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Ask Dr. K: ‘Functional dyspepsia’ is not a useful diagnosis

DEAR DOCTOR K: My doctor says I have “functional dyspepsia.” Medications haven’t helped. Could something more serious be wrong?

DEAR READER: Dyspepsia is a medical term for persistent upper abdominal pain or discomfort. When doctors use the word “functional,” they mean that there is no identifiable cause for the problem. By this definition, the majority of people with dyspepsia may have functional dyspepsia. I dislike the term “functional,” for reasons I’ll explain later.

For a diagnosis of functional dyspepsia (FD), a person has to have the following symptoms: fullness after meals, an appetite that is quickly quieted by a meal, and burning or pain in the high middle part of the stomach. In addition, there has to be no evidence of anything being wrong (such as an ulcer) in the anatomy of the esophagus (swallowing tube), stomach or small intestine. Lastly, the symptoms have to have been present for at least three months.

Before you can be given a diagnosis of FD, the doctor should have done tests to look for an underlying condition that could explain the symptoms, such as an ulcer or gastroesophageal reflux disease (GERD). You may be tested for the bacteria that cause many ulcers: H. pylori.

You may also have an upper endoscopy. During this uncomfortable but nonsurgical procedure, a flexible scope is passed through your mouth and down into the esophagus and stomach to look for abnormalities.

Unfortunately, no truly effective drug exists to treat FD. Your doctor may prescribe drugs to decrease contractions in the gastrointestinal tract or rid the gut of excess gas. Low doses of tricyclic antidepressants may also improve symptoms.

Herbal remedies are worth a try. Enteric-coated peppermint oil and caraway oil can reduce fullness, bloating and gastrointestinal spasms. (Peppermint oil may trigger reflux if you are predisposed to it.)

Finally, your symptoms may improve through lifestyle modifications. I’ve put a detailed list of helpful modifications on my website, AskDoctorK.com.

So why do I dislike the word “functional” — whether it’s attached to dyspepsia or any other condition? Because it implies that the problem isn’t “real.” It says that a person is faking or exaggerating symptoms in order to gain something — attention, sympathy, even money.

“Functional” conditions are defined as symptoms without an identifiable cause for the problem. No cause may have yet been “identified,” but that does not mean that a cause will not be identified in the future.

We doctors are supposed to figure out the cause of a person’s symptoms. When we can’t, we may regard it as a failure. And since we don’t like to fail, sometimes we react by implying or saying: “There’s nothing wrong with you. It’s all in your head.”

In my opinion, for a doctor to use the term “functional dyspepsia” is to play a sad old game: Blame the victim. Instead, why not try even harder to find causes of the symptoms?

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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