Summary about Disease
Functional dyspepsia (FD) is a chronic disorder characterized by persistent or recurrent symptoms of indigestion that are not attributable to structural or biochemical abnormalities. It's essentially indigestion with no identifiable underlying cause, like ulcers or cancer. Symptoms often include postprandial fullness, early satiation, epigastric pain, and epigastric burning. It significantly impacts quality of life but is not life-threatening.
Symptoms
The main symptoms of functional dyspepsia include:
Postprandial fullness: Uncomfortably full feeling after eating a normal-sized meal.
Early satiation: Feeling full very quickly during a meal, preventing you from finishing it.
Epigastric pain: Pain in the upper middle part of the abdomen (the epigastric region).
Epigastric burning: A burning sensation in the same area. Other symptoms can include:
Bloating
Nausea
Vomiting (less common)
Causes
The exact cause of functional dyspepsia is unknown. However, several factors are believed to play a role:
Gastric motility issues: Problems with the stomach's ability to empty its contents properly.
Visceral hypersensitivity: Increased sensitivity to pain and discomfort in the stomach.
Helicobacter pylori (H. pylori) infection: Although not a direct cause in all cases, infection with this bacteria can sometimes trigger or worsen symptoms.
Psychological factors: Stress, anxiety, and depression are often associated with FD and can exacerbate symptoms.
Dietary factors: Certain foods may trigger symptoms in some individuals.
Increased acid production: Some individuals may produce too much stomach acid.
Brain-gut interaction: Problems in the communication between the brain and the digestive system.
Genetics: Some studies indicate genetics may play a role.
Medicine Used
Treatment for functional dyspepsia focuses on symptom management. Medications commonly used include:
Proton pump inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, lansoprazole).
H2 receptor antagonists: Also reduce stomach acid production (e.g., ranitidine, famotidine).
Note: Ranitidine has been withdrawn from many markets due to safety concerns. Consult with a doctor before using any H2 receptor antagonist.
Prokinetics: Help speed up stomach emptying (e.g., metoclopramide, domperidone). Note: Use of these medications is limited due to potential side effects. Consult with a doctor before using any prokinetic agent.
Antidepressants: Tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help manage pain and psychological factors.
Antiemetics: Reduce nausea and vomiting (e.g., ondansetron).
Antibiotics: If H. pylori infection is present, antibiotics are used to eradicate the bacteria.
Other: Some studies have shown benefit in using peppermint oil, Iberogast, and other herbal remedies. Consult a doctor before using any herbal remedies, as they can have side effects and interactions with other medications.
Is Communicable
Functional dyspepsia is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
While there's no single "cure," these precautions can help manage symptoms:
Dietary modifications:
Avoid trigger foods (spicy, fatty, or acidic foods, caffeine, alcohol).
Eat smaller, more frequent meals.
Eat slowly and chew food thoroughly.
Avoid eating late at night.
Stress management:
Practice relaxation techniques (meditation, deep breathing, yoga).
Get regular exercise.
Seek therapy if needed.
Lifestyle changes:
Quit smoking.
Limit alcohol consumption.
Maintain a healthy weight.
Avoid NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can irritate the stomach.
Sleep Hygiene: Ensure adequate sleep, as sleep disturbances can worsen symptoms.
How long does an outbreak last?
Functional dyspepsia is a chronic condition characterized by intermittent flares of symptoms. It is not an outbreak in the traditional sense. Individual episodes of increased symptom severity can last for days, weeks, or even months. There may be periods of remission where symptoms are minimal or absent.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical exam: The doctor will ask about your symptoms, medical history, and medications.
Exclusion of other conditions: Tests are performed to rule out other possible causes of indigestion, such as:
Upper endoscopy: A thin, flexible tube with a camera is inserted into the esophagus, stomach, and duodenum to visualize the lining and check for abnormalities.
Blood tests: To check for H. pylori infection, anemia, and other conditions.
Stool test: To check for H. pylori infection.
Gastric emptying study: To assess how quickly the stomach empties its contents. If no other cause is found for the symptoms and the Rome IV criteria are met, a diagnosis of functional dyspepsia is made.
Rome IV Criteria: Must include one or more of the following symptoms for at least 3 months with symptom onset at least 6 months prior to diagnosis:
Bothersome postprandial fullness
Bothersome early satiation
Bothersome epigastric pain
Bothersome epigastric burning
Symptoms cannot be explained by structural disease including upper endoscopy.
Timeline of Symptoms
The timeline of symptoms is variable and can differ from person to person. It generally unfolds as follows:
Onset: Symptoms can begin gradually or suddenly.
Duration: Symptoms can be persistent (present most of the time) or intermittent (come and go).
Fluctuations: Symptom severity can fluctuate over time, with periods of exacerbation (worsening) and remission (improvement).
Chronic course: Functional dyspepsia is typically a chronic condition, meaning it can last for months or years.
Important Considerations
Rule out organic causes: It is essential to exclude other medical conditions before diagnosing FD.
Individualized treatment: Treatment should be tailored to the individual's specific symptoms and needs.
Long-term management: FD is often a chronic condition, requiring ongoing management.
Psychological support: Addressing psychological factors like stress, anxiety, and depression can be crucial for improving symptoms.
Patient education: Understanding the condition and management strategies can empower patients to take control of their health.
Adherence to treatment: Following the doctor's recommendations, including lifestyle changes and medication, is essential for optimal outcomes.
Regular follow-up: Regular check-ups with a healthcare provider are important to monitor symptoms, adjust treatment as needed, and address any concerns.