Dyspepsia, Functional



  • 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


  • 10–20% prevalence worldwide (varies based on criteria)
  • Overall more common in Western cultures
  • PDS subtype 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

Geriatric Considerations
Patients aged >60 years with new-onset dyspepsia should undergo endoscopy.

Pediatric Considerations
Be alert for family system dysfunction.

Pregnancy Considerations
Pregnancy may exacerbate symptoms.

Risk Factors

  • Other functional disorders: fibromyalgia, temporomandibular joint pain, chronic fatigue syndrome
  • Anxiety/depression, psychosocial stressors (e.g., divorce; unemployment; history of physical, sexual, or emotional trauma/abuse)
  • Smoking
  • Female gender
  • NSAID use

General Prevention

Avoid modifiable risk factors.

Commonly Associated Conditions

Other functional bowel disorders

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