Home Conditions Functional dyspepsia
Condition · Food pipe and stomach
Functional dyspepsia
Functional dyspepsia is long-standing indigestion in which endoscopy and other tests show no ulcer, growth or other structural cause. It causes uncomfortable fullness after meals, an inability to finish a normal meal, or pain or burning in the upper abdomen. It is one of the commonest gut conditions. It is a disorder of how the stomach and the brain signal to each other, and it is treated step by step.
At a glance
What it is
Recurring upper abdominal symptoms with a normal endoscopy: a stomach that is sensitive, or relaxes or empties poorly.
Common signs
Fullness after meals, feeling full early, and pain or burning in the upper abdomen.
How it is confirmed
From the pattern of symptoms, a test for H. pylori, and an endoscopy when one is called for.
How it is treated
Clearing H. pylori if present, changes to meals, and medicines for acid, stomach movement or nerve sensitivity.
What are the signs of functional dyspepsia?
The usual signs
- Uncomfortable fullness after an ordinary meal
- Feeling full after a few mouthfuls, so that you cannot finish a meal
- Pain or burning in the upper middle abdomen
- Upper abdominal bloating, belching and nausea
- Symptoms on several days a week, for months
The two patterns
- Meal-related: fullness and early fullness brought on by eating
- Pain-related: pain or burning that can come on an empty stomach or after food
Many people have both, and many also have IBS or acid reflux.
See a doctor promptly if you have
- Vomiting blood, or black, tarry stools
- Weight loss you cannot explain
- Food sticking when you swallow
- Vomiting that will not stop
- A low blood count (anaemia)
- Upper abdominal symptoms that start for the first time later in life
Sudden, severe abdominal pain with a hard abdomen is an emergency. Go to the nearest emergency department.
What it is
What is happening inside?
In functional dyspepsia the stomach looks normal but does not behave normally. Several changes have been measured:
- The upper part of the stomach does not relax enough to receive a meal, so a normal amount of food feels like too much.
- The nerves of the stomach and duodenum are more sensitive to stretch and to acid.
- In some people the stomach empties slowly.
- The lining of the duodenum can show mild inflammation under the microscope, sometimes after a gut infection.
- Signals between the stomach and the brain are amplified, more so with stress and poor sleep.
None of these shows on an endoscopy, which is why the endoscopy is normal. Functional dyspepsia is one of the gut-brain axis disorders.
Why it happens
The causes I look for
Several conditions cause the same symptoms. They are looked for first.
H. pylori infection
A stomach infection that is common in India. In some people, clearing it brings lasting relief.
Medicines
Anti-inflammatory painkillers, iron tablets, some antibiotics, and diabetes or weight-loss medicines that slow the stomach.
Reflux, gastritis and ulcers
These are seen at endoscopy and treated specifically. See acid reflux and gastritis.
Gallstones and the pancreas
Pain that comes in attacks, lasts for hours, or spreads to the back or right shoulder points away from the stomach. See gallstones.
Slow stomach emptying
Long-standing diabetes can affect the nerves of the stomach.
Coeliac disease and thyroid problems
Both can show up as indigestion, and both are screened for with blood tests.
How I find out
Which test answers which question?
H. pylori breath or stool test
It tells us: Whether the infection is present.
When I use it: In younger patients without warning signs, as the first step.
Upper GI endoscopy
It tells us: That there is no ulcer, growth or visible inflammation. Samples also show H. pylori and coeliac disease.
When I use it: With warning signs, symptoms that begin later in life, or symptoms that do not respond to treatment.
Ultrasound of the abdomen
It tells us: Whether there are gallstones or a problem in the liver or pancreas.
When I use it: When pain comes in attacks or sits under the right ribs.
Blood tests
It tells us: Whether there is anaemia, coeliac disease, a thyroid problem or raised blood sugar.
When I use it: At the first visit.
Treatment
How is functional dyspepsia treated?
Clear H. pylori if it is present
A two-week course of medicines, followed by a test to confirm that the infection has gone.
Change how you eat
- Smaller meals at regular times, eaten slowly
- Less fat in a single meal, because fat slows the stomach
- Dinner two to three hours before bed
- Note which foods bring on symptoms. Very oily or spicy food, coffee, alcohol and fizzy drinks are common ones.
Long lists of forbidden foods are rarely needed.
An acid-reducing medicine
A course of four to eight weeks, then a review. If it helps, the dose is brought down to the lowest that keeps you comfortable.
A medicine that helps the stomach move or relax
Used when fullness after meals is the main problem.
A low-dose medicine that calms the gut’s nerves
Certain antidepressant medicines, at low doses, reduce pain signals from the stomach. They are used for this effect on nerves, not for depression.
Sleep, stress and brain-gut therapies
Regular sleep, breathing practice and psychological therapies aimed at the gut can help people who have not improved with medicines.
Is surgery ever needed?
No. There is no operation for functional dyspepsia. If a scan shows gallstones or a small hernia, I will tell you plainly whether they explain your symptoms. Often they do not.
Root-cause care
The integrative view: what else I look at
- Meal rhythm: long gaps, rushed meals and late, heavy dinners are common and can be changed.
- Gut bacteria: symptoms that began after a gut infection, or after antibiotics. See microbiome restoration.
- Long-term acid-blockers: whether the medicine is still needed. See long-term acid-blockers.
- The tone of the nervous system: sleep, slow breathing and HRV biofeedback.
- Nutrition: people who have eaten less for months can run short of iron, vitamin B12 and protein.
Recovery
What should I expect?
| When | What happens |
|---|---|
| First visit | A history, an examination, a test for H. pylori and, where called for, an endoscopy. |
| Weeks 2 to 8 | Changes to meals and a first course of medicine. |
| Months 2 to 3 | If symptoms persist, the medicine is changed to one that acts on stomach movement or nerve sensitivity. |
| Long term | Symptoms can return for a while with stress, illness or a change of routine. You will know what to do. |
Questions patients ask me about functional dyspepsia
Is functional dyspepsia the same as gastritis?
No. Gastritis is inflammation of the stomach lining, seen at endoscopy and confirmed by biopsy. In functional dyspepsia the symptoms are present and the stomach looks normal. Many people who are told they have “gastritis” or “gas trouble” have functional dyspepsia.
Is it the same as acidity or GERD?
Not quite. In reflux the main symptoms are a burning that rises behind the breastbone and sour fluid in the mouth. In functional dyspepsia they are fullness and upper abdominal pain. The two often occur together.
Is functional dyspepsia curable?
It is treatable. In long-term studies, symptoms resolve in many people, come and go in others, and persist in a minority. Treatment aims at good control and at knowing what to do in a flare.
Do I need an endoscopy?
Not always. In a younger person without warning signs, testing for H. pylori and a trial of treatment come first. Endoscopy is advised with warning signs, with symptoms that begin later in life, or when treatment has not worked.
Will I have to take medicines for life?
Usually not. Medicines are given in courses and reviewed. Many people manage with changes to meals and an occasional short course.
Can stress cause functional dyspepsia?
Stress does not cause it alone, but it makes the stomach more sensitive and symptoms harder to ignore. The connection also runs the other way: long-standing symptoms cause worry and poor sleep.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- Rome IV criteria for gastroduodenal disorders. Stanghellini V et al. Gastroenterology. 2016. PubMed 27147122
- American and Canadian guideline on the management of dyspepsia. Moayyedi P et al. Am J Gastroenterol. 2017. PubMed 28631728
- Kyoto global consensus on Helicobacter pylori gastritis. Sugano K et al. Gut. 2015. PubMed 26187502
- American College of Gastroenterology guideline on the treatment of Helicobacter pylori infection. Chey WD et al. Am J Gastroenterol. 2024. PubMed 39626064
- Rome Foundation report on neuromodulators for gut-brain interaction disorders. Drossman DA et al. Gastroenterology. 2018. PubMed 29274869
- Rome IV overview of disorders of gut-brain interaction. Drossman DA. Gastroenterology. 2016. PubMed 27144617
- Twelve-year study showing the brain-gut pathway runs in both directions. Koloski NA et al. Gut. 2012. PubMed 22234979