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Understanding & Diagnosing Functional Dyspepsia

Monday, November 30th 2020 1:09am 5 min read
The Institute for Functional Medicine instituteforfxmed

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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

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