Functional dyspepsia is a condition characterised by persistent or chronic indigestion without an identifiable cause. Healthcare providers consider it a functional disorder, as standard diagnostic tests typically do not reveal any structural abnormalities or specific causes. Although it is a common and persistent condition, the symptoms can be intermittent. Continue reading to learn more about the symptoms and diagnosis of functional dyspepsia, as well as its similarities and differences with other gastrointestinal conditions and its potential link to stomach cancer.
Symptoms and Types of Functional Dyspepsia
Functional dyspepsia is classified into two main subtypes based on the symptoms experienced:
- Epigastric Pain Syndrome (EPS): This subtype is characterised by upper abdominal pain or discomfort. The pain is typically centred around the epigastric region (just below the ribcage) and may be burning or aching in nature. It is often unrelated to meals and may be triggered by stress or certain foods.
- Postprandial Distress Syndrome (PDS): It involves discomfort or a sensation of fullness soon after eating, often described as early satiety. Those with PDS may also experience bloating or nausea after meals. This subtype is primarily associated with symptoms that occur in response to eating.
Both types can occur simultaneously, and dyspepsia symptoms may vary in severity.
How Does It Develop?
Functional dyspepsia develops due to complex interactions between various factors that disrupts the normal functioning of the digestive system. These factors may include:
- Gastric motility: Abnormal movement of the stomach or intestines can lead to symptoms such as delayed or rapid gastric emptying.
- Visceral hypersensitivity: Increased sensitivity of the nerves in the gastrointestinal tract can cause discomfort or pain even during the normal digestive process.
- Psychological factors: Stress, anxiety, and depression can compromise digestive function and exacerbate symptoms.
- Infections: A history of gastrointestinal infections, such as Helicobacter pylori infection, may increase the risk of developing functional dyspepsia.
- Diet and Lifestyle: Certain foods, beverages, or habits (such as smoking) may trigger or worsen symptoms.
- Elevated acid secretion: Higher levels of stomach acid can irritate the digestive tract and lead to symptoms.
- Certain medications: Some medications can contribute to the development or exacerbation of functional dyspepsia.
- Intestinal microbiome changes: Alterations in the composition of the gut microbiome may impact digestive health and contribute to symptoms.
What Are the Potential Medical Complications of Functional Dyspepsia? Does Functional Dyspepsia Cause Stomach Cancer?
Although not directly linked to increased morbidity and mortality, it can indeed lead to physical and mental distress, significantly impacting the patient's quality of life. The persistent or recurrent symptoms of functional dyspepsia, such as abdominal pain, bloating, and nausea, can disrupt daily activities, affect appetite and eating habits, and contribute to anxiety and depression.
In some cases, individuals with functional dyspepsia may have underlying conditions, such as chronic gastritis or Helicobacter pylori infection, which are risk factors for stomach cancer. Therefore, while functional dyspepsia itself does not directly cause stomach cancer, it can serve as an indicator of potential underlying issues that may warrant further evaluation and management to reduce the risk of developing gastric malignancies.
How is it Diagnosed?
Functional dyspepsia is diagnosed by ruling out other potential causes of indigestion first. This is typically done through:
Medical history: A thorough review of symptoms, medical history, and any medications taken.
Physical examination: An examination to check for any obvious signs of other gastrointestinal issues.
Diagnostic tests: These include blood tests, stool tests, urea breath tests, and imaging studies (e.g., ultrasound, endoscopy) to rule out other causes such as peptic ulcers, gastritis, or GERD. Gastric emptying studies may also be conducted to examine how quickly the stomach empties food into the small intestine.
Risk Factors that Contribute to Functional Dyspepsia
Several risk factors can contribute to the development of functional dyspepsia, including:
- Stress, anxiety and depression
- Female gender
- Smoking and tobacco consumption
- Genetic predisposition
- Certain medications
- Dietary habits
- Alcohol consumption
- Helicobacter pylori infection
- Gastrointestinal hypersensitivity
How Can Dyspepsia Mimic the Symptoms of Early-Stage Stomach Cancer?
Functional dyspepsia can mimic the symptoms of early-stage stomach cancer because both conditions can present with similar digestive symptoms, making it challenging to differentiate between them based solely on clinical presentation. Common overlapping symptoms include:
- Upper abdominal pain or discomfort: Both dyspepsia and early-stage gastric cancer can cause pain or discomfort in the upper abdomen.
- Bloating and fullness: Patients with either condition may experience a sensation of fullness or bloating, particularly after meals.
- Nausea and vomiting: Both conditions can cause nausea and occasional vomiting.
- Loss of appetite: Early satiety or a lack of interest in food can be present in both dyspepsia and early-stage gastric cancer.
- Unexplained weight loss: Although weight loss is more commonly associated with gastric cancer, it can also occur in cases of severe dyspepsia.
Other Conditions that may Present Similar Symptoms
- Gastritis: Functional dyspepsia and gastritis share common symptoms such as upper abdominal pain or discomfort, bloating, nausea, and a sensation of fullness after meals. In order to differentiate between the two, a medical evaluation is necessary. Tests such as an endoscopy can diagnose gastritis, which often involves inflammation of the stomach lining, whereas functional dyspepsia lacks a clear structural cause. While they may exhibit similar symptoms, they are completely different conditions, and you can, at times, be affected by both.
- GERD/GORD: Both dyspepsia and GERD share common symptoms such as upper abdominal discomfort, bloating, and nausea. While both conditions can cause upper gastrointestinal symptoms, dyspepsia involves a broader range of potential triggers and underlying causes, whereas GERD specifically involves acid reflux from the stomach into the oesophagus.
- IBS (Irritable Bowel Syndrome): Functional dyspepsia and IBS are both digestive disorders that share some overlapping symptoms, such as abdominal pain, bloating, and discomfort. However, they affect different parts of the gastrointestinal tract. Dyspepsia primarily involves the upper GI tract, including the stomach, and presents symptoms like nausea, early satiety, and upper abdominal discomfort. In contrast, IBS primarily affects the lower GI tract and is characterised by altered bowel habits such as diarrhoea, constipation, or a combination of both. While there can be overlap in symptoms, the key differences lie in the location and nature of the digestive issues.
Treatment Options and The Importance of Lifestyle Changes
Functional dyspepsia treatment often involves a combination of medication and lifestyle changes. Doctors may prescribe medications like proton pump inhibitors (PPIs) to reduce stomach acid and alleviate symptoms. Psychological therapy and medications, such as low-dose antidepressants, may also be beneficial for managing stress, anxiety, or depression associated with dyspepsia.
Certain lifestyle changes are a key aspect of managing functional dyspepsia. This includes maintaining a healthy diet by avoiding trigger foods and eating smaller, more frequent meals. Reducing or eliminating alcohol and caffeine, quitting smoking, and incorporating stress-reduction techniques such as meditation, yoga, or deep breathing exercises can also be of help.
Outlook and Prognosis
Consultant Gastroenterologist from Alpha Digestive & Liver Centre, Dr. Benjamin Yip, emphasises the importance of seeking specialised medical evaluation when experiencing symptoms of functional dyspepsia. Since these symptoms can mimic those of stomach cancer and may occur in individuals as young as 30, it's essential not to overlook potential warning signs. Dr. Yip advises prompt medical assessment to rule out more serious conditions and ensure early intervention if necessary. An early diagnosis and appropriate management can lead to better outcomes and improved quality of life. Don't hesitate to consult your Gastroenterologist for a thorough assessment and personalised treatment plan if you experience persistent digestive issues.
Frequently Asked Questions
What does functional dyspepsia feel like?
Functional dyspepsia can feel like upper abdominal discomfort or pain, often centred around the epigastric region (just below the ribcage). Other symptoms may include bloating, nausea, early satiety (feeling full quickly), and a sensation of fullness after meals. Some patients may experience a burning or aching sensation in the upper abdomen.
Can anxiety cause functional dyspepsia?
Yes, anxiety can contribute to functional dyspepsia. Stress and anxiety can affect the digestive system and lead to symptoms such as discomfort, pain, or indigestion. Managing stress and anxiety through relaxation techniques, therapy, or medication can help alleviate the symptoms of dyspepsia.
What should I eat if I have functional dyspepsia?
If you have functional dyspepsia, focus on a balanced diet that includes easily digestible foods such as lean proteins, cooked vegetables, whole grains, and non-acidic fruits. Avoid trigger foods such as spicy, greasy, or acidic foods, and limit caffeine and alcohol consumption. Eating smaller, more frequent meals can also help manage symptoms. Consulting a Gastroenterologist or registered dietitian can provide personalised dietary recommendations.
To learn more about cancer screening procedures, check out this interview with Dr Benjamin Yip, Gastroenterologist in Singapore.
References:
- “Functional Dyspepsia”, DynaMed, 24 October 2023, https://www.dynamed.com/condition/functional-dyspepsia#GUID-73C7B8B3-9B57-45E5-9ED4-53998ED31D21
- “Functional Dyspepsia”, GI Society, November 2021,https://badgut.org/information-centre/a-z-digestive-topics/functional-dyspepsia/
- Lukas Macke, Christian Schulz, Peter Malfertheiner, The Fear of Gastric Cancer in Patients with Dyspepsia: Challenge in Specialist Care Gastroenterology. Digestive Diseases, July 2022, 40 (4), 409–416, https://karger.com/ddi/article/40/4/409/827909/The-Fear-of-Gastric-Cancer-in-Patients-with
- “Symptoms of stomach cancer”, Cancer Research UK, 30 June 2022, https://www.cancerresearchuk.org/about-cancer/stomach-cancer/symptoms
