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Functional dyspepsia
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In one pass If you feel full halfway through a meal, your upper belly is bloated and uncomfortable after eating, or the pit of your stomach aches and burns, yet an endoscopy finds nothing, this is very likely functional dyspepsia.
Educational content, not medical advice — consult a clinician.
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Chapter 1
Stomach trouble with a normal scope
If you feel full halfway through a meal, your upper belly is bloated and uncomfortable after eating, or the pit of your stomach aches and burns, yet an endoscopy finds nothing, this is very likely functional dyspepsia. The stomach's structure is fine; the way it works has gone wrong. It is not in your head, and it is not rare: by the international Rome IV criteria, about 1 adult in 14 has it.
It comes in two broad types. One is triggered by eating, with fullness after meals and feeling full too early. The other centers on pain or burning in the upper belly that is less tied to meals. The two often overlap. Knowing which one you lean toward helps you describe it clearly to a doctor and makes triggers easier to find.
A few situations do not belong here and need a doctor soon: trouble swallowing, unexplained weight loss, or repeated vomiting. Vomiting blood or passing black stools is bleeding in the gut: go to the emergency department the same day. Crushing chest pain with sweating or breathlessness should be treated as the heart first: go to the emergency department now.
It comes in two broad types. One is triggered by eating, with fullness after meals and feeling full too early. The other centers on pain or burning in the upper belly that is less tied to meals. The two often overlap. Knowing which one you lean toward helps you describe it clearly to a doctor and makes triggers easier to find.
A few situations do not belong here and need a doctor soon: trouble swallowing, unexplained weight loss, or repeated vomiting. Vomiting blood or passing black stools is bleeding in the gut: go to the emergency department the same day. Crushing chest pain with sweating or breathlessness should be treated as the heart first: go to the emergency department now.
Clinical · The criteria doctors use
The Rome IV criteria (the international diagnostic criteria for functional gut disorders) recognize four core symptoms. You need one or more of them, bothersome enough to affect daily life:Pain in the upper bellyBurning in the upper bellyFullness after mealsEarly satiation (being unable to finish a normal-sized meal)
The research version also requires symptoms that began at least 6 months before diagnosis and were active in the past 3 months. In the clinic, guidelines allow a duration of more than 8 weeks, so treatment is not delayed. The two types have different thresholds: the fullness type needs at least 3 days a week, and the pain type at least 1 day a week.
A few things are easy to mix up. Heartburn on its own is not a dyspepsia symptom; it points more to reflux (see gerd), though the two often occur together. Repeated vomiting is not typical either, and should make a doctor think of another condition. Symptoms that ease after passing stool or gas point to the bowel rather than the stomach.
The diagnosis has one more condition: no structural disease that would explain the symptoms. When people with dyspepsia in the community have an endoscopy, about 13% have erosive esophagitis, 8% a peptic ulcer, and fewer than 0.5% a cancer of the stomach or esophagus. The remaining 80% or so have functional dyspepsia.
Numbers · How common, and does it pass
Under the Rome IV criteria, the Rome Foundation's global survey estimated that about 7% of adults have functional dyspepsia, with wide differences between countries, from 2.4% in Japan to 12.3% in Egypt. With a broader definition, close to 30% of people have dyspepsia symptoms at any given time.Its course goes up and down. In about two-thirds of people the symptoms persist long term, better on some days and worse on others. Some people stop meeting the criteria, but their symptoms shift into another gut-brain disorder, such as irritable bowel syndrome. It does not shorten life; what it affects is quality of life and the ability to work.
These figures say two things: you are not unusual, and it behaves more like a long-term condition to manage than an illness cured in one go.
Chapter 2
The stomach should relax to receive food
Your stomach is not a bag of fixed size. When you start eating, its upper part (the fundus) actively relaxes, opening up room to receive the food, so the pressure inside barely rises. This step is called accommodation. It is run by a nerve reflex, and a key part of that reflex is a group of nerves that release nitric oxide.
In about 40% of people with functional dyspepsia, this step does not open up. Food arrives, the fundus does not make room, the stomach wall is stretched tight quickly, and the signal reaching the brain reads as full after a few bites. In a study, a drug that relaxes the fundus reopened this step, and fullness after the meal eased. That suggests the failed relaxation is not just a coincidence but one cause of early fullness.
It also explains why small portions eaten slowly often feel better: they give the fundus time to relax.
In about 40% of people with functional dyspepsia, this step does not open up. Food arrives, the fundus does not make room, the stomach wall is stretched tight quickly, and the signal reaching the brain reads as full after a few bites. In a study, a drug that relaxes the fundus reopened this step, and fullness after the meal eased. That suggests the failed relaxation is not just a coincidence but one cause of early fullness.
It also explains why small portions eaten slowly often feel better: they give the fundus time to relax.
Evidence · How the 40% was measured
Fundus relaxation is measured with a barostat: a soft balloon connected to a pressure pump is placed in the stomach and held at a constant pressure, and the test watches how much the balloon's volume grows after a meal. The better the fundus relaxes, the more room the balloon is given.A Belgian study used this method to compare 35 healthy people with 40 patients with functional dyspepsia. About 40% of the patients had too little fundus relaxation after a meal. In a multivariate analysis, this was linked only to early fullness, not to sensitivity to stretching, H. pylori infection, or slow gastric emptying. When the researchers then gave patients a drug that relaxes the fundus (sumatriptan), accommodation recovered and fullness after the meal eased.
Know the limits of this result. It is a physiology study from one center with a few dozen people, and the measurement requires a balloon in the stomach; it is not a routine hospital test. It explains where one kind of early fullness comes from. It does not prescribe one drug for everyone.
Myth · Is bloating always a slow stomach
Many people read all bloating as a stomach that moves too slowly, and take motility drugs or digestive aids for years. Mechanically, that route is right for only a small part of the picture.Slow gastric emptying does exist in some patients, but its link to symptoms is weak. A multicenter study found that in tertiary hospitals, functional dyspepsia and gastroparesis (markedly slowed emptying) could not be told apart by symptoms, emptying tests or tissue findings. Some people even empty too fast. And the failed fundus relaxation described above is not a stomach pushing too slowly; it is a stomach that did not make room.
That is why guidelines advise against routine gastric emptying tests for people with typical symptoms. Some motility drugs help some people, but the British guideline rates them as a weak recommendation with low certainty of evidence. Bloating is a symptom, and more than one mechanism sits behind it.
Chapter 3
A stomach too sensitive to stretch
For other people, the problem is not whether the stomach relaxes but how it senses. Stretched by the same small amount, their stomach reports discomfort, even pain, much earlier. When a balloon in the stomach is slowly inflated, about a third of people with functional dyspepsia feel discomfort or pain at lower pressures than healthy people, and this group has more pain and belching after meals.
The stomach is not the only sensitive part. In infusion experiments, acid reaching the duodenum (the first stretch of small intestine below the stomach) made the stomach more sensitive to stretching. Fat reaching the duodenum also made the stomach more sensitive to stretching; carbohydrate and protein did not. That is one mechanical clue to why a greasy meal is more likely to cause trouble.
So the endoscopy can be normal while the pain is real: the problem is an amplified signal, not a damaged organ.
The stomach is not the only sensitive part. In infusion experiments, acid reaching the duodenum (the first stretch of small intestine below the stomach) made the stomach more sensitive to stretching. Fat reaching the duodenum also made the stomach more sensitive to stretching; carbohydrate and protein did not. That is one mechanical clue to why a greasy meal is more likely to cause trouble.
So the endoscopy can be normal while the pain is real: the problem is an amplified signal, not a damaged organ.
Mechanism · Why it can linger after a stomach bug
Many people can name when it started: after a bout of acute gastroenteritis (a stomach bug), they never fully recovered. The data back this up. A of 19 studies found that more than 6 months after acute gastroenteritis, the odds of developing functional dyspepsia were about 2.5 times those of people who had not had it; in adults, about 9.6% developed functional dyspepsia after gastroenteritis. Salmonella, E. coli O157, Campylobacter, Giardia and norovirus have all been linked to it. These are observed associations: they show infection is a risk factor, not that it causes every case.One lead under study lies in the lining of the duodenum. Compared with healthy people, patients have more eosinophils and mast cells (two immune cells involved in allergy and inflammation) in the stomach and duodenum. This low-grade inflammation appears together with a looser gut barrier and changes in the nerves beneath the lining. Which is cause and which is effect is not yet settled.
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Mechanism · How the brain turns up the volume
Stretch and chemical signals from the stomach and duodenum travel to the brain along two lines: the vagus nerve and the spinal cord. In people with functional dyspepsia, the brain also processes these signals differently: brain imaging studies have found structural or functional differences in areas that handle sensation, pain control and emotion.Anxiety and depression often occur alongside functional dyspepsia, but whether they cause it has not been proven. One possible pathway: stress activates the stress-hormone axis, and the signaling molecules it releases may set off local inflammation in the gut, which can affect the barrier and the nerves and sends signals back to the brain, forming a loop that amplifies itself. One study found that anxiety levels were associated with the number of eosinophils in the duodenum.
This does not mean the symptoms are imagined. It means the wiring between gut and brain has had its gain turned up, and either end can be a place to intervene. That is why guidelines list psychological therapies and low-dose nerve-modulating drugs among the treatment options.
Chapter 4
What can set it off
Functional dyspepsia has no single cause, but a few things are worth checking and ruling out first:
H. pylori: infection with this stomach bacterium is linked to dyspepsia. Clearing it improves symptoms in some people and also lowers the risk of stomach cancer. Guidelines make testing for it the first step.Painkillers: non-steroidal anti-inflammatory drugs () such as ibuprofen and aspirin are a known risk factor for dyspepsia. If you take painkillers often, think of them first.A bout of acute gastroenteritis: the symptoms may be what that infection left behind.Food: the triggers reported most often are fatty foods, dairy, alcohol, coffee, red meat, carbonated drinks and spicy food.
These are clues, not verdicts. The same food upsets one person and not another, and your own record is how you tell.
H. pylori: infection with this stomach bacterium is linked to dyspepsia. Clearing it improves symptoms in some people and also lowers the risk of stomach cancer. Guidelines make testing for it the first step.Painkillers: non-steroidal anti-inflammatory drugs () such as ibuprofen and aspirin are a known risk factor for dyspepsia. If you take painkillers often, think of them first.A bout of acute gastroenteritis: the symptoms may be what that infection left behind.Food: the triggers reported most often are fatty foods, dairy, alcohol, coffee, red meat, carbonated drinks and spicy food.
These are clues, not verdicts. The same food upsets one person and not another, and your own record is how you tell.
Evidence · How much clearing H. pylori helps
The British guideline pooled 29 randomized trials with 6,781 patients who had functional dyspepsia and H. pylori. Among those given eradication treatment, the risk that symptoms were not cured or not improved was about 13% lower than in the control groups ( 0.87). In people whose infection was actually cleared, the effect was somewhat larger (0.74); in the trials that reported symptom cure, most assessed at 12 months, the benefit held (0.91). Side effects were more common with eradication treatment than with control.The effect is small, but it brings another benefit: clearing H. pylori lowers the risk of stomach cancer (see H. pylori). That is why the joint American and Canadian guideline advises that people under 60 without other problems first have a non-invasive H. pylori test and are treated if positive, while people aged 60 or over have an endoscopy first.
Know its limits. For people who test negative, or still have symptoms after the infection is cleared, the problem lies in how the stomach moves and senses. The next step is acid-reducing medicine and other options, not testing and treating again and again.
Myth · Must spicy food go forever
The part of chili that tastes hot is capsaicin, which acts on a receptor that senses heat and pain (TRPV1). About half of people with functional dyspepsia are especially sensitive to capsaicin and are more likely to feel nausea, warmth and pain after eating it.That does not mean giving it up for life. Studies cited by the British guideline found that regular, long-term capsaicin intake led to desensitization: after repeated stimulation, the receptor responds less. There are few such studies. They are not a reason to force down spicy food as treatment; they show that the sensitivity is not necessarily permanent.
The bigger risk lies at the other end: cutting out one food after another until little is left. The guideline estimates that up to half of people with functional dyspepsia may have avoidant or restrictive eating, and over-restriction brings nutritional and psychological problems of its own. That is why the guideline urges caution before recommending complex elimination diets such as low , and advises bringing in a dietitian early for people with severe symptoms, to avoid an overly narrow diet.
Chapter 5
What you can do, what doctors offer
The things you can do yourself all follow from the mechanisms above:
Keep a record first: for a week or two, note whether fullness and early fullness after meals dominate, or pain and burning even on an empty stomach, and which meal or food came before. This record is far more useful than saying you have a bad stomach: your doctor judges by it, and you find your triggers with it.Give the fundus time: eat small portions slowly, and avoid piling the greasy dishes into one meal. Symptoms usually peak 15 to 30 minutes after eating, which helps you spot the meal that caused them.Do regular aerobic exercise: the British guideline advises it for every patient, a strong recommendation with very low certainty of evidence.Breathe slowly: in one small trial of 40 people, breathing at 6 breaths a minute for 5 minutes a day for 4 weeks improved how much soup people could drink in a test meal, and their quality of life, more than in controls. It is one small trial, so treat it as a low-cost thing to try.
The rest belongs with a doctor: test for H. pylori first, then try medicines in order.
Keep a record first: for a week or two, note whether fullness and early fullness after meals dominate, or pain and burning even on an empty stomach, and which meal or food came before. This record is far more useful than saying you have a bad stomach: your doctor judges by it, and you find your triggers with it.Give the fundus time: eat small portions slowly, and avoid piling the greasy dishes into one meal. Symptoms usually peak 15 to 30 minutes after eating, which helps you spot the meal that caused them.Do regular aerobic exercise: the British guideline advises it for every patient, a strong recommendation with very low certainty of evidence.Breathe slowly: in one small trial of 40 people, breathing at 6 breaths a minute for 5 minutes a day for 4 weeks improved how much soup people could drink in a test meal, and their quality of life, more than in controls. It is one small trial, so treat it as a low-cost thing to try.
The rest belongs with a doctor: test for H. pylori first, then try medicines in order.
Clinical · The usual order of treatment
American, Canadian and British guidelines give a broadly similar order, and a doctor decides each step:Test for H. pylori, and clear it if positive. At 60 or over, or with warning signs (trouble swallowing, vomiting blood or black stools, unexplained weight loss, repeated vomiting), have an endoscopy first.Acid-reducing medicine: if the test is negative, or symptoms continue after the infection is cleared, try a course of a proton pump inhibitor (). The British guideline's pooled analysis shows it works, and a higher dose is no better, so the lowest dose that controls symptoms is used. For the trade-offs of long-term use, see gerd.Low-dose tricyclic antidepressants: used as gut-brain neuromodulators, started at a very low dose that a doctor raises slowly. They damp down amplified pain signals and also affect gut movement. The British guideline rates this a strong recommendation with moderate certainty of evidence. Another common class of antidepressants () has no evidence for overall symptoms.Motility drugs: some help some people; the recommendation is weak.Psychological therapies: cognitive behavioral therapy, hypnotherapy and stress management may help; the recommendation is weak and the certainty of evidence very low.
For severe or stubborn symptoms, the guideline advises care from a multidisciplinary team and clearly says to avoid opioid painkillers and surgery.
Evidence · How much evidence diet changes have
Eating is the most common trigger for functional dyspepsia, but the evidence for diet therapy is thinner than you might expect. Most of it comes from observational studies, not randomized trials.Food-diary studies found that people with functional dyspepsia eat smaller, more frequent and less fatty meals than healthy people. This is an adjustment they work out for themselves, and it fits the mechanisms of a fundus that does not relax and a duodenum that is sensitive to fat. Whether small frequent meals or a low-fat diet can cure it has not been shown in trials.
A low- diet (one that limits several kinds of sugars that ferment easily in the gut, often used for irritable bowel syndrome) showed no significant difference from traditional dietary advice in a randomized trial from India: response rates were 67% versus 57% at 4 weeks, and 46% versus 41% at 12 weeks. So the British guideline concludes that there is not enough evidence to recommend any specific diet therapy.
The practical reading: use your own record to find the few foods that really upset you, and eat less of them or spread them out, rather than cutting everything on a generic list.
Chapter 6
When to see a doctor
A diagnosis of functional dyspepsia assumes other diseases have been ruled out. The following do not belong to it and need a doctor soon:
Trouble swallowing, at any ageVomiting blood, or passing black stools (bleeding in the gut: go to the emergency department the same day)Unexplained weight loss, especially at 55 or olderRepeated vomiting
If you are over 40 and have a family history of stomach or esophageal cancer, or grew up in an area with a higher risk of stomach cancer, have an endoscopy early rather than just suppressing symptoms with medicine.
Crushing chest pain with sweating or breathlessness should be treated as a heart problem first: go to the emergency department now.
These signs are not a diagnosis. They tell you when to stop adjusting things yourself and have a doctor see you in person.
Trouble swallowing, at any ageVomiting blood, or passing black stools (bleeding in the gut: go to the emergency department the same day)Unexplained weight loss, especially at 55 or olderRepeated vomiting
If you are over 40 and have a family history of stomach or esophageal cancer, or grew up in an area with a higher risk of stomach cancer, have an endoscopy early rather than just suppressing symptoms with medicine.
Crushing chest pain with sweating or breathlessness should be treated as a heart problem first: go to the emergency department now.
These signs are not a diagnosis. They tell you when to stop adjusting things yourself and have a doctor see you in person.
Red flag · Age and the threshold for a scope
The British guideline (following the criteria of the UK's National Institute for Health and Care Excellence, NICE) lists the situations that call for an urgent endoscopy:Trouble swallowing at any ageAge 55 or over with dyspepsia, upper belly pain or reflux, together with weight lossOver 40 and from an area with a higher risk of stomach cancer, or with a family history of stomach or esophageal cancer
At 55 or over, dyspepsia that does not respond to treatment or comes with nausea or vomiting calls for considering an endoscopy, less urgently. At 60 or over, upper belly pain with weight loss calls for considering an urgent abdominal CT scan to rule out pancreatic cancer.
Note: NICE lists vomiting blood in the less urgent endoscopy column, but that refers only to the referral route for checking for cancer. Vomiting blood or passing black stools is bleeding in the gut: go to the emergency department the same day; do not wait for an appointment. The joint American and Canadian guideline instead advises an endoscopy first for anyone with dyspepsia at 60 or over, and earlier for people who grew up in a country with a high risk of stomach cancer. If you grew up in China, the chapter in H. pylori on why China is so affected gives the background.
These thresholds are the lines doctors use to decide on tests. They are not the line for deciding whether to see a doctor: if symptoms are getting worse, or you are unsure, asking early is always right.
Bleeding from the gut (vomiting blood, black stools), weight loss and trouble swallowing are also reasons for an endoscopy first in the reflux guideline, and chest pain needs the heart ruled out before it is blamed on the stomach.
References · 8
- Black, C. J., Paine, P. A., Agrawal, A., Aziz, I., Eugenicos, M. P., Houghton, L. A., Hungin, P., Overshott, R., Vasant, D. H., Rudd, S., Winning, R. C., Corsetti, M., & Ford, A. C. (2022). British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut, 71(9), 1697-1723. GRADE-rated. Rome IV prevalence about 7% (2.4% Japan to 12.3% Egypt); about 80% of people with dyspepsia have FD after endoscopy (13% erosive oesophagitis, 8% peptic ulcer, <0.5% cancer); symptoms chronic in about two-thirds; no effect on mortality. Subtypes: postprandial distress (fullness, early satiation, at least 3 days a week) and epigastric pain (pain or burning, at least 1 day a week), often overlapping; heartburn is not a dyspeptic symptom; vomiting suggests another disorder. Pathophysiology in subsets: delayed emptying (weak link to symptoms), impaired fundic accommodation (early satiation, fullness, weight loss), mechanical and chemical hypersensitivity, duodenal acid and lipid (not carbohydrate or protein) infusion raising sensitivity to gastric distension, about half chemically hypersensitive to capsaicin with desensitisation after chronic ingestion, duodenal eosinophils and mast cells raised, anxiety and depression associated but causality unconfirmed; postinfection FD almost threefold odds. Diet: symptoms peak 15-30 min after eating; common triggers fatty foods, dairy, alcohol, coffee, red meat, carbonated drinks, spicy food; patients eat smaller, more frequent, lower-fat meals (food-diary studies); insufficient evidence for dietary therapies including low FODMAP (an Indian RCT: 67% vs 57% at 4 weeks, 46% vs 41% at 12 weeks, not significant); up to 50% may have ARFID, avoid over-restrictive diets. Recommendations: regular aerobic exercise (strong, very low); test and treat H. pylori (strong, high): RR of symptoms not cured or not improved 0.87 (0.83-0.92) in 29 trials of 6,781 patients, 0.74 in those successfully eradicated (16 trials), and 0.91 (0.88-0.94) in the subset of trials reporting symptom cure, mostly at 12 months; PPI efficacious with no dose response, lowest effective dose (strong, high); TCAs second line at low dose (strong, moderate); SSRIs no evidence (weak, moderate); CBT, hypnotherapy, stress management (weak, very low). Urgent endoscopy for dysphagia at any age, aged 55 or over with weight loss, or over 40 from an area of increased gastric cancer risk or with a family history of gastro-oesophageal cancer; non-urgent at 55 or over with treatment-resistant dyspepsia or nausea or vomiting; urgent CT considered at 60 or over with abdominal pain and weight loss to exclude pancreatic cancer. NICE's 'non-urgent endoscopy' column includes haematemesis, but only as a cancer-referral route, not as the urgency of the bleed (full text PMC9380508; PMID 35798375). 10.1136/gutjnl-2022-327737
- Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 117(1), 27-56. GRADE-rated. Diagnosis: for classic heartburn and regurgitation without alarm symptoms, an 8-week empiric trial of a PPI once daily before a meal (strong, moderate), then an attempt to stop it in responders (conditional, low); endoscopy first for dysphagia or other alarm symptoms (weight loss, GI bleeding) and for multiple Barrett's risk factors (strong, low); chest pain without heartburn, after adequate evaluation to exclude heart disease, calls for objective testing for GERD (conditional, low). Lifestyle: weight loss in overweight and obese patients (strong, moderate); avoiding meals within 2-3 hours of bedtime, avoiding tobacco, avoiding trigger foods and elevating the head of the bed for nighttime symptoms are each conditional, low (the text: alcohol, smoking, chocolate, peppermint and high-fat foods lower LES pressure in the laboratory, but few studies document benefit from avoiding them; several RCTs support head-of-bed elevation or a wedge for nocturnal symptoms). Drugs: PPI 30-60 min before a meal rather than at bedtime (strong, moderate); PPI over H2RA for healing and for maintaining healed erosive esophagitis (strong); maintenance PPI indefinitely or antireflux surgery for LA grade C or D esophagitis (strong, moderate); on-demand or intermittent PPI for non-erosive disease (conditional, low); use the lowest effective dose; rebound acid hypersecretion after stopping has been shown in healthy controls, but strong evidence that symptoms increase after abrupt withdrawal is lacking; bedtime H2RA lost pH control (tachyphylaxis) after a month. Extraesophageal symptoms: look for non-GERD causes first (strong, moderate); without typical heartburn or regurgitation, reflux testing BEFORE PPI therapy (strong, moderate); with typical symptoms as well, consider twice-daily PPI for 8-12 weeks before more testing; LPR should not be diagnosed from laryngoscopy alone; some studies attribute 21-41% of chronic cough to GERD, but PPIs do not help chronic cough in most patients, and two RCTs found no asthma benefit from twice-daily PPI. Safety: in the Moayyedi RCT (17,598 people, pantoprazole 40 mg vs placebo, 3 years) only enteric infections differed (1.4% vs 1.0%), so most observational PPI harms look like residual confounding. GERD prevalence is up to six-fold higher at BMI above 35; about two-thirds of pregnant women have heartburn. No national prevalence figures are given (full text, PMC8754510; abstract, PMID 34807007). 10.14309/ajg.0000000000001538
- Tack, J., Piessevaux, H., Coulie, B., Caenepeel, P., & Janssens, J. (1998). Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology, 115(6), 1346-1352. Gastric barostat in 35 healthy subjects and 40 patients: impaired accommodation in 40% of patients, associated (multivariate) only with early satiety; not with hypersensitivity, H. pylori or delayed emptying. Sumatriptan, which relaxes the fundus, restored accommodation and improved meal-induced satiety. One centre, small sample (abstract, PMID 9834261). 10.1016/s0016-5085(98)70012-5
- Kindt, S., & Tack, J. (2006). Impaired gastric accommodation and its role in dyspepsia. Gut, 55(12), 1685-1691. Review: the accommodation reflex is an important part of normal gastric physiology; impaired in about 40% of functional dyspepsia; covers the reflex pathways with a focus on nitrergic neurons and serotonergic receptors. Only the abstract was read (PMID 16854999); do not hang reflex-arc details on it beyond that. 10.1136/gut.2005.085365
- Tack, J., Caenepeel, P., Fischler, B., Piessevaux, H., & Janssens, J. (2001). Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology, 121(3), 526-535. Gastric barostat in 80 healthy subjects and 160 patients: hypersensitivity to distention in 34% of patients, associated with postprandial pain, belching and weight loss; those patients did not differ in other pathophysiological features (abstract, PMID 11522735). 10.1053/gast.2001.27180
- Moayyedi, P., Lacy, B. E., Andrews, C. N., Enns, R. A., Howden, C. W., & Vakil, N. (2017). ACG and CAG clinical guideline: management of dyspepsia. The American Journal of Gastroenterology, 112(7), 988-1013. Conditional: endoscopy for dyspepsia at age 60 or over, younger if at higher risk of malignancy (childhood in a high gastric cancer risk country, family history); alarm features alone should not automatically trigger endoscopy under 60. Under 60: non-invasive H. pylori test and treat; if negative or no response, a PPI trial; then tricyclic antidepressants or prokinetics. Routine motility testing not recommended (abstract, PMID 28631728). 10.1038/ajg.2017.154
- Ford, A. C., Yuan, Y., & Moayyedi, P. (2020). Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis. Gut, 69(12), 2113-2121. In healthy infected individuals (7 RCTs, 8,323 participants): gastric cancer incidence RR 0.54 (95% CI 0.40-0.72), NNT 72; mortality RR 0.61. 10.1136/gutjnl-2020-320839
- Hjelland, I. E., Svebak, S., Berstad, A., Flatabø, G., & Hausken, T. (2007). Breathing exercises with vagal biofeedback may benefit patients with functional dyspepsia. Scandinavian Journal of Gastroenterology, 42(9), 1054-1062. 40 patients randomised; biofeedback group breathed at 6 breaths per minute, 5 minutes a day for 4 weeks. Drinking capacity on a soup drink test (p = 0.02) and dyspepsia-related quality of life (p = 0.01) improved more than in controls; baseline vagal tone and intragastric volume did not change. One small trial, not replicated (abstract, PMID 17710670). 10.1080/00365520701259208