Certain individuals may experience pain or discomfort (“dyspepsia”) in the upper part of the abdomen without a doctor being able to find a cause after reasonable investigation. Such individuals may be diagnosed with functional dyspepsia. Even though definitive pathology may not be found, this condition can cause severe symptoms and be disabling. It is not an uncommon diagnosis and is often related to stress. Functional dyspepsia can be very difficult to treat (responding poorly to therapy) and may cause the patient much distress, especially if they are told "there is nothing wrong with you".

Investigations often used in the investigation of upper abdominal pain (dyspepsia):

• Gastroscopy
• Blood tests, including a full blood count, CRP, liver function tests, serum calcium level - as clinically indicated.
• Imaging, e.g ultrasound or CT scan 

Rome IV criteria

A set of criteria for functional disorders has been created and is called the Rome IV criteria. According to the Rome IV criteria, the diagnosis of functional dyspepsia has the following requirements:

1. Must have at least one of the following:

• Bothersome epigastric pain
• Bothersome epigastric burning
• Bothersome early satiety
• Bothersome postprandial fullness

AND

2. No evidence of structural disease that is likely to explain the symptoms

AND

3. Symptom onset at least six months before the diagnosis and fulfilling the above criteria for at least the last 3 months

Treatment

Functional dyspepsia, like most functional disorders, may not respond well to treatment. A step-wise approach to therapy is recommended, as follows:

1. Test for and eradicate H. pylori infection if present
2. Trial of PPI therapy (anti-acid drugs) 
3. Pain modulating therapy e.g. Amitryptaline or pregabalin (Lyrica)