Diagnosis
Definition: There are two subtypes of functional dyspepsia: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS)
H&P Consistent with FD
Rome III diagnostic criteria for functional dyspepsia.
DDx of Dyspepsia.
R/o alarm symptoms.
R/o organic or structural causes of dyspepsia.
Labs: CBC, CMP (LFTs), serum lipase and amylase, H. Pylori testing.
EGD if age ≥60 or if the patient has any alarm features.
Treatment & Patient Education
-There is some benefit from reassurance and “naming” a patient’s condition.
-Epigastric pain syndrome: Tx with PPI or H2-blockers.
-Postprandial distress syndrome: Tx with a motility agent such as metoclopramide. 2nd line: TCAs and buspirone
-If TCAs and prokinetics don’t help, do EGD with biopsies if not already done.
Key Points
- NB: Sucralfate, antacids, and selective antidepressants are not effective in functional dyspepsia. However, TCAs and buspirone have shown some benefit and are reasonable options for postprandial distress syndrome.
- Labs aimed at r/o alarm features (eg, iron deficiency anemia) and underlying metabolic diseases that can cause dyspepsia (eg, diabetes, hypercalcemia).
Further Reading
Brun R, Kuo B. Functional Dyspepsia. Therapeutic Advances in Gastroenterology. 2010;3(3):145-164. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002577/
N Engl J Med. 2015 Nov 5;373(19):1853-63. Functional Dyspepsia.
Am Fam Physician 2011;83(5):547-552. Update on the evaluation and management of functional dyspepsia.