Functional Dyspepsia

Diagnosis

Predominantly epigastric pain, early satiety, or discomfort after meals, with no structural cause found on investigation. Per Rome criteria, symptoms must be present for the last 3 months, with onset at least 6 months before diagnosis (see Irritable Bowel Syndrome for the current Rome V update — the diagnostic threshold for functional dyspepsia is essentially unchanged across Rome IV/V). Two overlapping subtypes are recognised: postprandial distress syndrome (meal-related fullness/early satiety) and epigastric pain syndrome (pain/burning not necessarily meal-related) — they frequently co-exist.

Investigations: bloods (FBC, UEC, LFTs); H. pylori testing (see H. pylori). Consider endoscopy for most patients, depending on risk factors and alarm symptoms (see GORD / PUD for the alarm-symptom list).

Management

Reassurance.

Drug therapy: PPI at standard dose. If the main symptom is discomfort or bloating, domperidone 10mg up to three times daily. Consider a trial of low-dose TCA if the above is ineffective. Consider CBT, particularly if features of depression are present.