How is functional dyspepsia diagnosed?

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Lawrence S. Friedman, MD
Gastroenterology
Functional dyspepsia (FD) is used to describe persistent upper abdominal pain or discomfort for which there is no identifiable cause, such as peptic ulcer disease. As a first step toward both diagnosis and treatment, your doctor will probably prescribe one or more drugs that curtail acid secretion to see if the dyspepsia clears. The doctor may also order a fecal, blood, or breath test to detect the presence of H. pylori bacteria. If the test is positive, the doctor will prescribe antibiotics to eradicate the bacteria. If symptoms have not improved after a few weeks, the next step will probably be endoscopy to check for ulcers.

People over age 55 (some experts say over age 45) with a new onset of dyspepsia and those with a family history of gastrointestinal cancers should be promptly evaluated for underlying cancer. Prompt evaluation is also needed for patients whose dyspepsia is accompanied by additional worrisome symptoms, such as weight loss, dysphagia (difficulty swallowing), gastrointestinal bleeding, or anemia (low blood count). Only after tests and drug trials fail to pinpoint another cause can the condition be labeled FD.

Certain tests can reveal whether the gastrointestinal tract is functioning properly, such as gastric-emptying tests or motility studies. Other tests may be done to rule out other conditions associated with dyspepsia, which include other gastrointestinal and non-gastrointestinal conditions, such as gastroesophageal reflux disease (GERD), and diabetes and hyperthyroidism, respectively.

Your physician will take a full medical history, including what drugs – over-the-counter and prescription – you are taking, as dyspepsia may also be caused by certain medications. Your diet will also be discussed, and a food diary requested to rule out any food sensitivities.

Tests that may be given to rule out other conditions include an upper gastrointestinal (GI) series of x-rays to visualize the stomach and duodenum, and a barium enema and colonoscopy to view the lower gastrointestinal tract.

A blood test or urea breath test may be done to check for helicobacter pylori bacteria (H. pylori bacteria), which is associated with peptic ulcers, and imaging tests such as abdominal ultrasound sonography, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI) may be done to rule out non-intestinal diseases.

Other tests may be given as well, depending on the symptoms reported.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.