Functional dyspepsia

Functional dyspepsia can cause a number of different symptoms. The two most typical kinds are:

• Pain or a burning feeling in the upper abdomen (belly), often unrelated to meals (epigastric pain syndrome)
• Feeling full early on while eating, or feeling full after eating (postprandial distress syndrome)

Other symptoms that may be directly related to functional dyspepsia include:

• Bloating and cramping in the upper abdomen
• Frequent burping
• Nausea and feeling unwell
• Vomiting (less common)

The symptoms may be almost constant or come in phases.

Some symptoms, such as insomnia, aren't in the digestive tract. Generally speaking, functional dyspepsia often has a greater effect on quality of life in the following people: women and older people, and those with anxiety disorders and depression.

Children and teenagers can also have functional dyspepsia. Their main symptoms are pain in the upper or lower abdomen.

There is a lack of research on the causes of functional dyspepsia. Various factors are believed to play a role.

Things like pressure, stretching or chemical substances in food don't normally cause receptors and nerves in the stomach to trigger pain. But the way we feel pain is influenced by complex physical and psychological processes that are all interconnected. For instance, if an inflammation or infection irritates the mucous membrane lining the stomach, normal stomach activities might still feel painful after the inflammation has gone away.

Other causes may include:

• A chronic infection with bacteria called Helicobacter pylori.
• A healthy stomach stretches and relaxes after eating. Some people’s stomachs don't do this. As a result, the contents of their stomach don't spread out enough, which can easily cause a permanent feeling of being full or even nausea.
• It might take longer than usual for the stomach contents to be passed on to the small intestine.
• Experts suspect that other factors can cause stomach problems too. These include mental stress, tension, anxiety disorders and depression. Researchers are also looking into the role of things like immune system processes in the small intestine and genetic predispositions.
• The symptoms might be caused or affected by changes in the gut microbiome (the mix of bacteria living in the bowel) too.

Researchers are also looking into various causes of recurring indigestion in children and teenagers. Children often get belly ache when they're feeling anxious, worried, out of their depth, or have distressing experiences. In turn, their belly ache can affect children mentally and they might start doing fewer activities. A distressing family situation can increase the risk of longer-lasting functional stomach problems in children. Children who have a family member with chronic pain (of any kind) are more likely to develop these problems. The risk may also be higher if the symptoms already develop at pre-school age or if they occur together with anxiety or depression.

Around 20-30 % of adults in Germany have long-term stomach trouble. In over half of those who go to the doctor because of it, no physical causes can be found. That means that about 10-15 % of people living in Germany have functional dyspepsia (recurring indigestion for no clear reason).

The true percentage is probably higher, though, because it can be difficult to tell it apart from other stomach problems.

Stomach pain and other symptoms that are signs of functional dyspepsia are about as common in children and teenagers as they are in adults. About 10-20 % of children have the typical long-lasting or recurring symptoms.

Functional dyspepsia symptoms can last for months or years. In half of those affected, the symptoms disappear without treatment after several years. The condition may return and repeatedly lead to symptoms. Some people constantly have stomach pain or other symptoms of functional dyspepsia.

Almost half of the long-term stomach symptoms are triggered or made worse by other physical causes or medications. Because of this, it is only considered to be functional dyspepsia if other potential causes of the symptoms have been checked and ruled out. These include

• Medications like anti-rheumatic drugs or iron supplements
• Food intolerances like a gluten or lactose intolerance
• Reflux disease (GERD)
• Inflammation of the membranes lining the stomach, food pipe or first part of the small intestine (duodenum)
• Inflammation of the pancreas
• Stomach ulcers
• Unusual bowel movements or irritable bowel syndrome (IBS)
• Gallstones
• Poor blood flow in the abdominal arteries
• Cancer in the upper digestive organs (rare)

Sometimes gastritis or gallstones are diagnosed but the symptoms aren't completely typical. Then the person may have functional dyspepsia on top of the other diagnosed condition.

Doctors diagnose functional dyspepsia based on a description of the symptoms together with physical examinations and other tests. These may include blood and stool tests, an ultrasound scan of the abdomen, or a gastroscopy. Gastroscopy can be done as an outpatient procedure. If children have stomach problems over a period of weeks, you should talk to your pediatrician and discuss the next steps together.

The good news is that functional dyspepsia isn’t dangerous. The aim of treatment is to relieve the often distressing symptoms, or at least help you cope better with them.

Some people with functional dyspepsia say that certain foods make their symptoms worse, so they change their diet. Other people find that eating smaller, low-fat meals spread across the day can help. But research has not shown that changing your diet generally leads to an improvement.

Other things that can help include eating in a pleasant environment, chewing your food well, and taking your time when eating. Some people also find that breathing techniques and acupuncture have a positive effect. Relaxation and stress management techniques like autogenic training and progressive muscle relaxation can be helpful too. Exercise and sports stimulate your digestion.

Essential oils and extracts from various plants (like peppermint and caraway oil) can relieve cramping and might stimulate the digestive tract too. Medications that reduce acid production in the stomach, like proton pump inhibitors and H2-receptor antagonists, can also help. But they have only been approved for the treatment of other digestive problems and diseases (off-label use). Studies have found that these medications can relieve the symptoms of functional dyspepsia. They are recommended as a treatment for this condition.

If someone has a Helicobacter pylori infection in the lining of their stomach, that is often treated first. It is also important to treat other illnesses such as irritable bowel syndrome or psychological problems such as depression.

If children have symptoms over a period of weeks, it can be a good idea to talk to your pediatrician and discuss the next steps: How can the symptoms be dealt with better? Where can you find psychological support? Are other medical examinations a good idea and, if so, when? These are some of the questions you can discuss.

Functional dyspepsia can affect your overall wellbeing and everyday life. The symptoms often make it hard to enjoy eating and drinking.

Some people don't want to go to the doctor because they're worried about unpleasant outcomes. Some ignore their symptoms or find their own explanations for them. Others don't feel like their symptoms are being taken seriously. But talking to your doctor and having medical examinations can both help to relieve symptoms and to find a suitable treatment.

Many people with unexplained symptoms are worried that they may have cancer. But stomach problems are only rarely caused by cancer. Warning signs like blood in your stool or losing weight for no known reason should be looked into, though.

A lot of people try to fix the problem themselves. Some withdraw from social life or call in sick a lot. Others change their diet and use expensive special products, buy over-the-counter medication from the pharmacy, or try to find relief with natural medicine treatments like acupuncture and osteopathy. But trying out all sorts of treatments can cause more stress and have side effects. If you want to try doing things for yourself, it is best to talk to your doctor about which treatments are suitable – and which treatments are not. They will also be able to tell you which treatments are covered by statutory health insurers (in Germany).

People often learn to cope better with the symptoms over time. New possibilities can open up if you stop putting all of your energy into fighting the symptoms. Rethinking what is really important in your everyday life and observing your own limits might help.

And last but not least, it’s important not to stop doing things that you enjoy. This also applies to social activities and staying in touch with friends and family.

When people are ill or need medical advice, they usually go to see their family doctor first. In our "Health care in Germany" topic you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.