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Functional

Dyspepsia
Patient
bupa.co.uk

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INTRODUCTION

Functional dyspepsia, sometimes referred


to as non-ulcer dyspepsia, is a common
functional disorder of the upper digestive
tract (stomach and upper small intestine).
Functional dyspepsia is characterised by
chronic or recurrent upper abdominal pain
or discomfort, often in conjunction with
feelings of early satiety (fullness), pressure in
the abdomen, burning, bloating, belching or
nausea. Symptoms may occur after eating a
meal, but can happen at any time. Similarly,
certain foods or drinks may worsen symptoms
for some people.
As with other functional disorders, there
is no evidence of organic disease or other
structural abnormality in the gut (such as
an ulcer or inflamed esophagus) that can
account for the symptoms that are present.
While the condition is uncomfortable and can
be distressing, especially if symptoms are
chronic, functional dyspepsia does not cause
other, more serious conditions. The symptoms
associated with functional dyspepsia can
be addressed, as outlined further in this
leaflet, and the prognosis for the condition is
generally quite good.

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CAUSES

The exact cause of functional dyspepsia is not known, however symptoms are
thought to be linked to an increased sensitivity in the esophagus and upper
gastrointestinal system, which can be triggered by a variety of factors.

These may include: impaired peristalsis (contraction and Functional Dyspepsia is one of several conditions known as
relaxation of the intestinal muscles that move food functional gastrointestinal disorders. The term functional
through the upper digestive tract), acid secretion, diet, disorder refers to the presence of symptoms with a normal
lifestyle, and psychological factors. Many people with clinical examination and normal investigations. In other
functional dyspepsia have an increased awareness of their words there is nothing visibly wrong with the body. In the
stomach and upper gut activity and can have impaired case of functional dyspepsia, the lining of the gut is not
digestion or be sensitive to food intake. Many people with inflamed and the amount of acid in the stomach is normal.
functional dyspepsia find that certain foods can make This can be very frustrating for patient and clinicians
symptoms worse, however, food is not the cause of especially when the symptoms are very severe. An organic
functional dyspepsia. disorder refers to conditions where symptoms are
associated with findings on clinical examination and/or
abnormal diagnostic tests which identify the source of
symptoms and direct future treatment.

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Contributory elements to the
development of functional dyspepsia
Biological factors with functional dyspepsia properly. This is because the
signals that travel back and forth from the brain to the
Functional dyspepsia can be caused by a failure of
gut, controlling the nerves, are disrupted in some way.
the stomach or upper digestive system to move food
Because of this, food, drinks, and emotions may trigger
through the body in a normal way. Typically, the
pain. The sensitivity, as mentioned above, stems from
body moves food through the digestive system by
hypersensitive gut nerves that send excess signals to the
rhythmically contracting and relaxing the muscles of
brain, particularly to the area that processes pain. The
the digestive system. In this way, food moves from
brain then sends abnormal signals back to the gut to alter
the stomach through the intestinal tract. However, in
its motility or relax muscles. This back and forth electrical
those with functional dyspepsia, this process is often
communication between the brain and gut is represented
disturbed and the stomach or small intestine may not
by the brain-gut axis and understanding this interaction
relax, contract, or empty normally after a meal.
forms the basis of current treatment approaches to
Issues relating to the brain-gut axis functional dyspepsia.

The link between the brain and the gut has been Emotional factors
well established. Research using MRI scans showed It has recently become evident that stress and other
that certain areas in the gut and in the brain are more psychological factors, such as anxiety and depression,
active in functional dyspepsia than in non-functional can affect the gastrointestinal system. These
dyspepsia subjects. It is therefore believed that functional psychological factors can make functional dyspepsia
dyspepsia is related to excessive nerve transmission symptoms worse, and sufferers more sensitive and less
between the gut and the brain, which is mediated by tolerant of food. Heightened emotional states can lead
nerve chemicals (neurotransmitters). In other words, a to chemical changes in the body that can hinder the
primary trigger driving functional dyspepsia symptoms process of digestion. This can be cyclical as well, as the
is that the gut is hypersensitive to stimuli and that food uncomfortable nature of functional dyspepsia can lead
does not pass through the digestive systems of people to more stress, depression, anxiety or anger.

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symptoms

General Symptoms
The symptoms of functional dyspepsia vary between each individual, as does their
severity. At times, symptoms and signs can be mild, and at other times they can be
painful and debilitating. Symptoms are often worse after eating and tend to come and
go in bouts.

Core symptoms of functional dyspepsia often include


the following:
oo Pain or discomfort in your upper abdomen or chest
oo A feeling of fullness in your upper abdomen
oo A burning feeling in your neck or esophagus (heartburn)
oo Loss of appetite
oo Belching
oo Bloating
oo Nausea
oo Vomiting

Stress/depression/anxiety Alarm symptoms


The symptoms of functional dyspepsia It is important to see a doctor if you have:
can mostly be managed at home and do
not require urgent care. However, due to oo a noticeable change in any of the
the discomfort, pain and/or distress of general or associated symptoms of
functional dyspepsia, the clinical picture functional dyspepsia
may well be accompanied by feelings of oo difficulty swallowing
depression, anxiety and/or stress. These oo difficulty breathing
psychological factors should be related oo frequent vomiting or blood in
to your doctor, who can help to manage
your vomit
or treat them, along with your physical
symptoms.
oo family history of stomach cancer
oo family history of gastric cancer
oo shortness of breath
oo unintentional weight loss
oo or if you are 55 or older

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DIAGNOSIS
Functional dyspepsia is a functional gastrointestinal An international working group developed a list of
disorder, with no obvious physical abnormalities of the diagnostic criteria for functional dyspepsia. These criteria
digestive tract, and so there is no specific test that can were developed in Rome and are now at their third version
determine if it is present. Therefore, functional dyspepsia hence they are being referred to as the Rome III criteria.
is largely a diagnosis of exclusion. Your doctor will need
In some cases, particularly if you have alarm symptoms
to ask you a series of health questions, take your medical
(see previous heading), your doctor may want to carry out
history, and complete a physical exam in order to rule out
additional tests. This is to rule out the possibility of other,
other causes. A diagnosis is made based on the symptoms
more serious conditions, or infection or inflammation or
you describe and the exclusion of other causes.
the upper GI tract.

Functional Dyspepsia Rome III


diagnostic criteria
Symptoms must include one or more of the following:

1 Bothersome postprandial fullness

These criteria need to be


fulfilled for the last three
2 Early satiation months with symptom
onset at least six months
prior to diagnosis

3 Epigastric pain

4 Epigastric burning

and
No evidence of structural disease (including at upper endoscopy) that
5 is likely to explain symptoms

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In some cases, particularly if you have alarm symptoms (see previous heading), your
doctor may want to carry out additional tests. This is to rule out the possibility of
other, more serious conditions, or infection or inflammation or the upper GI tract.

Further Tests
If alarm symptoms are raised, further tests may be recommended in order to rule
out other conditions. Further investigations may include the following, depending on
your symptoms and concerns:

Endoscopy Computerised tomography (CT) scan


This test is used to examine the oesophagus, stomach, A CT scan may be used to scan the abdomen and pelvis,
and duodenum by inserting a thin, flexible tube down the producing cross-sectional images of the abdominal
oesophagus. organs, which can be used to help rule out other physical
causes for symptoms.
Helicobacter pylori test
A stool or breath test may be performed to rule out Food allergy tests
the presence of h. pylori, which is a type of infection If your doctor suspects your symptoms may be linked to
sometimes associated with dyspeptic symptoms. an intolerance of certain foods, he or she may order
a food allergy test or ask you to eliminate certain products
Blood tests
from your diet for a period of time.
A blood sample may be required to rule out more serious
conditions.
Barium swallow and meal X-ray
This test involves ingesting a drink that contains barium
prior to having an abdominal X-ray. Barium is a substance
that can be seen on X-ray images, enabling your doctor to
more clearly see the inside of your gut

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TREATMENT

Once diagnosed with functional dyspepsia, there are a Eat regularly


number of treatment options that can help you alleviate Irregular eating patterns have been proven to exacerbate
your symptoms. Sometimes, with mild to moderate cases the symptoms of functional dyspepsia. Try to eat meals
of functional dyspepsia, symptoms can be managed at at regular intervals and avoiding skipping meals or going
home by changing elements of your diet and lifestyle. a long time without eating, which can make symptoms
When symptoms are more severe, or if your functional worse. Eating small to moderate portions and eating
dyspepsia has become chronic, medication and slowly have also been known to decrease symptoms of
psychological treatments can also be useful. The different functional dyspepsia.
psychological treatments for functional dyspepsia are
Lifestyle
cognitive behavioural therapy (CBT), psychodynamic
psychotherapy and hypnotherapy. Smoking
Discussing these treatment options with your doctor, while Smoking is known to greatly exacerbate the symptoms
considering your symptoms and how functional dyspepsia of functional dyspepsia. If you smoke, it is recommended
is affecting your daily life, can help identify the most that you quit.
appropriate treatment options.
Caffeine and alcohol
Diet, Lifestyle, and Exercise
If a dietary or lifestyle cause is suspected, it may be Caffeine and alcohol are known to worsen the symptoms
helpful to change your diet or exercise regime. Your GP of functional dyspepsia. If you consume caffeinated or
may also refer you to a dietician or recommend some of alcoholic beverages, it is recommended that you reduce
the following dietary changes to see if they help reduce your intake of these, or exclude them altogether.
your symptoms.
Weight Management
Diet
If you are overweight, your doctor may recommend losing
Identify problem foods weight or seeing a nutritionist who can help you identify
In many cases, certain foods and drinks can exacerbate and address your diet. Being overweight can contribute to
the symptoms of functional dyspepsia. Foods with a the symptoms of functional dyspepsia and losing weight
high fat or sugar content, for example, can slow down may help improve or alleviate your symptoms.
the passage of food through the gut and break down
producing gas and liquid, which may make dyspeptic Exercise
symptoms worse. While these foods are not the cause
Your doctor will likely recommend that you exercise
of functional dyspepsia, your gut may not tolerate them
well. Identifying and limiting your intake of certain types regularly. Many people find a light to moderate exercise
of foods, in conjunction with a healthy, balanced diet, may regime helpsalleviate symptoms of functional dyspepsia
improve your symptoms. and reduces stress. Talk to your GP about finding the type
of exercise programme that would be most suitable and
Consider the following list of foods and drinks that are
enjoyable for you. Try to exercise three times per week, for
sometimes associated with functional dyspepsia and
consider limiting your intake if you are finding any of these a minimum of 30 minutes, doing something that increases
make your symptoms worse: your heart rate and breathing, such as brisk walking,
swimming, cycling or using a cardiovascular machine.
oo fatty foods (such as fried food, higher fat meats, cheese,
Therapeutic Interventions
nuts, etc)
If more conservative treatment, such as changes to diet
oo acidic foods (such as citrus fruits/juice or tomatoes and
and exercise routines do not help relieve your symptoms,
tomato-based products)
or if functional dyspepsia is having a significant impact on
oo spicy foods your daily activities and quality of life, a talking therapy
oo alcohol or counseling can often be helpful. This is particularly true
oo caffeinated beverages (such as coffee, tea or soda) for those who experience high levels of stress, or who
feel stress worsens their symptoms. Reducing the amount
oo carbonated beverages
of tension you experience or learning tools to manage
oo lactose stress and anxiety can often reduce the severity and
oo chocolate frequency of functional dyspepsia symptoms and improve

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your overall quality of life. It can also be helpful to talk to Medication
someone who understands how difficult such conditions
If other more conservative treatments do not have an
can be, and to discuss the correlation functional dyspepsia
effect on your functional dyspepsia, medication can
may have to your mood, troubling thoughts, or negative
sometimes be prescribed to reduce the severity of
feelings. There are a range of therapeutic treatment
symptoms. For further more specialised medications
options available which your doctor may recommend
consult your gastroenterologist.
and that can help alleviate stress or manage feelings of
depression. The main therapeutic approaches available for Acid-suppressing medications
functional dyspepsia are cognitive behavioural therapy,
psychodynamic psychotherapy and hypnotherapy There are a range of over-the-counter medications from
your pharmacist that may help reduce the amount of acid
Cognitive behavioural therapy (CBT) in the stomach. If your stomach is sensitive to acid, these
antacid medications may reduce dyspeptic symptoms,
CBT is a psychotherapeutic approach based on cognitive
such as bloating or upper abdominal discomfort. Acid-
and behavioural principles that aims to identify and
suppressing medications are not a long-term solution
understand negative thoughts, beliefs and patterns
however, and should only be used as needed and in the
of behaviour. Once these emotions and patterns are
short-term.
recognized, you can then better understand and change
them based on a series of action oriented and problem Prescription-only medications
solving strategies. Many studies show thatif youcan
train yourself to react differently to stress, anxiety and If other means of controlling symptoms do not work,
depression (i.e. tothink more positively or incorporate your GP or gastroenterologist may try another type of
relaxation techniques), your physical symptoms of pain prescription medication, such as a prokinetic drug, to
and discomfort can be alleviated. Thus, the task in CBT is address your symptoms.
to break the chain in terms of how you may be responding
Anti-depressant medications
to anxiety.
If you are experiencing high levels of stress and/
Psychodynamic psychotherapy or depression, your doctor may recommend an
Psychodynamic psychotherapy is a more explorative antidepressant medication in addition to diet and exercise,
therapy, which focuses on gaining an understanding or in conjunction with psychotherapy treatment. These
of unconscious processes that lie behind current medications can help with symptoms of depression and
presentations. These processes often relate to the past via the brain-gut axis can inhibit the activity of neurons
and so the objective is to gain insight into how our that control the intestines. Sometimes antidepressant
past affects and influences our current feelings and medications are prescribed at a very low dose in the
behaviour.Psychodynamic psychotherapists can help you absence of depression as these have been shown to
to exploreyour feelings of stress and discomfort around reduce the pain signals that eminate from the gut in
functional dyspepsia, how this might relate to other parts functional bowel disorders.
of your life, and how you might go about addressing
these in a psychologically healthy way. Psychodynamic
psychotherapy, therefore, involves bringing less conscious
psychological dynamics into awareness, finding words to
describe such feelings, and working through them in a
safe and confidential setting.

Hypnotherapy
Hypnotherapy has been shown to help some people with
functional disorders reduce their symptoms of pain and
discomfort. Hypnosisis used to change your unconscious
minds attitude towardsyour symptoms. You can have
hypnotherapy as an outpatient, oryou can learn self-
hypnosis techniques to practice at home.

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COMPLICATIONS

While functional dyspepsia is not linked to any life-threatening


condition or illness, there can often be an impact on day-to-day
activities and quality of life. For some people, the difficulties of coping
with the symptoms of functional dyspepsia (ie frequently belching
or experiencing discomfort in the abdomen) may limit their ability or
desire to make plans, maintain social commitments and recreational
activities. The pain and discomfort of functional dyspepsia, combined
with the effect it can have on ones social, work, or personal
activities can be very taxing. Over time, this may lead to feelings of
discouragement, stress, depression, and anxiety.
If you are experiencing any of these symptoms, or if you feel
functional dyspepsia is limiting your activities or negatively affecting
your quality of life, it is recommended that you visit your GP, who
will be able to help identify an appropriate and effective treatment
for you.

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SUPPORT AND
FURTHER RESOURCES
Living with functional dyspepsia can be uncomfortable
and challenging and it can be difficult to know where
to turn for help. While your first point of contact should
always be your GP or gastroenterologist, educational
and community resources may help you to cope more
effectively with functional dyspepsia and improve your
quality of life.
The Core Charity (www.corecharity.org.uk) is such a
non-profit organisation that raises awareness and funds
research on gut and liver disease, promotes education
on gut function, and provides contacts for patient
organisations and support groups.

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