Functional Dyspepsia

Abstract

Unexplained fullness after eating, inability to finish a normal-sized meal (early satiety), and/or epigastric pain or burning are common symptoms. In clinical practice the likeliest explanation is functional dyspepsia, where by definition esophagogastroduodenoscopy is normal, with no other structural explanation found. Symptoms may be primarily after eating, as in postprandial distress syndrome, or may have no relationship to meals (epigastric pain syndrome). The diagnosis of functional dyspepsia requires exclusion of organic disease. The pathogenesis is incompletely understood and is likely multifactorial. In a minority, Helicobacter pylori (H. pylori) infection plays a role, but some patients have microscopic duodenal inflammation characterised by eosinophils, and sometimes mast cells. Currently, treatment involves a stepwise approach. If H. pylori infection is present, eradication therapy may be beneficial. Acid suppression is otherwise first-line therapy. An antidepressant (a low-dose tricyclic agent) or prokinetic agent is second-line therapy.