Functional Dyspepsia

What is functional dyspepsia (indigestion)?

Functional dyspepsia, also known as non-ulcer dyspepsia, is a type of chronic indigestion that has varied degrees of impact on daily activities. It's usually caused by a meal, and it can be a real ache, but it can also feel like heartburn, bloating, or nausea. In Malaysia, the prevalence of dyspepsia is estimated to be between 15% and 25%.
If you have a collection of symptoms that are particularly related to the upper gastrointestinal tract but have no evident cause, you may have functional dyspepsia.
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What kinds of functional dyspepsia are there?

• Epigastric pain syndrome (EPS): This condition causes pain or burning in the upper abdomen.
• Postprandial distress syndrome (PDS): You may be unable to eat a full meal or feel overly full following a normal meal.
• Overlapping EPS and PDS: A combination of both of the above symptoms.​​

What are the causes of functional dyspepsia?

The exact cause is not clearly understood. However, it is believed that multiple elements are likely to be at play. There are several risk factors that have been identified as increasing your chances of developing functional dyspepsia:
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(i) Helicobacter pylori infection

• NSAID use in the past
• Smoking
• Pregnancy
• Anxiety and stress
• Diet
• Lifestyle
• Obesity
• Allergens

​(ii) Changes in the intestinal microbiota
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What are the symptoms of functional dyspepsia?

• Pain in the abdomen
• Feeling heavy after a meal
• Loss of appetite
• Nausea
• Vomiting
• Feeling full after eating small quantities of food
• Burning sensation in your chest
• Abdominal bloating

How does a doctor know it is functional dyspepsia?

When no other reason for the symptoms can be established, functional dyspepsia is diagnosed by a process of elimination of other medical conditions. Your doctor may undertake some routine blood and stool tests to rule out other possibilities. Doctors may also perform an ultrasound, a colonoscopy and allergy tests to look for all kinds of illnesses. When all tests are unremarkable, a doctor may diagnose you with functional dyspepsia.

Before confirming the diagnosis, a set of criteria based on Rome IV must be met, which includes:
(i) Any of the symptoms listed noticed at minimum 3 days per week over the preceding 3 months

• Upper abdomen burning
• Upper abdomen pain
• Early fullness
• After meal fullness
  

​​(ii) Disruption of daily habits
(iii) Six-month or longer symptom duration

How to reduce the symptom of functional dyspepsia?

There are three forms of therapies for bloating caused by functional digestive system abnormalities: medication, dietary adjustments, and psychological treatment.
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Medications

Prior to committing to a therapy plan for lowering dyspeptic symptoms, H pylori testing is critical. If a patient tests positive for H pylori, eradication of the bacteria is the top priority.
In H pylori negative patients, there is a selection of medications prescribed by your doctor specifically to aid relieve functional dyspepsia. These include:

i) Medication that helps in reducing stomach acid: By neutralizing or minimizing the effects of acid, it allows the stomach lining to repair. This helps to alleviate acid reflux symptoms like heartburn.

ii) Low-dose antidepressants: These medications, which are normally offered in low doses, may contribute to decrease dyspepsia related pain and suffering, while also managing psychological stressors.

iii) Prokinetic agents: These medications quicken the clearance of your stomach content and may constrict the connection between your stomach and oesophagus, minimising the risk of upper abdominal discomfort.
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Diet

Healthy eating habits: Prioritizing a nutritious diet can help to alleviate symptoms. It is advised that you eat a nutritious and balanced diet based on the Malaysia Food Pyramid 2020, as illustrated in the diagram.

FODMAP exclusion diet: FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, as portrayed in the diagram. These foods are poorly absorbed in the intestines, causing luminal distension and bloating.

Psychological

Functional dyspepsia is not a psychological disorder, but negative thinking has been shown to disrupt gut-brain communication. When you feel anxious, the gut receives a signal from the brain that the body is in danger. As a result, symptoms of functional gastrointestinal diseases may get worse.

• Proper exercise and rest can help reduce stress and positively influence functional dyspepsia symptoms.
• Good quality of sleep should not be neglected.
• Alternatively, you may seek help from healthcare workers whom will be able to provide treatments such as cognitive behavioral therapy, hypnotherapy techniques, and relaxation breathing techniques.

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Takeaway message from My Gut Brain Centre

Doctors aren't always sure how functional dyspepsia manifests itself. However, it is a rather common condition that prompts a patient to visit their doctor. Diagnosis and treatment may be challenging; thus, healthcare workers and patient should work hand in hand to optimise your lifestyle. It is important that you tell doctor all your symptoms and that you don’t be afraid to share how it is affecting your quality of life.
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As a doctor, it is important to educate patients on the definition and course of functional dyspepsia, because patient awareness is crucial to therapy success.
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