Functional dyspepsia

Start with NHS indigestion

The NHS uses indigestion (dyspepsia) for a cluster of upper-gut symptoms: upper abdominal pain or discomfort, heartburn, acid reflux, nausea, or vomiting, typically lasting weeks rather than a single heavy meal. That is the everyday door most people walk through. It is also how NHS.uk titles the condition.

NICE CG184 distinguishes uninvestigated dyspepsia (symptoms that have not yet been investigated) from functional dyspepsia after investigation has not found an explanatory disease — for example ulcer, oesophagitis, or cancer on the appropriate pathway. That post-investigation name is also called non-ulcer dyspepsia in older NICE CKS wording. FD is a disorder of gut–brain interaction. Rome IV criteria were published in 2016; Rome V criteria were published in 2026.

PDS and EPS

Rome criteria split FD into two subtypes that can overlap:

• Postprandial distress syndrome (PDS) — bothersome fullness after meals, or early satiety (feeling full before the meal is finished).
• Epigastric pain syndrome (EPS) — bothersome pain or burning in the epigastrium (the upper middle abdomen).

NICE CKS describes the same pairing. Many people have features of both.

What FD is not

• Heartburn alone is not FD. Predominant heartburn and regurgitation are managed as reflux / GORD. Dyspepsia and reflux can overlap; that still does not make isolated heartburn a functional dyspepsia diagnosis.
• FD is not gastroparesis. Gastroparesis is delayed stomach emptying without blockage, shown on a gastric-emptying test. Some people with FD have mildly delayed emptying. The labels are not interchangeable, and the care pathways are not the same.

Common symptoms

• Upper abdominal pain or burning (EPS)
• Post-meal fullness or early fullness (PDS)
• Nausea; bloating in the upper abdomen
• Symptoms that persist, with normal or non-explanatory endoscopy when one has been done

NHS advice still applies on red-flag features (for example difficulty swallowing, vomiting blood, or unexplained weight loss): those need medical care, not a Rome subtype discussion.

Approaches people discuss

Indigestion care starts with a clinician. This is not a gastric-pacemaker shopping list.

• Established Review medicines that irritate the stomach, test for Helicobacter pylori with the correct test conditions, and consider a time-limited PPI or H2-receptor antagonist if the person tests negative — all via a clinician (NICE CG184 / CKS and NHS indigestion). ACG/CAG 2017 likewise recommends a non-invasive H. pylori test-and-treat approach, then a PPI if needed, and does not recommend routine gastric-emptying testing. Sources: NICE CG184; NICE CKS; NHS indigestion; ACG/CAG 2017.
• Established Secondary-care options in the BSG 2022 functional dyspepsia guideline, including neuromodulators in selected people — a specialist decision, not a medicine to start from a webpage. Sources: BSG 2022 FD guideline.
• Emerging Dietetic advice and gut–brain behavioural approaches used alongside medical care (smaller meals and related habits stay supportive, not a cure). Sources: BSG 2022 functional dyspepsia guideline.
• Limited Treating functional dyspepsia as if it were gastroparesis, or chasing a gastric pacemaker, without an emptying study and a motility team.

Community insights

Anecdotal themes:

• People often arrive via years of “just indigestion” or a long PPI script. The FD name can help, if it is used accurately.
• Heartburn-heavy stories belong on the reflux page; meal-fullness stories sound more like PDS.
• Online threads blur FD and gastroparesis. Lived nausea does not decide which test is indicated.
• Eating pattern changes (smaller meals) are commonly tried; they are not a substitute for H. pylori testing when that is indicated.