More About Functional Dyspepsia
In the ‘What is indigestion’ section, we talked about the 4 main medical categories of dyspepsia
and you were probably surprised to find out that the most common category was ‘functional
dyspepsia’ (60%) - i.e. where no medical cause was found for symptoms after investigation.
So, given that functional dyspepsia affects up to a quarter of the population, it
would appear useful to consider it in more detail. It is particularly important
because sufferers are likely to have significant symptoms which could well be hindering
their quality of life and performance at work.
What is meant by Functional Dyspepsia?
Functional dyspepsia is defined as:
- Persistent or recurrent pain or discomfort centred in the upper abdomen (stomach
area – see Diagram 1)
- Symptoms for at least 12 weeks (but not necessarily continuously) within the preceding
year
- No other cause has been found for the symptoms following clinical investigation
e.g. endoscopy
- Symptoms aren’t relieved by bowel actions (distinction from irritable bowel syndrome
–IBS– which is similar but affects the bowels).
The two major types of functional dyspepsia, based on the patient’s main symptom,
are:
- Ulcer-like dyspepsia – pain in the stomach area.
- Dysmotility-like (abnormal stomach movements) dyspepsia – discomfort (e.g. bloating
and feeling of fullness, especially after meals) in the stomach area.(See Diagram 2)
What causes it?
The cause is still unknown. However it is currently considered to be a mixture of
abnormalities of movement and sensation within the stomach area, tied in with elements
of emotional distress (i.e. stress, anxiety etc).
The emotional distress is thought to cause an upset in the body’s sub-conscious
nervous system at the place where it acts upon the stomach wall. In certain predisposed
individuals this leads to the spasm and abnormal sensations (i.e. pain or discomfort)
in the stomach area associated with functional dyspepsia. See illustration.
How can I best cope with it?
Some patients, particularly those with mild symptoms, are happy with an explanation
of the condition and reassurance that there is nothing more sinister.
Sufferers may benefit from dietary and lifestyle modifications, including avoiding
offending foods (e.g. high fat diets) drinks (e.g. coffee, tea, alcohol), and cigarettes.
These suggestions are in line with general healthy lifestyle recommendations.
The response to medicines is variable and it’s often a case of seeing which medicine
best suits the individual patient. The most common initial choices are an acid reducing
agent or a ‘prokinetic’, a product which helps the stomach to empty. The medication
should be taken short term, but if symptoms are persistent and severe, it may need
to be taken regularly over a longer period.
Other medicines, such as painkillers or spasm reducing agents, can be tried on an
individual basis, but once again the results are variable.
In patients with more severe or persistent symptoms, addressing the connection between
the emotional distress and the symptoms has improved responses. These therapies
are aimed at reducing the symptoms through the patient learning to cope better and
be more in control of their symptoms, and often include relaxation exercises, which
can be specifically focused on the stomach.
The long-term results for functional dyspepsia using stomach-focused hypnotherapy
are very encouraging. The majority of patients were able to cope with their symptoms
and also stopped taking any medication. However, this and other similar therapies
may not be readily available and they all require a significant commitment, usually
weekly half-hour sessions over an average of 3 months.