Functional Dyspepsia

What is Functional Dyspepsia?

Dyspepsia sounds like a complicated word but it is just the medical term used for indigestion. Functional dyspepsia (also called non-ulcer stomach pain or non-ulcer dyspepsia) can be loosely translated to mean chronic indigestion1.

Functional dyspepsia is a very common disorder in Singapore, and it can last a long time. There are two main types of functional dyspepsia, which are

Epigastric pain syndrome (EPS): symptoms associated with upper abdominal pain and burning
Postprandial distress syndrome (PDS): symptoms that occur after eating such as bloating, nausea, and feeling full after small meals

What are the common causes of Functional Dyspepsia in Singapore?

When a condition is preceded by the word functional, it means there are no known causes. But some factors may contribute to worsening symptoms, these factors are

Allergens
Inefficient emptying of the stomach after meals
Change in the amount or types of bacteria that live in the gastrointestinal tract
Helicobacter Pylori (H.Pylori) infection

Inflammation of the gastrointestinal tract
Increase in stomach acid production
Stress
Non-steroidal inflammatory drugs (NSAIDs) side effects

What are the symptoms of Functional Dyspepsia?

The symptoms of functional dyspepsia are different with everyone but some common symptoms include

Abdominal pain or burning
Sour taste in your mouth
Weight loss
Feeling full after eating a small meal
Nausea and vomiting

Feeling bloated
Indigestion
Acid reflux
Heartburn

The symptoms of functional dyspepsia are very similar to the symptoms of gastritis, duodentis, peptic ulcer disease, gastric cancer, irritable bowel disease (IBD), and irritable bowel syndrome (IBS), a proper diagnose is necessary to figure out what your medical condition is.

Is Functional Dyspepsia painful?

Yes, it is a painful condition that can even affect your quality of life.

Who is at risk of Functional Dyspepsia in Singapore?

Functional dyspepsia can affect anyone and while the exact cause is unclear, certain factors may increase your risk such as4:

Infections: the H.Pylori bacteria has been linked to many gastrointestinal conditions; it colonises the stomach and reduces the protective mucus layer, exposing the stomach to harsh acids and making you more susceptible to gastrointestinal problems.
Recent antibiotics use: antibiotics are like a double-edged sword for the gastrointestinal tract. It is used as treatment for many bacterial infections, but it can cause a multitude of problems by wreaking havoc in the balance of good bacteria in the stomach. It works by killing off bacteria, but it does not discriminate between good bacteria and bad bacteria. Therefore, probiotics are often prescribed together with antibiotics to try and reintroduce the necessary good bacteria.
Long-term use of NSAIDs: just like the H.Pylori bacteria, long-term use of NSAIDs have been linked to many gastrointestinal conditions. It wears down the protective mucus layer of the stomach and leaving it exposed to the acids which then makes you more susceptible to gastrointestinal problems.
Overweight: obesity has long been associated with many gastrointestinal problems such as functional dyspepsia, peptic ulcer disease, gastritis, duodenitis, etc.
Smoking: risk factor for PDS in particular.
Psychosocial dysfunction: studies have shown that patients with psychosocial dysfunction have an increased risk of functional dyspepsia.
Females: women are more likely than men to suffer from functional dyspepsia.

How is Functional Dyspepsia (Indigestion) diagnosed?

Your gastroenterologist will conduct a number of tests in order to identify what is causing your gastrointestinal discomfort, he/she may use the following tests1:

Gastroscopy: A thin and flexible tube with a light and camera attached at one end will be inserted into your mouth and guided down your oesophagus and into your stomach and duodenum (upper part of the small intestine).

Blood tests: to check for any infections (viral or bacterial) that could be causing your symptoms.
Breath tests: two types of breath tests will be conducted; the urea breath test to check for the presence of H.Pylori and the hydrogen breath test to check for small intestinal bacterial overgrowth. It usually involves you blowing into a bag where a device is used to test for the presence of certain gasses.

If no presence of any medical condition can be found and you have had symptoms for the past three months or more, you will be diagnosed with functional dyspepsia.

What are the treatment options for Functional Dyspepsia in Singapore?

The treatment prescribed depends on your symptoms and the suspected probable cause of your functional dyspepsia, treatment options include1,2,4,12:

Proton pump inhibitor (PPIs): these help to reduce the amount of acid present in the stomach, making it easier for your stomach lining to heal.
Histamine receptor blockers (H2 blockers): these prevent the stomach from producing too much acid which helps you heal.
Prokinetic drugs: more effective with PDS than EPS. They help your stomach to empty its contents quickly into the small intestine without holding onto food for too long.
Antidepressants: this is used for patients whose symptoms appear to be related to the nervous system. It helps to reduce the patients’ perception of pain and discomfort and helps the stomach to relax.

Diet: patients will also be advised to consume small, regular, and low-fat meals.

Frequently asked questions

Is functional dyspepsia the same as irritable bowel syndrome (IBS)?

Functional dyspepsia and IBS may coexist together as medical conditions and they are often misdiagnosed as each other but a thorough examination will help your gastroenterologist to identify which one you are suffering from.

What is the difference between dyspepsia and functional dyspepsia?

The main difference is that we know the cause of dyspepsia which include overeating, fatty, greasy, and spicy food, but the cause of functional dyspepsia is currently unknown.

References

Cleaveland Clinic Medical Professional. (2022, 1 10). Functional Dyspepsia. Retrieved from Cleaveland Clinic: https://my.clevelandclinic.org/health/diseases/22248-functional-dyspepsia
Nicholas J Talley, T. G. (2017). Functional dyspepsia. Australian Prescriber, 209-213.
Silver, N. (2021, November 23). Functional Dyspepsia Causes and Treatment. Retrieved from healthline: https://www.healthline.com/health/functional-dyspepsia
Pilin Francis, S. R. (2022). Functional Dyspepsia. Florida: StatPearls.
Bytzer, P. (2010). Dyspepsia as an adverse effect of drugs. Best Practice and Research. Clinical Enterology, 109-120.
Michael P. Jones, A. S. (2021). Antibiotic use but not gastrointestinal infection frequently precedes first diagnosis of functional gastrointestinal disorders. United European Gastroenterology Journal, 1074-1080.
Wayne Ho, B. M. (2008). The Relationship Between Obesity and Functional Gastrointestinal Disorders. Gastroenterology and Hepatology, 572-578.
Nicholas J. Talley, N. P. (2021). Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies. Alimentary Pharmacology and Therapeutics.
Sandra Barry, T. G. (2006). Functional dyspepsia: Are psychosocial factors of relevance. World Journal of Gastroenterology, 2701-2707.
G Magni, F. d. (1987). DSM-III diagnoses associated with dyspepsia of unknown cause. The American Journal of Psychiatry, 1222-1223.
Kate Napthali, N. K. (2016). Women and Functional Dyspepsia. Women's Health, 241-250.
Hiroshi Yamawaki, S. F. (2018). Management of functional dyspepsia: state of the art and emerging therapies. Therapeutic Advances in Chronic Disease, 23-32.

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal