What causes functional dyspepsia?

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Lawrence S. Friedman, MD
Gastroenterology
Although there are several theories, no one really knows what causes functional dyspepsia (FD) -- persistent upper abdominal pain or discomfort for which there is no identifiable cause. Many experts don't think that excess gastric acid is to blame. Studies have found no irregularities in acid secretion in dyspeptic patients and no correlation between symptoms and increased acid production. But the theory remains under consideration, as does the possibility that the abdominal pain associated with FD results from acid leaking through the gastric or duodenal mucosa, which has been altered in some way. Some other ideas include:
  • Pain hypersensitivity. Many experts believe that patients with FD are more sensitive to pain than people without FD, and that they may have a lower threshold for pain than their healthy counterparts.
  • Motility or sensation problems. The symptoms of FD may reflect abnormal motility -- that is, a problem with the movement of the digestive tract which might slow the emptying of the stomach, triggering symptoms.
  • Stress, anxiety, or other psychological factors. Anxiety, emotional stress or depression are common in people with functional dyspepsia. Treating these factors improves symptoms for some people.
  • H. pylori infection. While the role of H. pylori infection as a cause of ulcers and gastritis is well established, its involvement in FD is unclear. H. pylori infection is only slightly more common in people with FD than in the general population. Although the organism may contribute to FD symptoms in some cases, there's currently no way to distinguish these people from those in whom H. pylori does not cause FD. In most cases, eradicating H. pylori with antibiotics doesn't significantly improve FD symptoms.
  • Duodenitis. Another condition that might produce symptoms of FD is duodenitis, a long-term inflammation of the lining of the duodenum. However, less than 20% of people with FD have this condition.
  • Diet. Certain fatty foods are often blamed for dyspepsia. This connection makes sense because fat ingestion not only delays gastric emptying, but also increases distension of the stomach. Substances like alcohol and coffee may also aggravate symptoms.
  • Drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially aspirin, can cause dyspepsia, ulcers, and gastritis. Other drugs such as opiates, iron preparations, and digitalis may also cause dyspepsia.

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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.