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What is functional dyspepsia?

Understanding your condition

Functional dyspepsia is the presence of recurring indigestion symptoms with no clear cause. The symptoms include feelings of fullness with even a small meal, and a burning or gnawing sensation in the stomach area around the upper abdomen which can occur at any time, not just meal times.

Functional dyspepsia disrupts all aspects of life and is common in Australia, affecting around 1 in 10 people, and more women than men. It is also referred to as nonulcer dyspepsia or nonulcer stomach pain, and is the most common form of discomfort to the upper abdominal area.

middle aged man with functional dyspepsia digestive discomfort pressing fingers into chest
melbourne functional medicine practitioner mark payne discussing supplements for functional dyspepsia with patient

Functional dyspepsia, taking a deeper look

Often misdiagnosed, functional dyspepsia is suspected as a result of intestinal inflammation, sometimes developing following gastroenteritis. Potential underlying triggers can include Helicobacter pylori infection, altered motility (the transit of food) through the stomach and duodenum, an inability of the stomach muscles to relax when eating, and/or disrupted upper digestive tract gut flora.

With considerable overlap, distinguishing functional dyspepsia from gastro-oesophageal reflux disease (GORD/GERD), IBS or other digestive conditions requires extensive analysis by a skilled practitioner. Our functional medicine practitioners are digestive health specialists with the experience and time to find the answers you need to get well.

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Functional dyspepsia symptoms

Discomfort and pain to the chest or upper abdominal area may have a diverse range of potential causes. Conditions of the heart and respiratory system should be ruled out first, and if pain is acute or there is any doubt, medical assistance should be sought immediately.

The symptoms of functional dyspepsia can be intermittent, long lasting, and may include:

  • Epigastric burning or pain in the mid to upper abdomen/stomach area, below the sternum that may be unrelated to meals, sometimes relieved by eating
  • Early satiation - feeling full after a small meal
  • Lack of appetite
  • Nausea
  • Bloating
  • Belching

Functional dyspepsia is divided into two common presentations, based on symptoms and in the absence of any another condition providing an explanation:

Postprandial distress syndrome - where feeling full and/or unable to eat after a small meal, often resulting in discomfort, nutritional deficiencies and weight loss.

Epigastric pain syndrome - burning in the mid-upper abdomen of 1 day per week in the past 3 months, for at least 6 months, not necessarily after eating. May be relieved by eating.

It is common for functional dyspepsia to be present alongside IBS, and GORD/GERD with symptom overlap, making teasing out the diagnosis difficult.

Causes of functional dyspepsia

What causes functional dyspepsia in Australia? The statistics are similar to the rest of the western world with up to one third of the population experiencing recurrent gastrointestinal symptoms without signs of structural change to the oesophagus, stomach or upper intestines. A single cause for functional dyspepsia is unclear, however there are a number of risk factors known to contribute to its development:

  • Being female
  • Stress, anxiety, psychological distress, or a history of trauma which disturbs the gut-brain axis, affecting motility(transit time of food), digestion, gastric emptying and gut flora
  • Slow gastric emptying
  • Acute gastroenteritis infection - bacterial, viral or protozoan including H. pylori
  • Upper gastrointestinal system inflammation
  • Dysbiosis of the upper small intestinal microbiome
  • Impaired stomach muscle relaxation
  • Inflammation of the duodenum
  • Smoking
  • Dysbiosis of oral microflora
  • Use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, Advil, Motrin, ibuprofen
  • Presence of IBS, or GORD/GERD symptoms
  • Alterations to the mucosal lining of the gut
  • Heightened sensitivity to sensation in the gut (visceral hypersensitivity)

What causes eczema?

There isn’t one single cause of eczema but a range of potential contributing factors that are unique to each person. These include:

Genetics

Research has found people with the ‘atopic triad’ have a defective barrier of the skin and upper and lower respiratory tracts.

These genetic alterations cause a loss of function of filaggrin (filament aggregating protein), which is a protein in the skin that normally breaks down to create natural moisturisation and protect the skin from penetration by pathogens and allergens.

Filaggrin mutations are found in approximately 30 percent of people with atopic dermatitis, and also predispose people to asthma, allergic rhinitis (hayfever), keratosis pilaris (dry rough patches and bumps on the skin), and ichthyosis vulgaris (a chronic condition which causes thick, dry, scaly skin.)If one parent carries this genetic alteration, there is a 50 percent chance their child will develop atopic symptoms. And that risk increases to 80 percent if both parents are affected. 

Food allergy and sensitivity

Food hypersensitivity has been found to cause or exacerbate atopic dermatitis in 10-30% of cases, and 90% of these are caused by eggs, milk, peanuts, soy and wheat.

Compromised gut health

The connection between the gut microbiome and skin health is complex, however, research has found the microbiota contributes to the development, persistence, and severity of atopic dermatitis through immunologic, metabolic and neuroendocrine pathways.

Nutritional deficiencies

Deficiency of Omega-6 essential fatty acids (EFA) has been linked with the increased incidence of atopic dermatitis, along with the inability for the body to efficiently metabolise EFA’s to gamma linoleic acids (GLA) and arachidonic acids (AA).

Weather and environment

Changing weather conditions can certainly aggravate eczema symptoms, but the triggers are subject to change among individuals.

Hormones

Hormones also play a role in the course of atopic dermatitis, including the stress hormone cortisol which triggers an inflammatory immune response affecting all organs of the body, including the skin.

Mould exposure

Mould exposure and susceptibility to mould can cause Chronic Inflammatory Response Syndrome (CIRS), of which dermatitis is a manifestation.

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Functional dyspepsia treatment - the conventional approach

Conventional treatment of functional dyspepsia in Australia may take a number of consultations to establish a diagnosis, due to overlap of symptoms with other conditions. To establish this diagnosis, your GP will review your symptoms and make a physical examination. Various blood tests, H. pylori testing and X-ray may be required.

Initially ruling out heart or respiratory conditions, you may also require an endoscopy, where a small, flexible camera is passed down the oesophagus into the stomach and upper small intestines. An endoscopy may identify damage to the oesophagus, stomach or upper intestines indicating conditions such as gastric or peptic ulcers, oesophagitis or GORD/GERD. An endoscopy must be conducted if any of the following are present:

  • Signs of anaemia or bleeding to the digestive system
  • Vomiting
  • Worsening of symptoms
  • Previous gastric surgery
  • Unexplained weight loss
  • Over 55 years
  • Difficulty in swallowing
  • Family history of stomach cancers

Once functional dyspepsia has been identified, medication may be prescribed, such as:

  • Proton pump inhibitors (PPIs)- such as Somac, Nexium, Prilosec, and Prevacid which reduce the amount of acid secreted by stomach cells. Manufacturers recommend that PPIs are not taken longer than 14 days in a cycle and for no longer than 3 months total. Side effects can include poor digestion and absorption of nutrients
  • H2 receptor antagonists - these inhibit the production of gastric acid. Side effects can include poor digestion and absorption of nutrients
  • Prokinetic drugs - which stimulate the stomach to empty more rapidly
  • Over the counter antacid medicines such as Gaviscon which neutralise acid, inhibiting digestion and absorption of nutrients
  • Fundic relaxors - such as Cisapride or the anti-anxiety drug buspirone, to relax stomach muscles
  • Low dose tricyclic antidepressants such as amitriptyline
  • Antibiotics - such as rifaximin, which are non-selective antimicrobial agents that kill both beneficial and detrimental species alike, and disrupt the gut flora diversity and makeup

These medications have side effects and can contribute long term to poor digestion, nutrient depletion and disrupted gut flora, triggering other digestive symptoms, and are generally not recommended long-term.

Other treatment strategies include:

  • Counsellor or therapist referral for behavioural therapy to help cope with symptoms that medication cannot relieve
  • Some dietary recommendations may be made, such as eating smaller, low-fat meals, eliminating wheat, carbonated drinks, fatty, and fried or spicy foods

A 2016 study identified that current conventional treatments for functional dyspepsia are ‘largely unsatisfactory’. This is why many people with functional dyspepsia are looking for long-term, natural solutions to their digestive discomfort.

Functional dyspepsia treatment - the functional medicine approach

Functional dyspepsia natural treatment can be very effective, safe and long lasting. Using evidence based methods within a holistic framework, our functional medicine dyspepsia specialists have a unique approach to all digestive conditions. The first step involves isolating the root cause of the symptoms with detailed investigations of:

  • Symptoms and signs
  • Your family history and genetic susceptibility
  • Digestive function history
  • Detailed personal medical history
  • Travel, specific illness and symptom history
  • Medications, supplementation
  • Diet and lifestyle
  • Environmental exposures

Functional testing may help identify pathogens, parasites and infections, such as H. pylori using state of the art pathology labs. These tests may include:

  • GI Map or, GI 360 - state of the art testing isolating via DNA PCR, a far more accurate test than culturing.

Other functional testing may be required to identify:

  • Food allergy / intolerances
  • Nutrient deficiencies
  • Gut dysbiosis / IBS / SIBO other suspected conditions

Natural treatments for indigestion will vary according to the underlying causes, but may include:

  • Stimulating vagus nerve tone which has been recognised as an effective treatment for functional dyspepsia. Measuring heart rate variability can be indicative of the effectiveness of this strategy as the vagus nerve serves both digestive and cardiac system functions
  • Lifestyle medicine such as stress resilience techniques - meditation, mindfulness, Shinrin-yoku (forest bathing)
  • Strategies to improve sleep, quit smoking, alcohol, and decrease weight
  • Dietary recommendations - to eliminate food intolerances, trigger foods and improve nutrient status
  • Supplements to promote healthy digestion such as betaine hydrochloride, digestive enzymes, slippery elm powder, fibre supplements
  • Supplements for mucosal repair such as zinc, Vitamin A, Vitamin C, magnesium and glutamine
  • Herbal medicines for mucosal repair / anti inflammatories - meadowsweet, calendula, licorice, turmeric, marshmallow, aloe
  • Herbal antacids such as meadowsweet, slippery elm powder, and alfalfa
  • Digestive stimulants to improve gastric emptying (used with caution) - gentian & ginger
  • Anti-pathogenic herbs such as pomegranate husk, garlic, turmeric, berberine
  • Other herbs as required e.g. anti anxiety, mood modulation, detoxification, bile production and tone/repair of gastric muscles and mucosal linings
  • Precision probiotics to facilitate a diverse, and healthy microbiome
  • Fibre supplementation (prebiotics) to maintain a healthy microbiome, and enhance digestive emptying

At Melbourne Functional Medicine, our functional dyspepsia specialists are familiar with all kinds of digestive disorders and have effective, natural and safe treatment strategies to help you find the relief you are looking for. All natural treatments for indigestion are personalised to treat the whole person, and will consider and address other conditions or symptoms you may be experiencing.

Our unique 6 month program gives you ongoing support from your own practitioner and health coach team to get you well again. Making the changes necessary to improve health can be hard, so having your own health coach to inspire, educate, empower and support you can help you achieve wellness quicker and easier than doing so alone. It is this revolutionary approach to your health that gets results for many Australians like you. Read our success stories for more information.

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FAQs

What causes indigestion?

Causes of indigestion can range from a variety of digestive disorders, side effects of medications, stress, food intolerances, disrupted gut flora, slow transit time of food through the digestive system, infections and parasites.

If symptoms are ongoing and no obvious cause is identified, then this may be termed functional dyspepsia.

What does indigestion feel like?

Indigestion is a broad term describing discomfort, pain or burning sensations to the mid-upper abdomen.

It can vary from person to person, depending on the underlying cause, and may include other symptoms such as nausea, burping, belching, vomiting, lack of appetite, feeling full after eating only a small amount.

How do I get rid of indigestion? Why won’t my indigestion go away?

Depending on what is causing the indigestion, the treatment will vary. Indigestion can be due to a number of digestive conditions such as gastro-oesophageal reflux disease (GORD/GERD), functional dyspepsia, IBS, SIBO, food intolerances, parasitic infections, and microbiome disturbances.

Short term interventions that may bring relief are ginger tea, chamomile tea, lemon balm tea, or slippery elm powder, depending on what is causing your discomfort. While these can provide short term relief, treating the root cause is what will often resolve indigestion for good.

Determining which treatments are suitable is best done by a functional medicine functional dyspepsia specialist practitioner, who will investigate in detail and treat the root cause, not just the symptoms for effective natural treatment of functional dyspepsia and indigestion.

What does burping after eating mean?

Burping after eating can mean gas is accumulating in the stomach and upper digestive system. This accumulation of gas may be due to a variety of factors, including:

  • Eating quickly and gulping extra air with food
  • Stress or anxiety
  • Food intolerances
  • Gastro-oesophageal reflux disease (GORD/GERD)
  • Acid reflux
  • Small intestinal bacterial overgrowth (SIBO)
  • Irritable bowel syndrome (IBS)
  • Microbiome disturbances
  • Functional dyspepsia

Indigestion is a general term for upper digestive discomfort, or pain and can be related to all of the above digestive conditions.

Determining the cause of your burping may require the help of a digestive specialist practitioner. Detailed case history taking, state of the art functional testing and years of experience make Melbourne Functional Medicine one of Australia’s functional dyspepsia and digestive natural health specialists. See here for more information on the digestive conditions we can help you with.

What is the best way to sleep with indigestion?

Eating smaller meals, at least 3 hours prior to laying down may help reduce indigestion. Depending on the cause of the indigestion, short term relief may be found with the following natural remedies for indigestion:

  • Ginger, chamomile, lemon balm tea/s
  • Licorice tea
  • Peppermint tea
  • 3 tsp of slippery elm powder mixed in a glass of water, and drunk quickly after mixing. This can line the digestive system, and also support the health of the microbiome. It is important to remain well hydrated if taking any fibre supplement such as slippery elm powder.

Laying with the head elevated, with either a block under the head end of the bed, or under the mattress may help.

Seeking the help of a functional dyspepsia or digestive health functional medicine practitioner to identify the cause of indigestion symptoms will enable a clear treatment strategy for long term relief.

Does stress cause heartburn and indigestion?

It can be hard to know when stress is affecting digestion, as often we don’t recognise we are experiencing chronic stress when our day to day life is filled with stressors.

Pressures of money, work, family, noisy or toxic environments, driving in traffic, and unexpected events - and any number of things that affect us everyday can cause us to become accustomed to a chronic low level of stress.

When we are chronically stressed, our fight and flight nervous system (called the sympathetic nervous system, or SNS) is activated.

When activated, the SNS state assumes that we are running away from a perceived threat (like a bear or tiger), and diverts the body’s resources toward an emergency escape by increasing blood flow to muscles, eyes and our brain, while inhibiting processes to do with digesting food, such as making saliva and digestive juices and moving food through the digestive tract.

This leads to a slowing down of digestion that causes the symptoms of indigestion/heartburn.

Can exercise help with indigestion?

Exercise is useful in stimulating the digestive system to move food through the intestines (peristalsis), helping waste removal, and improving bowel movement frequency. Increasing the frequency of our bowel movements, particularly when the digestive system is sluggish (called ‘slow motility’) can be helpful for improving indigestion.

This is especially the case with those who experience ongoing constipation which can be a cause of indigestion. Constipation or slow motility can affect the digestive system in many ways by altering the makeup and species of our gut flora, as they are very sensitive to alterations of pH.

This can then create conditions such as reflux, indigestion, functional dyspepsia, IBS, SIBO and more, if left untreated.

Other measures that can help digestion are:

  • Drinking at least 2 L of clean water, daily
  • Meditation, yoga, Tai Chi or mindfulness to improve stress resilience
  • Eat whole, unprocessed fruits and vegetables every day
What is functional dyspepsia?

Functional dyspepsia could be described as indigestion pain in the chest, or upper abdomen that occurs without any apparent cause. It is sometimes referred to as nonulcer stomach pain. Symptoms usually include:

  • Feeling full after eating a small or regular sized meal
  • Lack of appetite
  • Burping
  • Belching
  • Nausea
  • Burning, gnawing pain or sensation to the mid-upper abdomen

Once all other explanations have been ruled out, such as cardiac pain, acid reflux (GORD/GERD), gastritis, IBS, IBD, SIBO, seeking a functional dyspepsia natural treatment will help to resolve symptoms for good.

Functional medicine treatment of functional dyspepsia will identify the root cause of the symptoms and treat them accordingly. Natural remedies for indigestion and digestive disorders can be safe, effective and give you back your health.

Can’t find what you’re looking for? Reach out to the team directly – we’ll be happy to assist.

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