Functional dyspepsia

What it is

Dyspepsia is a presenting symptom rather than a diagnosis, and the same symptom carries several diseases. It generally describes pain or discomfort in the epigastric region, a range of symptoms arising from the upper GIT, present for at least 3 months; NICE takes symptoms present for 4 weeks or more of upper abdominal pain or discomfort, heartburn, gastric reflux, or vomiting. Ulcer disease, which is a focal defect in the mucosa that penetrates the muscularis mucosal layer, as gastric ulcers or as duodenal ulcers in the duodenum, may be asymptomatic, may cause dyspepsia, or may show itself through its complications. Dyspepsia is also one of the clinical features of Zollinger-Ellison syndrome, a gastrin-secreting non-beta islet cell tumor associated with MEN1, alongside abdominal pain, chronic diarrhea, weight loss and GI bleeding.

In 70-80% no clinically significant cause is found, and that is functional dyspepsia; approximately 25% have an underlying organic cause, with a 13% prevalence of erosive oesophagitis, 8% of peptic ulcer disease and 0.3% with gastric or oesophageal cancer. Functional dyspepsia is defined by the Rome III criteria as at least one of bothersome postprandial fullness, early satiation, epigastric pain or epigastric burning, with no evidence of structural disease, including at upper endoscopy, that is likely to explain the symptoms; the criteria must be fulfilled for the past three months, with symptom onset at least six months before diagnosis.