What medications help treat functional dyspepsia?

Lawrence S. Friedman, MD
No truly effective drug exists to treat functional dyspepsia (FD) -- persistent upper abdominal pain or discomfort for which there is no identifiable cause. Many patients respond no better to drugs than to placebo. It is noteworthy, however, that in almost all clinical trials, 25% to 60% of patients respond to medications, and therefore doctors often recommend them, including over-the-counter antacids and omeprazole or other proton pump inhibitor.

Herbal remedies may also be worth a try. In several clinical trials, a combination of enteric-coated peppermint oil and caraway oil successfully reduced fullness, bloating, and gastrointestinal spasms in patients with functional dyspepsia. (Enteric-coated means that the preparation is able to pass through the stomach and won't dissolve until it reaches the small intestine.) Be aware, however, that peppermint oil may trigger gastroesophageal reflux in people who are predisposed to it.

Doctors may recommend other medications. Anticholinergic medications that decrease contractions in the gastrointestinal (GI) tract, such as hyoscyamine (Levsin), may be used for up to four to six weeks. Simethicone, which rids the gut of gas bubbles, is safe and may help if you have both dyspepsia and flatulence. Finally, the doctor may prescribe a low dose of a tricyclic antidepressant such as amitriptyline (Elavil, Endep). Some studies have found that tricyclics improve symptoms.

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