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Functional dyspepsia and disorders of gut-brain interaction

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2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Functional dyspepsia cannot explain haemodynamic instability, haematemesis, melaena, rigid peritonism, acute coronary features, jaundice with sepsis or persistent vomiting with severe dehydration. Stabilise and investigate these presentations urgently. Progressive dysphagia, iron-deficiency anaemia, an upper-abdominal mass, persistent vomiting or qualifying weight loss requires the current urgent endoscopy or suspected-cancer pathway, even when earlier endoscopy was normal.

Synopsis

Diagnose functional dyspepsia positively after appropriate assessment, distinguish meal-related and pain phenotypes from dangerous structural disease, and deliver integrated gut-brain treatment without invalidating symptoms.

  • Functional dyspepsia is a disorder of gut-brain interaction producing epigastric pain or burning, early satiation or postprandial fullness without structural disease that adequately explains the symptoms.
  • Postprandial distress syndrome is dominated by meal-related fullness and early satiation; epigastric pain syndrome centres on pain or burning, and overlap is common.
  • Ask separately about retrosternal heartburn, biliary attacks, pancreatic pain, exertional pressure, vomiting and dysphagia because these imply different tests and pathways.

Key red flags

Upper gastrointestinal alarm

Progressive dysphagia, haematemesis, melaena, iron-deficiency anaemia, persistent vomiting, palpable mass or qualifying unexplained weight loss activates urgent structural and cancer assessment rather than routine functional treatment.

Investigation priorities

01
Helicobacter pylori breath or stool-antigen testFirst step

Detect active infection and select eradication treatment in uncomplicated uninvestigated dyspepsia.

Management branches

TriageSeparate functional from urgent structural disease

A person presents with epigastric pain, burning, early satiation or post-meal fullness.

  1. Assess physiology and exclude bleeding, perforation, cardiac ischaemia, pancreatitis and biliary sepsis before considering a routine dyspepsia pathway.
  2. Ask about dysphagia, vomiting, weight loss, anaemia, mass, family history, NSAIDs and age-linked onset, then apply current NG12 and endoscopy criteria.
Initial dyspepsiaTest and treat in a deliberate sequence

Uninvestigated dyspepsia is stable and has no urgent endoscopy indication.

Key medicines

Proton-pump inhibitorUse a current NICE full-dose preparation for a four-week empirical dyspepsia course, then step down to the lowest effective or intermittent strategy after review.
Helicobacter pylori eradication regimenUse the locally recommended seven-day combination selected for penicillin allergy, prior macrolide or metronidazole exposure and regional resistance information.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom