Functional dyspepsia

Specialty: Gastrointestinal.

• Non-ulcer indigestion
• functional gastric discomfort
• pseudogastritis

Why it occurs

• Disorder of the brain-gut axis with gastric visceral hypersensitivity to mechanical distension by food or acid
• Mild to moderate delay in non-obstructive gastric emptying (fundus gastric accommodation disorder)
• Subclinical infection or post-infectious state after acute bacterial gastroenteritis due to Helicobacter pylori or other pathogens
• Concomitant psychological alterations (somatization, generalized anxiety, major depression) that amplify the gastric nociceptive afferent signal.

Initial workup

Breath test with urea labeled with Carbon-13 for detection of Helicobacter pylori infection (or H. pylori antigen test in stool) | Upper digestive endoscopy (EDA, mandatory for those over 55 years of age or in the presence of any warning sign to rule out gastric cancer, esophagitis or peptic ulcer) | Ultrasound of the upper abdomen (to rule out hepatobiliary or biliary stone pathology) | Complete blood count, erythrocyte sedimentation rate (ESR), CRP and IgA antitransglutaminase antibodies (to rule out celiac disease with dyspeptic presentation).

Standard management

• Proton pump inhibitors — omeprazole 20 mg/day, pantoprazole 40 mg/day or rabeprazole 20 mg/day for 4-8 weeks, effective for the relief of epigastric pain syndrome
• Prokinetics — itopride 50 mg three times a day, cinitapride 1 mg three times a day or domperidone 10 mg three times a day before meals, mainly indicated for postprandial distress syndrome
• Tricyclic antidepressants at low doses — amitriptyline 10-25 mg at night; modulates visceral hypersensitivity and decreases the transmission of epigastric pain to the central nervous system
• Selective serotonin reuptake inhibitors or mirtazapine (15 mg at night, useful if the patient presents with severe early satiety and associated weight loss due to anxiety).