Dyspepsia, Functional

Basics

Description

  • Dyspepsia is defined as the presence of postprandial fullness, early satiety, and epigastric or burning pain for the last 6 months in the absence of systemic, structural, or organic disease.
  • Rome IV criteria divides patients into two subtypes:
    • Postprandial distress syndrome (PDS): which is defined as the feelings of fullness that interferes with the ability of intake of a normal-sized meal; more common
    • Epigastric pain syndrome (EPS): which is defined as recurrent burning epigastric pain or discomfort
  • System(s) affected: gastrointestinal (GI)
  • Synonym(s): idiopathic dyspepsia; nonulcer dyspepsia; nonorganic dyspepsia; PDS; and EPS

Epidemiology

Prevalence

  • 5–20% prevalence worldwide (varies based on criteria)
  • Overall more common in Western cultures, women, and younger adults
  • PDS subtype may be more common in Eastern cultures.

Etiology and Pathophysiology

Unknown but proposed mechanisms or associations include gastric motility disorders including abnormal gastric emptying and accommodation, vagal sensory dysfunction, eosinophilic duodenitis, Helicobacter pylori infection, alteration in upper GI microbiome, postinfectious complications, immune activation, inflammation, and gut-brain axis disorders

Genetics

Possible link to G-protein β3 subunit 825 CC genotype, serotonin transport genes, and/or cholecystokinin-A-receptor gene polymorphismsGeriatric Considerations
Patients age >60 years with new-onset dyspepsia should undergo endoscopy.Pediatric Considerations
Be alert for family system dysfunction.Pregnancy Considerations
Pregnancy may exacerbate symptoms.

Risk Factors

  • Other functional disorders: fibromyalgia, temporomandibular joint pain, chronic fatigue syndrome, irritable bowel syndrome.
  • Anxiety/depression, psychosocial stressors (e.g., divorce, unemployment; history of physical, sexual or emotional trauma/abuse)
  • Infection with H. pylori
  • Smoking
  • Female gender
  • NSAIDs use
  • Gastroparesis
  • Gastroesophageal reflux disease (GERD)

General Prevention

Avoid modifiable risk factors.

Commonly Associated Conditions

Other functional bowel disorders (common)

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