Do you also have stomach pain when you eat? Can't find a reason? Let's talk about (Functional Dyspepsia)!

Do you often feel full, have a burning sensation in your stomach, or just feel upset after eating? Sometimes you can't even find a reason for this, right? Even after going to a doctor and doing a bunch of tests, they may say, "You're not sick." Many people experience this. That's what we call ``Functional Dyspepsia'', a digestive disorder that is difficult to find a clear cause for.

What is `(Functional Dyspepsia)`? Simply put...

Simply put, ``Functional Dyspepsia`` is a condition where you have chronic indigestion, but no clear cause can be found. ``Dyspepsia`` is another word for indigestion. It is a pattern of symptoms that occur together after eating and during digestion. ``Functional`` means that your indigestion symptoms cannot be attributed to any of the usual physical causes (such as an ulcer or gastritis).

Your symptoms may sound like those of peptic ulcer disease or gastroesophageal reflux disease (GERD) . However, tests show that only a small number of people have these conditions. The rest have what is called Functional Dyspepsia.

Imagine, your car's engine is making a noise, but the mechanic can't find anything wrong. Everything looks fine from the outside, but there's something wrong.

Are there different types of this?

Functional Dyspepsia is more of a syndrome than a single disease. This means that the way it affects each person and the symptoms they experience can vary. Doctors have divided it into two main types:

1. Epigastric pain syndrome: This type of pain is mainly felt in the upper part of the stomach and is similar to heartburn . It is not always related to meals. It can sometimes occur on an empty stomach. This is somewhat similar to the symptoms of GERD.

2. Postprandial distress syndrome: This is a condition in which stomach discomfort occurs after eating. For example, feeling full even after eating a small amount (early satiety), feeling full, bloating, and stomach pain after eating. This is somewhat similar to the symptoms of peptic ulcers.

Not everyone fits into either of these two categories. Some people may experience a mix of both, or may experience a combination of both.

What are the main symptoms of this?

With ``Functional Dyspepsia'', you may experience one or more of the following symptoms:

• Pain in the upper abdomen (epigastric pain):Pain in the upper abdomen, just below the rib cage. This area is called the ``epigastrium''. This is where your stomach, pancreas, duodenum (the first part of the small intestine), and part of your liver are located.
• Bloated stomach: A feeling of discomfort and fullness in the stomach after eating. This is often associated with gas, bloating, and other things like gas. It can also feel like your stomach is pulling.
• Fullness and loss of appetite: Feeling full while eating, after eating, or even after not eating much (early satiety) . Sometimes, loss of appetite can occur even before eating.
• A Burning Sensation: A burning sensation in the chest, also known as "heartburn", is common with these indigestion symptoms. This is usually caused by stomach acid coming up your esophagus (acid reflux). You may also feel a burning sensation inside your stomach.

In addition to this, other features such as these can also be seen:

• Excessive belching
• Nausea or gagging
• If you have IBS (irritable bowel syndrome), your symptoms (e.g. frequent bowel movements or constipation) may also increase.
• Feeling stressed or emotionally uncomfortable.

Why does this `(Functional Dyspepsia)` occur? What are the causes?

Doctors call a "functional" disorder a disorder that has no direct, obvious cause for symptoms. One reason for this may be the close connection between your gut and your brain (gut-brain axis) . These types of functional disorders seem to be related to your nervous system and the way you perceive and feel pain or discomfort.

Although there is no single cause of ``Functional Dyspepsia'', several factors may contribute to it:

• Visceral hypersensitivity: Imagine that your nervous system is a little too sensitive. You are more likely to react physically to stress. You may be unconsciously tightening your muscles, or your digestive system may be slowing down due to stress. You may also be very sensitive to normal things happening inside your organs. This can make digestion feel uncomfortable even when it is going well.
• Motility disorders of the digestive system:This means there are problems with the way food moves and moves through your digestive system (GI tract). This can also be a result of poor communication between your brain and digestive system. The nerves and muscles in your digestive system may not be working properly. This can cause food to get stuck in one place, or the organs may not be fully relaxed and not allow food to pass through.
• Gut dysbiosis: An imbalance in the microbes in your gut (called your microbiome) can lead to symptoms of functional dyspepsia. For example, the bacteria H. pylori can damage the lining of your stomach, causing inflammation and making it more sensitive to stomach acid. Also, if bacteria grow too much in the small intestine, it can cause bloating and difficulty digesting fats.
• Eosinophilic duodenitis: Some people with functional dyspepsia have been found to have an excess of a type of white blood cell called eosinophils in the first part of the small intestine (duodenum). This can cause long-term inflammation (duodenitis). These eosinophils are there to protect you from your immune system, infections, and allergies. This may be caused by a previous infection or a food allergy.

What are the risk factors for this condition?

There are several other factors that increase the risk of developing ``Functional Dyspepsia``:

• Psychological factors: Mental conditions such as anxiety, depression (mood disorders), or traumatic events or abuse experienced in the past.
• Family history: A family history of nervous system disorders or other functional GI disorders such as IBS.
• Food sensitivities: Sensitivity to certain foods (e.g., foods belonging to the `(FODMAPs)` group) or intolerance to certain foods (e.g., `(lactose intolerance)` - difficulty digesting milk and dairy products).
• Atopy: This means having multiple allergic conditions, such as asthma, eczema, and hay fever.

How do doctors figure this out exactly?

Doctors diagnose `(Functional Dyspepsia)` after confirming your symptoms and ruling out other causes (e.g. `(GERD)`, `(Peptic Ulcer Disease)`). Sometimes you may already have one of these conditions and be treated for it. However, if those treatments do not reduce your indigestion symptoms, then you should still consider `(Functional Dyspepsia)`.

The symptoms of ``Functional Dyspepsia'' are not always present and may come and go. Doctors diagnose it by considering the following factors:

• Have the symptoms persisted for at least three months ?
• Has it been at least six months since the symptoms first started?
• Are these symptoms not relieved by swallowing, passing air (diarrhea), or having a bowel movement?
• Aren't these symptoms related to pain caused by gallstones (biliary colic) or other gallbladder pain?

Once doctors have confirmed that you have indigestion (dyspepsia), they will look for a physical cause (e.g., an ulcer, an infection). They may do tests like these:

• Blood tests: Check for common infections and conditions.
• Breath tests: For example, the urea breath test can check for the presence of the bacteria H. pylori. The hydrogen breath test can check for abnormal bacterial growth in the gut.
• Gastric emptying studies: Check how quickly/slowly food moves from your stomach into the small intestine.
• Upper endoscopy: A thin tube is inserted through the mouth to look inside the stomach, esophagus , and first part of the small intestine. This is done to check for anything unusual, such as an ulcer. If necessary, a small piece of tissue (biopsy) may be taken for examination.

What is the treatment for this?

If tests reveal an underlying cause (e.g., bacterial overgrowth, motility disorder), your doctor will treat that first. However, many times, even after treating these underlying causes, your symptoms of ``Functional Dyspepsia'' do not completely go away. Therefore, your doctor will suggest other treatments to help control your symptoms. This is usually a combination of several treatments .

Some medications used for ``Functional Dyspepsia``:

• If there is a bacterial infection , antibiotics are prescribed.
• Prokinetics are drugs that stimulate the movement of the digestive system.
• Medicines that reduce stomach acid: proton pump inhibitors (PPIs) (e.g. omeprazole) or H2 blockers (e.g. Ranitidine).
• Tricyclic antidepressants in low doses to calm the nervous system and reduce pain (although these are medications given for depression, they are also used in low doses for conditions like this).

In addition, there are also complementary and alternative medicine methods:

• Plant-based formulas: For example, capsules containing peppermint and caraway oil, or herbal mixtures such as Iberogast® (you will have to ask your doctor if these are available in Sri Lanka).
• Mind-body relaxation therapies:Meditation, yoga, biofeedback (a method of becoming aware of the body's functions and learning to control them), psychotherapy.
• Dietary changes: Identify which foods are not good for you and are making your symptoms worse by doing an ``Elimination diet`` (stopping and looking at one food group at a time) and adjusting your daily diet accordingly.
• Acupuncture: Some studies have shown that this method also provides some relief.

What happens if you have `(Functional Dyspepsia)`? What can you expect?

For many people, Functional Dyspepsia is a chronic condition that recurs throughout life. It can take some time, and a bit of trial and error, to find the treatments and habits that work for you and reduce your symptoms. You may get some relief, but it may not go away completely. But, most importantly, it is not serious. So don't worry.

When should I see a doctor?

You should definitely seek medical advice if you have:

• If you haven't been tested for digestive system diseases yet.
• If your symptoms change or become clearly worse.
• If you vomit frequently.
• If your weight is decreasing for no reason.

With no clear cause or definitive cure, the diagnosis of ``Functional Dyspepsia'' can be a bit confusing for those looking for answers. ``Functional GI disorders'' are a bit more complex. They involve your brain, your nervous system, your diet, your lifestyle, and sometimes even underlying causes in your body. That's why they can be a bit more difficult to manage.

Medical tests can help identify and rule out certain contributing factors. But ultimately, you are the only one who can truly understand what makes your symptoms better and what makes them worse. As you try different treatments and identify your triggers, you will find your own unique way to live with Functional Dyspepsia.

Take home message

• ``(Functional Dyspepsia)`` is a real discomfort that you feel. It's not "just in your mind."
• This is managed by controlling the symptoms, which can be helped by lifestyle changes, diet, and possibly medication.
• It's very important to work with a doctor. Talk openly about your symptoms, what you're feeling, and what you've tried.
• Don't give up hope. Many people find ways to cope with this condition. You are not alone!

` Functional dyspepsia, indigestion, stomach pain, bloating, chest inflammation, digestive system, stress