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- The presence of bothersome postprandial fullness, early satiety, or epigastric pain/burning in the absence of causative structural disease (to include normal upper endoscopy) for at least 1 to 3 days per week for the preceding 3 months, with initial symptom onset at least 6 months prior to diagnosis (Rome IV criteria)
- Rome IV criteria divide patients into two subtypes:
- Postprandial distress syndrome (PDS)
- Epigastric pain syndrome (EPS)
- System(s) affected: GI
- Synonym(s): idiopathic dyspepsia; nonulcer dyspepsia; nonorganic dyspepsia; PDS; and EPS
Unknown; accounts for 70% of patients with dyspepsia and ~5% of primary care visits
- 10% prevalence worldwide (varies based on criteria)
- More common in Western cultures
- PDS may be more common in Eastern cultures.
- Predominant age: adults (can be seen in children)
- Predominant gender: female > male
Etiology and Pathophysiology
Unknown but proposed mechanisms or associations include gastric motility disorders, visceral pain hypersensitivity, Helicobacter pylori infection, alteration in upper GI microbiome, postinfectious complications, immune activation, inflammation, and gut-brain axis disorders
Possible link to G-protein β3 subunit 825 CC genotype, serotonin transport genes, and/or cholecystokinin-A-receptor gene polymorphisms
Patients age >60 years with new-onset dyspepsia should undergo endoscopy.
Be alert for family system dysfunction.
Pregnancy may exacerbate symptoms.
- Other functional disorders: fibromyalgia, temporomandibular joint pain, chronic fatigue syndrome
- Anxiety/depression, psychosocial stressors (e.g., divorce, unemployment)
- Female gender
Avoid foods and habits known to exacerbate symptoms.
Commonly Associated Conditions
Other functional bowel disorders