Understanding & Diagnosing Functional Dyspepsia

Understanding and Diagnosing Functional Dyspepsia

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 Because dyspepsia can present with a multitude of symptoms, clinicians are encouraged to look for red flags that are clinical indicators of a possible serious underlying condition.2 Yet on diagnostic work-up, only 20 to 30% of patients with FD are found to have frank diseases that account for their symptoms.3

The causes of FD are varied and complex.3 The most common underlying causes include chronic gastrointestinal bleeding, unexplained weight loss, difficulty in swallowing, persistent or protracted vomiting, iron deficiency anemia, palpable abdominal mass, coughing spells or nocturnal aspiration, previous peptic ulcer disease, and long-term ingestion of NSAIDs, including aspirin.2

FD may also have overlapping symptoms with food hypersensitivity and irritable bowel syndrome, like abdominal discomfort, bloating, and altered bowel habits.4 Recently, chronic duodenal low-grade inflammation and infection in FD has been observed in patients.1 Altered duodenal gut microbiota, food antigens, or infection may precipitate duodenal micro-inflammation.1

A 2018 screening of 200 patients discovered food hypersensitivity in 4% of those with a functional gastrointestinal disorder.2 Furthermore, a strong association was found between wheat sensitivity and FD in a 2018 population-based study.5 Self-reported wheat sensitivity was defined as people who reported gastrointestinal symptoms on ingestion of wheat-based foods, but did not suffer from celiac disease, inflammatory bowel disease, or colorectal cancer.5 A 2016 randomized double-blind study suggests that gluten may be a major trigger for functional gastrointestinal symptoms,6 and a 2013 study suggests that gluten-sensitive enteropathy may be a frequent and unsuspected cause of dysmotility-like dyspepsia.7

Along the gastrointestinal-neural axis, low-grade intestinal inflammation may also provoke motor-sensory abnormalities.1 The prevalence of gut motor dysfunction is about 20-30% in patients with FD, including occasionally rapid gastric emptying.1

Psychiatric comorbidities such as depression and anxiety are another feature of functional gastrointestinal disorders like dyspepsia.8 In actuality, these psychological problems may determine the emergence, persistence, or severity of FD.9 A 2016 study suggests that patients with FD had significantly higher mean scores for anxiety, depression, and psychological distress than people without the disorder.10 The findings add to the growing literature that claims a vast majority—about two thirds—of patients with FD suffer from these psychiatric comorbidities.9

Learn to recognize and treat the most important antecedents and triggers of gastrointestinal dysfunction in IFM’s GI Advanced Practice Module (APM). This course will supply you with the foundational background, insight, and in-depth clinical thinking to confidently work up and treat patients who may present with conditions, signs, and symptoms indicative of gastrointestinal dysfunction.

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  1. Jung HK, Talley NJ. Role of the duodenum in the pathogenesis of functional dyspepsia: a paradigm shift. J Neurogastroenterol Motil. 2018;24(3):345-354. doi:10.5056/jnm18060.
  2. Ramanayake RPJC, Basnayake BMTK. Evaluation of red flags minimizes missing serious diseases in primary care. J Family Med Prim Care. 2018;7(2):315-318. doi:10.4103/jfmpc.jfmpc_510_15.
  3. Madisch A, Andresen V, Enck P, Labenz J, Frieling T, Schemann M. The diagnosis and treatment of functional dyspepsia. Dtsch Arztebl Int. 2018;115(13):222-232. doi:10.3238/arztebl.2018.0222.
  4. Ismail FW, Abid S, Awan S, Lubna F. Frequency of food hypersensitivity in patients with functional gastrointestinal disorders. Acta Gastroenterol Belg. 2018;81(2):253-256.
  5. Potter MDE, Walker MM, Jones MP, Koloski NA, Keely S, Talley NJ. Wheat intolerance and chronic gastrointestinal symptoms in an Australian population-based study: association between wheat sensitivity, celiac disease and functional gastrointestinal disorders. Am J Gastroenterol. 2018;113(7):1036-1044. doi:10.1038/s41395-018-0095-7.
  6. Elli L, Tomba C, Branchi F, et al. Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients. 2016;8(2):84. doi:10.3390/nu8020084.
  7. Santolaria S, Alcedo J, Cuartero B, et al. Spectrum of gluten-sensitive enteropathy in patients with dysmotility-like dyspepsia. Gastroenterol Hepatol. 2013;36:11-20. doi:10.1016/j.gastrohep.2012.07.011.
  8. Holtmann G, Shah A, Morrison M. Pathophysiology of functional gastrointestinal disorders: a holistic overview. Dig Dis. 2017;35(Suppl 1):5-13. doi:10.1159/000485409.
  9. Adibi P, Keshteli AH, Daghaghzadeh H, Roohafza H, Pournaghshband N, Afshar H. Association of anxiety, depression, and psychological distress in people with and without functional dyspepsia. Adv Biomed Res. 2016;5:195. doi:10.4103/2277-9175.190936.

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