Non-ulcer Dyspepsia Functional Dyspepsia

Authored by , Reviewed by Dr John Cox on | Certified by The Information Standard

Non-ulcer dyspepsia causes pain and sometimes other symptoms in your upper tummy (abdomen). The cause is often not clear. Medication to reduce stomach acid helps in some cases. Infection with Helicobacter pylori may cause a small number of cases. Clearing this infection, if present, helps in some people.

Non-ulcer dyspepsia is sometimes called functional dyspepsia. It means that no known cause can be found for the symptoms. That is, other causes for dyspepsia such as duodenal ulcer, stomach ulcer, acid reflux and oesophagitis, inflamed stomach (gastritis) and eosinophilic oesophagitis are not the cause. The inside of your gut looks normal if you have a test called a gastroscopy (endoscopy) - see below. It is the most common cause of dyspepsia. About 6 in 10 people who have repeated (recurring) bouts of dyspepsia have non-ulcer dyspepsia.

The symptoms seem to come from the upper gut but the cause is not known. If you have tests, nothing abnormal is found inside your gut. The lining inside your gut looks normal and is not inflamed. The amount of acid in the stomach is normal.

The following are some theories as to possible causes:

  • Sensation in the stomach or the first part of the small intestine (the duodenum) may be altered in some way - an 'irritable stomach'. About one in three people with non-ulcer dyspepsia also have irritable bowel syndrome and have additional symptoms of lower tummy (abdominal) pains, erratic bowel movements, etc. The cause of irritable bowel syndrome is not known.
  • A delay in emptying the stomach contents into the duodenum may be a factor in some cases. The muscles in the stomach wall may not work as well as they should.
  • Infection with a germ (bacterium) called Helicobacter pylori (commonly just called H. pylori) may cause some cases. See the separate leaflet called Stomach Pain (Helicobacter Pylori) for more details.
  • Some people feel that certain foods and drinks may cause the symptoms or make them worse. It is difficult to prove this and food is not thought to be a major factor in most cases. Those foods and drinks which have been suspected of causing symptoms or making symptoms worse in some people include:
    • Peppermint
    • Tomatoes
    • Chocolate
    • Spicy foods
    • Hot drinks
    • Coffee
    • Alcoholic drinks
  • Anxiety, depression, or stress are thought to make symptoms worse in some cases.
  • A side-effect of some medicines can cause dyspepsia:
    • The most common culprits are anti-inflammatory medicines such as ibuprofen and aspirin.
    • There are various other medicines which sometimes cause dyspepsia, or make dyspepsia worse. These include antibiotics, steroids, iron, calcium antagonists, nitrates, theophyllines, and bisphosphonates. (Note: this is not an exhaustive list. Check with the leaflet that comes with your medication for a list of possible side-effects.)
    • If you suspect a prescribed medicine is causing the symptoms, or making them worse, see your doctor to discuss possible alternatives.

Strictly speaking, non-ulcer dyspepsia is a diagnosis that is made only when no other cause can be found for the symptoms (such as an ulcer). Therefore, prior to the diagnosis being made you may have had a gastroscopy (endoscopy). In this test a doctor looks inside your stomach and first part of your small intestine (the duodenum) by passing a thin, flexible telescope down your gullet (oesophagus). If you have non-ulcer dyspepsia, the inside of your gut looks normal. However, most people with dyspepsia do not have an endoscopy. See the separate leaflet called Indigestion (Dyspepsia) for an overview of dyspepsia and when tests are advised.

A test to detect the H. pylori germ (bacterium) may be done. If H. pylori is found then it may be causing the symptoms. See the separate leaflet called Stomach Pain (Helicobacter Pylori) for more details about H. pylori and how it can be diagnosed and treated. Briefly, it can be detected in a sample of stools (faeces), or in a breath test, or from a blood test, or from a sample (biopsy) taken during an endoscopy.

Reassurance and explanation

This is often helpful. Some people worry that they may have a serious disease such as stomach cancer. Worry and anxiety can make symptoms worse. It may be useful to know that you have non-ulcer dyspepsia and not some other disease. However, you will have to accept that pain, discomfort and other dyspeptic symptoms are likely to come and go.

Clearing H. pylori infection

If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, as mentioned, infection with H. pylori is probably a coincidence rather than a cause in most cases of non-ulcer dyspepsia. For example, one study found that only about 1 in 15 people with non-ulcer dyspepsia who were infected with H. pylori were cured by clearing H. pylori. Treatment, briefly, involves a one-week course of two antibiotics plus an acid-suppressing medicine.

Acid-suppressing medicines

A one-month trial of medication that reduces stomach acid is often advised. This helps in some cases but not all. It may work because the lining of your stomach may be extra sensitive to the acid. Or, it may work because you may have very mild inflammation in your stomach that comes and goes but is never found if you have an endoscopy test to look into your stomach. See the separate leaflet called Indigestion Medication for more information.

Lifestyle changes

The National Institute for Health and Care Excellence (NICE) recommends the following lifestyle changes:

Symptoms of non-ulcer dyspepsia tend to come and go. You are likely to have times when symptoms go completely and times where they are troublesome. Non-ulcer dyspepsia does not lead to cancer or other serious illnesses.

Further reading and references

  • ; NICE Clinical Guideline (Sept 2014)

  • ; NICE CKS, September 2017 (UK access only)

  • ; Functional dyspepsia. Aust Prescr. 2017 Dec40(6):209-213. doi: 10.18773/austprescr.2017.066. Epub 2017 Dec 4.

  • ; Dyspepsia: When and How to Test for Helicobacter pylori Infection. Gastroenterol Res Pract. 20162016:8463614. doi: 10.1155/2016/8463614. Epub 2016 Apr 28.

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