Treatment for functional dyspepsia

By Lim Ju-won

Dyspepsia is a common problem associated with gastroesophageal reflux disease (GERD) or gastritis, but may be the first symptom of peptic ulcer and occasionally cancer.

Hence, unexplained newly-onset dyspepsia in people over 55 or the presence of other alarming symptoms may require further investigation such as upper gastrointestinal endoscopy.

Functional dyspepsia is a condition of impaired digestion that causes an upset stomach in the upper abdomen.

Functional dyspepsia often has recurrent and chronic pain or discomfort. The most common symptoms of functional dyspepsia include upset stomach, discomfort or pain in the upper abdomen, bloating, and fullness quickly than expected when eating. Some people also have nausea, belching, or heartburn.

To figure out the cause of your symptoms, your doctor will ask you some questions and perform a physical exam.

If you are older than 55 or have serious symptoms, such as persistent vomiting, unintentional weight loss, or difficulty swallowing, you should be investigated by upper gastrointestinal endoscopy.

If you are younger than 55 or you do not have serious symptoms, you might be offered other types of testing such as a breath urea test or stool test to find out if a Helicobacter pylori infection is present.

If your symptoms do not get better within four to eight weeks or if you get worse, you should consider asking for an upper gastrointestinal endoscopy.

Some people feel better after making changes in what they eat. This might include avoiding fatty foods, which can slow the emptying of the stomach, eating small and frequent meals instead of three large meals. And avoiding foods that make you feel worse will make you feel less pain.

The use of medicines that reduces stomach acidity may be effective. Proton pump inhibitors (PPIs) are more likely than other types of acid reducers to improve heartburn.

If you are diagnosed with an H. pylori infection and you have a stomach ulcer, treating the H. pylori can help to reduce the symptoms of functional dyspepsia. If you test positive for H. pylori but you do not have a stomach ulcer, consult your doctor to see if you should be treated or not. Low doses of an antidepressant medicine such as tricyclic antidepressants (TCA) might help to reduce symptoms, even if you are not depressed.

It is not clear how TCAs work, but they seem to improve pain when taken at low doses. The dose of TCAs used to treat pain is usually much lower than that used to treat depression.

The author is an Assistant Professor at Seoul National University Hospital International Healthcare Center (SNUH-IHC).