Dyspepsia (indigestion)

Functional dyspepsia is ongoing pain, burning or fullness in the upper abdomen when tests do not show an ulcer, a cancer or another structural cause. Most people call it indigestion. Day to day it can mean feeling uncomfortably full after a normal sized meal, getting full so quickly that meals go unfinished, or a burning ache above the belly button that comes and goes for months at a time.

What functional dyspepsia is, and what it is not

A normal endoscopy does not mean nothing is wrong. It rules out ulcers, inflammation and cancer, and that is part of what makes a diagnosis of functional dyspepsia possible. The difficulty lies in how the stomach relaxes and empties, and in how nerve signals from the gut are processed. Neither of those shows up as visible damage, so the stomach can look entirely normal while the symptoms carry on. This is a recognised diagnosis with defined criteria, not a label applied when no explanation can be found.

It is also not the same as acid reflux, although plenty of people have both. Reflux causes burning that rises into the chest and throat, while functional dyspepsia centres on the upper abdomen. Doctors describe two main patterns: postprandial distress syndrome, where fullness or getting full too quickly follows meals, and epigastric pain syndrome, where pain or burning is the main problem.

Signs and symptoms

• Pain or burning in the upper abdomen, above the belly button
• Feeling uncomfortably full after a normal sized meal
• Getting full very quickly, so meals go unfinished
• Bloating or pressure in the upper abdomen
• Nausea, sometimes with burping
• Less appetite, or eating less because of the discomfort
• Symptoms that come and go over months or years

The mix differs between people, and it changes over time. Some find that meals are the trigger, while for others pain arrives regardless of eating, and long settled stretches can be followed by weeks when symptoms return.

What raises the risk

Some risk factors cannot be changed:

• Being female, as reported rates are consistently higher in women
• A past bout of gastroenteritis, which can be followed by lasting upper abdominal symptoms
• Helicobacter pylori infection, a stomach bacterium that can be tested for and treated

Others can often be worked on, usually with support from a health care team:

• Smoking
• Regular use of anti inflammatory medicines such as ibuprofen or naproxen
• Alcohol intake
• Untreated anxiety or low mood, which are closely linked to how severe symptoms feel

How functional dyspepsia is diagnosed in Canada

Functional dyspepsia is usually identified clinically, using the Rome IV symptom criteria, rather than by routine endoscopy. A review in the British Columbia Medical Journal notes that non invasive testing for Helicobacter pylori, by urea breath test or stool antigen test, is recommended for everyone with these symptoms, and that blood tests for celiac disease may be added. Your doctor will also go through the medicines you take, since some anti inflammatory pain relievers irritate the stomach lining. Upper endoscopy is generally reserved for older adults and for anyone with alarm features, and a gastric emptying study is used when a gastroenterologist suspects the stomach is emptying too slowly.

Treatment and day-to-day management

Clinical research for Dyspepsia (indigestion) is enrolling. See the current studies ↓

Because there is no single cause to remove, care in Canada works through the options in turn and keeps what helps. Depending on your pattern of symptoms, your test results and what matters to you, a health care team may discuss:

• Dietary changes, including smaller and more frequent meals and less fat, and structured plans such as low FODMAP or Mediterranean style eating, often guided by a registered dietitian
• Testing for Helicobacter pylori and, where it is found, treating it
• Acid suppressing medicines such as proton pump inhibitors
• Neuromodulator medicines, including low dose tricyclic agents, prescribed here for pain signalling rather than for mood
• Psychological therapies such as cognitive behavioural therapy and gut directed hypnotherapy, and prokinetic medicines, usually within a team that includes more than one kind of clinician

There is no reliable way yet to predict which of these will suit a particular person, so the order is worked out case by case. These are decisions for you and your own clinician, and nothing on this page is a recommendation about any of them.

When to talk to a doctor

• Unintended weight loss, ongoing vomiting, or difficulty swallowing
• Vomiting blood, black tarry bowel movements, or rectal bleeding
• New upper abdominal symptoms starting at age 60 or older, or a family history of stomach or esophageal cancer, both of which warrant prompt assessment

Why clinical research matters for functional dyspepsia

Many people still have symptoms after acid suppression, treatment for Helicobacter pylori and dietary change, and there is no reliable way to predict who will respond to what. Studies now underway are testing neuromodulators, newer prokinetic and fundic relaxing agents, gut directed psychological therapies delivered by app or video, dietary interventions, and treatments aimed at the lining of the duodenum and at immune signalling after an infection. Researchers are also working on better ways to separate the postprandial distress and epigastric pain patterns, because the two may respond differently.

Clinical studies are how those questions get answered. Taking part is voluntary, you give informed consent before anything begins, and you can stop at any time without affecting the care you get from your own doctor. Joining a study does not mean giving up the care you have now, and no one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• British Columbia Medical Journal: functional dyspepsia in primary care
• Canadian Digestive Health Foundation
• Gastrointestinal Society (Canadian Society of Intestinal Research)
• HealthLink BC