Swipe Down Towards End To Download PDF File👇👇👇
Functional Dyspepsia: A Complete Overview
Introduction
Functional dyspepsia (FD), often referred to as non-ulcer dyspepsia, is a common gastrointestinal disorder characterized by persistent or recurrent pain or discomfort in the upper abdomen without any identifiable structural cause. It is a type of functional gastrointestinal disorder, meaning that although symptoms are real and often severe, they occur without observable abnormalities on routine diagnostic tests like endoscopy or imaging.
Epidemiology
Functional dyspepsia affects about 10–30% of the global population at some point in their lives. It occurs in both genders, but women tend to be affected slightly more often than men. It can affect individuals of any age but is more commonly seen in young to middle-aged adults.
Causes and Risk Factors
The exact cause of functional dyspepsia is not well understood, but several contributing factors have been identified:
- Gastrointestinal Motility Disorders: Delayed gastric emptying or abnormal gastric accommodation may play a role.
- Visceral Hypersensitivity: Increased sensitivity to stomach distension and chemical stimuli can contribute to symptoms.
- Helicobacter pylori Infection: Although not always present, H. pylori may be a trigger in some individuals.
- Psychosocial Factors: Stress, anxiety, and depression are frequently associated with FD and can exacerbate symptoms.
- Dietary Habits: High-fat meals, spicy foods, alcohol, and caffeine are commonly reported triggers.
- Medications: Certain drugs, like NSAIDs or antibiotics, can worsen or mimic symptoms.
Clinical Features
According to the Rome IV Criteria, functional dyspepsia is diagnosed based on the presence of one or more of the following symptoms for the past 3 months (with symptom onset at least 6 months before diagnosis):
- Postprandial fullness: Feeling excessively full after eating a normal-sized meal.
- Early satiation: Feeling full too quickly upon starting a meal.
- Epigastric pain: Burning or discomfort in the upper middle abdomen.
- Epigastric burning: A sensation of heat or burning in the upper abdomen.
These symptoms occur in the absence of any structural disease that could explain them.
FD is subcategorized into:
- Postprandial Distress Syndrome (PDS): Dominated by meal-related symptoms like fullness and early satiation.
- Epigastric Pain Syndrome (EPS): Characterized by upper abdominal pain or burning unrelated to meals.
Diagnosis
The diagnosis of functional dyspepsia is clinical and based on history and physical examination. However, some investigations are often necessary to rule out other conditions:
- Upper GI endoscopy: To exclude peptic ulcers, cancer, or esophagitis.
- H. pylori testing: Through urea breath test, stool antigen, or biopsy.
- Blood tests: To rule out anemia, infection, or inflammation.
- Imaging: Rarely needed unless red flags are present.
Red flag symptoms that warrant further evaluation include:
- Unintentional weight loss
- Progressive dysphagia
- Recurrent vomiting
- Gastrointestinal bleeding
- Family history of upper GI cancer
Management
The treatment of functional dyspepsia aims at symptom relief and improving quality of life.
1. Lifestyle and Dietary Modifications:
- Eat smaller, more frequent meals
- Avoid fatty, spicy, or gas-producing foods
- Limit alcohol, caffeine, and smoking
- Manage stress through relaxation techniques or therapy
2. Pharmacological Treatment:
- Proton Pump Inhibitors (PPIs): Effective especially for epigastric pain syndrome.
- H2-receptor antagonists: An alternative to PPIs.
- Prokinetic agents: Useful for postprandial distress (e.g., domperidone, metoclopramide).
- Antidepressants: Low-dose tricyclic antidepressants or SSRIs can help with visceral hypersensitivity and associated anxiety/depression.
- Antibiotics: Eradication of H. pylori in infected individuals can lead to symptom improvement in some cases.
3. Psychological Therapies:
- Cognitive Behavioral Therapy (CBT)
- Hypnotherapy
- Gut-directed psychotherapy
These are considered particularly helpful for patients with significant psychological comorbidity.
Prognosis
Functional dyspepsia is a chronic relapsing condition. Although it is not life-threatening and does not lead to serious complications, it significantly affects the patient’s quality of life. Long-term management often involves a combination of lifestyle changes, reassurance, and symptom-targeted therapy.
Conclusion
Functional dyspepsia is a prevalent and challenging gastrointestinal disorder that lacks a clear organic cause but presents with significant discomfort and impact on daily life. A tailored approach involving diet, lifestyle, medications, and psychological support provides the best outcomes for patients. Ongoing research into the brain-gut axis and gut microbiome may offer new treatment avenues in the future.
.jpeg)
