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Indigestion Riddle: The Quest for an Effective Functional Dyspepsia Treatment

Hippocrates once said, “All diseases begin in the gut.” The Greek physician hit the nail on the head, as the quality of nutrients that our body receives is highly dependent on the efficiency of the conveyor belt of the digestive tract. Any form of disruption in the digestive tract can cause discomfort and illnesses, and may eventually impact overall health.  The National Institute of Health (NIH) estimates that 60 to 70 million people in the U.S. are affected by various digestive and gastrointestinal diseases. Among these illnesses, the most common is functional (idiopathic) dyspepsia, commonly known as indigestion. According to a recent national survey, functional dyspepsia affects close to 39 million Americans. That’s a big number, but it begs the question: why has an effective functional dyspepsia treatment proven elusive?

Understanding Functional Dyspepsia and its Impact on Gut Health

Initially, dyspepsia was recorded in the 18th century and was thought to be a nervous disorder—the kind of illness lumped under the concept of “nervous temperament” when no physical disorder could be detected. In modern medicine, dyspepsia refers to chronic or recurring pain and discomfort around the upper abdomen. Depending on the triggers, dyspepsia can be classified as organic (caused by ulcers or cancers), drug-induced, generated by extraintestinal diseases (such as diabetes mellitus or hypothyroid), and as functional dyspepsia.

quote of Michael Epstein amid the discussions on functional dyspepsia treatment
Dr. Michael Epstein talks about functional dyspepsia symptoms.

Often, functional dyspepsia symptoms include a bloated feeling, nausea, belching and sensation of fullness, even with minimal food intake. As in any other illnesses, an efficient functional dyspepsia treatment can only be drawn through proper diagnosis. However, physicians and researchers often refer to functional dyspepsia as a heterogeneous disease.

Clearly, with the variety of triggers for indigestion, it is imperative for patients to go through appropriate tests and assessments.

The Rome Criteria: The Key to Successful Functional Dyspepsia Treatment

The Rome Foundation is a nonprofit foundation based in Raleigh, NC. In 1994, the foundation gathered clinicians and scientists around the world to understand gastrointestinal functions and diseases. Rome I was published through international consensus. The criteria, also titled “The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology, and Treatment—A Multinational Consensus”, became the basis of subsequent publication. The Rome Criteria IV published in May 2016 is the most recent version. Clinicians are currently using this fourth version with the classification and diagnosis of patients with an FGID (the disorder of gut-brain interaction).

Symptoms as Basis of Management of Functional Dyspepsia

Under the Rome Criteria IV, Functional Dyspepsia has been classified under two syndromes—Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS). Postprandial Distress Syndrome encompasses meal-related symptoms. Epigastric Pain Syndrome is characterized by burning pain below the ribs, right above the stomach. Based on the observed symptoms, patients are then administered appropriate functional dyspepsia treatment options.

For instance, epigastric pain syndrome is managed via acid-suppression therapies such as proton pump inhibitors (Omeprazole, Lansoprazole), anti-histamines (Ranitidine, Famotidine), and antacids (Simethicone). On the other hand, postprandial distress syndrome is treated with motility drugs such as Cisapride, Domperidone, and Mosapride.

a photo quote of Lawrence Friedman amid the discussions on functional dyspepsia treatment and gut health
Dr. Lawrence S. Friedman points out a vital fact about treating functional dyspepsia.

New Findings and Innovations around Functional Dyspepsia Treatment

  • Pylori eradication as a path for functional dyspepsia treatment. Helicobacter pylori or H. Pylori is a gut bacteria that attacks the lining of the stomach. Once H. Pylori has caused enough damage, acid seeps through the stomach lining which can lead to ulcers. Clinical trials have shown that the eradication of H. Pylori bacteria significantly improved the conditions of the sample. Most significantly, early detection is crucial. Urea breath testing for H. pylori is helping clinicians by providing a clinically-accepted, non-evasive and non-endoscopic testing for patients. Commonwealth Diagnostic International (CDI) uses a state-of-the-art liquid scintillation counter and research-based protocols in their Urea Breath Test kit for H. pylori.
a photo quote of Brennan M. Spiegel amid the discussions on functional dyspepsia treatment
Brennan M. Spiegel weighs in on the challenge in diagnosing malabsorption syndrome.
  • Anti-depressant as a functional dyspepsia treatment. Within the context of the gut-brain connection theory, the patient’s pain signal from the stomach is weakened when functional dyspepsia symptoms occur. Amitriptyline and escitalopram were observed to improve Postprandial Distress Symptoms (PDS) among patients. However, further research and studies are needed.
  • Herbal treatments for functional dyspepsia management has been gaining following recently. Some patients are looking at herbal remedies as an alternative way to manage functional dyspepsia. While some may opt for a natural cure at home, FDGard offers a specially formulated medical food for functional dyspepsia’s dietary management. Each FDGard capsule has caraway oil and l-Menthol, which is the prime component of peppermint oil. They ease abdominal discomfort, nausea, bloating and fullness, and belching. Likewise, pharma giant Bayer combines nine medicinal herbs in Iberogast to help relieve stomach cramps, bloating and feelings of pressure.
a photo of a man holding his stomach in pain beside magnified images of gut bacteria amid the search for effective functional dyspepsia treatment
The proper analysis of functional dyspepsia symptoms will aid in dispensing appropriate functional dyspepsia treatment.

Beyond Functional Dyspepsia Symptoms

Clearly, stress and diet play a role in functional dyspepsia. Anxiety, depression, and stress can trigger symptoms in some people. Focusing on our mental health can help in decreasing functional dyspepsia symptoms.

Sensitivity to certain food and drinks like alcohol, caffeine, and spices can also activate the symptoms. Monitoring and taking note of your diet will help you identify your triggers.

Undeniably, a healthy body starts with a healthy gut. Any barriers in our ability to digest food and absorb nutrients can throw off the body’s rhythm and functions. Illnesses related to digestion such as functional dyspepsia should be a top priority. For now, the search for an effective functional dyspepsia treatment is a work in progress.


For more on the importance of gut health, check out this interview with field expert Dr. Steven Gundry.