Diagnosing Fd - Functional Dyspepsia: Digestive Disorders

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Diagnosing FD

People with functional dyspepsia have the symptoms of an ulcer without the ulcer itself. Both conditions seem to be stress-related and affect people of all ages. In many cases, the symptoms of both respond to treatment with a placebo pill (which contains no active ingredient). In both conditions, pressing on the patient's abdomen may produce tenderness.

Your doctor's goal will be to confirm or exclude the possibility of an ulcer. Pain is the most common symptom of an ulcer. Usually, it is a dull, gnawing ache that comes and goes. The pain of a duodenal ulcer often occurs long after eating, often two to three hours after a meal or in the middle of the night, and is relieved by food. The pain of a gastric ulcer often comes on soon after eating.

During a medical exam, your doctor will ask questions about your medical history and about the frequency of the pain, how long it's persisted, and when it's most severe. Discomfort that feels worse on an empty stomach and is relieved by eating suggests a duodenal ulcer, although it isn't definitive. Ulcer pain often awakens a person during the night. If this pain is relieved by antacids or H₂ blockers taken at bedtime, it may indicate an ulcer. Your physician will also address other health habits, such as whether you smoke or drink alcoholic beverages, and will want to know if other family members have ever been diagnosed with an ulcer.

To confirm the presence of an ulcer, the doctor may order an endoscopy or upper GI series. However, some physicians are hesitant to order these tests because in most instances of dyspepsia, results are negative and are unlikely to influence initial treatment strategies. Still, a patient will no doubt take comfort in learning that he or she doesn't have an ulcer.

Diagnosing FD is further complicated by the disorder's resemblance to other illnesses. Gastritis, GERD, irritable bowel syndrome, chronic pancreatitis (inflammation of the pancreas), stomach cancer, and hepatobiliary pain (pain originating from the liver or gallbladder) all can cause symptoms much like those of FD (see "Functional dyspepsia: What else could it be?"). In short, a clinical examination may not be sufficient to exclude an ulcer or some other disease as the source of the symptoms.

Tests and medication

As a first step toward both diagnosis and treatment, your doctor will probably prescribe one or more drugs that curtail acid secretion (see Table 2) to see if the dyspepsia clears. The doctor may also order a fecal, blood, or breath test to detect the presence of H. pylori bacteria. If the test is positive, the doctor will prescribe antibiotics to eradicate the bacteria. If symptoms have not improved after a few weeks, the next step will probably be endoscopy to check for ulcers (see Figure 8).

Figure 8: Upper GI endoscopy Depending on your symptoms, your doctor may want to take a look in your esophagus and stomach with an endoscope, a flexible tube with a light and camera at the end. With local anesthesia, you will be asked to lie on your side while the doctor gently slides the scope through your mouth and down your esophagus into the stomach while watching for lesions on a video monitor. This illustration shows the presence of a peptic ulcer, a raw, crater-like break in the lining of the stomach that could be the source of pain.

People over age 45 with a new onset of dyspepsia and those with a family history of gastrointestinal cancers should be promptly evaluated for underlying cancer. Prompt evaluation is also needed for patients whose dyspepsia is associated with additional worrisome symptoms, such as weight loss, dysphagia (difficulty swallowing), gastrointestinal bleeding, or anemia (low blood count). Only after tests and drug trials fail to pinpoint another cause is the condition labeled FD.

Last updated:	August 21, 2007