Clinic: I thought I had an ulcer, but my doctor ruled that out
and wants to run tests. He said it could be functional
dyspepsia. What causes this, and is it treatable?
dyspepsia (also called nonulcer dyspepsia) and peptic ulcers
can feel much the same. But, unlike a peptic ulcer, which
involves open sores in the digestive tract, functional
dyspepsia involves recurring indigestion or stomach pain that
has no obvious cause. Common signs and symptoms of functional
dyspepsia include a burning sensation or discomfort in your
upper abdomen or lower chest; bloating; belching; an early
feeling of fullness when eating; and nausea. While not
life-threatening, the symptoms can significantly affect your
quality of life.
To begin the
diagnostic process, your health care provider likely will
perform a physical exam. Blood tests may be performed to help
rule out other diseases that can cause symptoms similar to
to help with diagnosis is endoscopy, in which a thin,
flexible, lighted instrument (endoscope) is passed down your
throat so that your doctor can view your esophagus, stomach
and the first part of your small intestine (duodenum).
Endoscopy also allows your doctor to collect small pieces of
tissue (biopsy) from your stomach or duodenum to look for
inflammation or cancerous growths.
care provider can determine whether an endoscopy is needed,
but endoscopy generally is recommended in adults 60 and older
who have symptoms. A normal result on this test most often
indicates functional dyspepsia. Endoscopy also may be
performed on adults younger than 60 who have “alarm”
features — such as weight loss, anemia, difficulty
swallowing or persistent vomiting — along with dyspepsia
symptoms. But this is determined on an individual basis.
If no abnormal
results are found with endoscopy, a noninvasive breath or
stool test to check for the Helicobacter pylori (H. pylori)
bacterial infection may follow to guide the course of
treatment. This test also is used for adults under 60 with no
alarm features. If H. pylori is present, your health care
provider may recommend an antibiotic to eliminate the
For those who
test negative for the bacterium, as well as for those whose
symptoms persist after antibiotic treatment and clearance of
H. pylori, the first line of treatment is to reduce stomach
acid. This may be performed using two types of medications:
proton pump inhibitors or H2-receptor blockers. Proton pump
inhibitors reduce acid by shutting down the tiny pumps within
stomach cells. Examples include esomeprazole (Nexium),
lansoprazole (Prevacid) and omeprazole (Prilosec). H2-receptor
blockers, including famotidine (Pepcid) and ranitidine
(Zantac), reduce acid production by blocking histamine
receptors in stomach cells.
options don’t manage your symptoms, other medications are
available, including those that affect nerve endings in the
stomach. Cognitive behavioral therapy also may be recommended
as a way to cope with the symptoms and reduce the stress that
may trigger stomach pain.
functional dyspepsia lacks a fully understood cause and its
symptoms overlap with other gastrointestinal conditions, the
diagnosis of functional dyspepsia can be challenging.
Researchers continue to explore better means of clearly