019 cross-sectional study compared depression and anxiety levels of patients diagnosed specifically with either PDS or EPS with healthy volunteers and found increased anxiety for both EPS and PDS patients.¹¹ But those with PDS showed significantly lower rates of general health and social functioning in addition to elevated depression levels compared to patients with EPS.¹¹