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Functional Dyspepsia (Rome IV Criteria)

Chronic upper abdominal symptoms without identifiable structural cause, classified into postprandial distress syndrome and epigastric pain syndrome by Rome IV with stepwise management including PPI, prokinetics, neuromodulators, and Helicobacter eradication.

Written by: Saygı Hospital Health Guide Editorial Board
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This content is for general information; please consult your physician for diagnosis and treatment.

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What is Functional Dyspepsia (Rome IV Criteria)?

Functional dyspepsia is a chronic disorder of gut-brain interaction defined by Rome IV as one or more of postprandial fullness, early satiation, epigastric pain, or epigastric burning for at least three months with onset at least six months prior, occurring at least three days per week, with no evidence of structural disease (including normal upper endoscopy) to explain the symptoms.

Rome IV recognizes two subtypes that may overlap: postprandial distress syndrome (PDS) characterized by meal-induced bothersome postprandial fullness or early satiation, and epigastric pain syndrome (EPS) characterized by bothersome epigastric pain or burning unrelated to meals. Pathophysiology involves impaired gastric accommodation, delayed gastric emptying, visceral hypersensitivity, low-grade duodenal eosinophilia, altered microbiota, and central nervous system processing.

Workup includes upper endoscopy in patients over 60 or with alarm features (weight loss, anemia, vomiting, dysphagia, family history of GI cancer), Helicobacter pylori testing, basic labs, and selective imaging. Diagnosis is clinical once organic disease is excluded. Treatment is stepwise: lifestyle and dietary changes, H. pylori eradication if positive, PPI for EPS-predominant, prokinetics for PDS-predominant, low-dose TCAs or mirtazapine for refractory cases, and psychological therapies including cognitive behavioral therapy and gut-directed hypnotherapy.

Symptoms

Postprandial fullness disturbing daily activities (PDS)
Early satiation preventing completion of regular meals (PDS)
Bothersome epigastric pain at least one day per week (EPS)
Epigastric burning without classic reflux features (EPS)
Frequent belching, nausea, mild bloating
Symptom relief patterns variable, often anxiety- and stress-related
Absence of alarm features (weight loss, dysphagia, GI bleeding)

Risk Factors

Female sex, younger age, lower socioeconomic status
Helicobacter pylori infection in some populations
History of acute gastroenteritis (post-infectious dyspepsia)
Anxiety, depression, somatization, history of trauma
NSAID use, smoking, high coffee or alcohol intake
Comorbid IBS, GERD, fibromyalgia, chronic fatigue
Low-grade duodenal eosinophilia and altered gut microbiota

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent dyspepsia symptoms for three months or more
  • New-onset dyspepsia after age 60 (mandates upper endoscopy)
  • Alarm features: unintended weight loss, anemia, dysphagia, persistent vomiting, GI bleeding, or family history of upper GI cancer
  • Failure of empirical PPI therapy after 4-8 weeks
  • Symptoms significantly affecting nutrition, sleep, or quality of life
  • Recurrent symptoms after Helicobacter eradication or initial response
  • Need for psychological evaluation if anxiety or depression dominate

Treatment Methods

01
Patient education and reassurance with explanation of disorder of gut-brain interaction
02
Lifestyle modifications: small frequent meals, low-fat diet, avoid trigger foods, weight loss if obese, smoking cessation, limit caffeine and alcohol
03
Helicobacter pylori test-and-treat strategy in regions with prevalence above 10%; eradication produces durable benefit in a subset
04
PPI 4-8 weeks for EPS-predominant or overlap; step-down or on-demand once controlled
05
Prokinetics for PDS-predominant: metoclopramide short-term (caution due to extrapyramidal side effects), domperidone where available with QTc monitoring, itopride, or acotiamide
06
Neuromodulators: low-dose TCAs (amitriptyline 10-50 mg) for refractory pain; mirtazapine 15 mg for early satiation, weight loss, and overlap with anxiety/depression
07
Psychological therapies: cognitive behavioral therapy, gut-directed hypnotherapy, mindfulness; consider STW5 herbal preparation; ongoing follow-up to adjust therapy and screen for new alarm features

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.