Functional Dyspepsia
Ongoing upper tummy pain, burning, early fullness or uncomfortable fullness after meals, with tests that look normal. It’s a real gut–brain problem, not imagination, and about 1 in 14 people have it. Treatments work best stepped and combined.
Symptoms
- Fullness type: feeling uncomfortably full after normal meals, or full after a few bites
- Pain type: burning or pain in the upper tummy, not only after meals
- Many people have both, and many also have IBS or reflux
- Symptoms come and go, often worse with stress, big or fatty meals
See your GP soon for any of these: weight loss you can’t explain, vomiting that won’t settle, trouble swallowing, black or bloody stools, low iron or anaemia, a family history of bowel or stomach cancer, or new symptoms after 60.
Why it happens
- The stomach doesn’t relax properly to receive food, or empties unevenly
- The stomach and duodenum are oversensitive: normal stretching feels painful
- Mild inflammation in the duodenum, sometimes after a gut infection
- The gut–brain connection amplifies signals, especially with stress, anxiety or poor sleep
Tests
- A breath or stool test for Helicobacter pylori
- Blood tests: full blood count, iron, coeliac serology
- A gastroscopy for red flags or new symptoms after 60
- Repeated scopes and scans don’t help once the diagnosis is made
What helps
Most people need 2 or 3 of these together.
- Step 1 · Self-careSmaller, more frequent meals; less fat; eat slowlyBig, fatty meals are the classic trigger for the fullness type.
- Works
- Helps many with fullness symptoms
- Cost
- Free
- How long
- Ongoing
- Watch for
Your stomach isn’t a storage unit. Graze, don’t feast.
- Step 2 · GPTest for and treat H. pyloriIf positive, a week or two of antibiotics plus an acid-reducing tablet.
- Works
- Cures dyspepsia in a small minority (about 1 in 14 treated) and prevents ulcers
- Cost
- Script costs
- How long
- 1–2 weeks
- Watch for
- Antibiotic side effects; confirm it’s gone afterwards.
- Step 3 · Pharmacy or GPAcid-reducing tablets (PPIs) for 4–8 weeksBest for the pain or burning type.
- Works
- Helps about 1 in 10 more people than placebo
- Cost
- $10–25
- How long
- 4–8 weeks, then stop or step down
- Watch for
- Don’t stay on them long term without a reason.
- Step 4 · GPLow-dose amitriptyline or another gut–brain medicineTurns down oversensitive gut nerves. Mirtazapine helps early fullness with weight loss.
- Works
- Amitriptyline helps about 1 in 6 more people than placebo in trials, especially the pain type
- Cost
- $25 script or less
- How long
- Trial 8–12 weeks
- Watch for
- Sleepiness, dry mouth, constipation.
An antidepressant at a fraction of the dose. Your gut nerves don’t care what the box says.
- Step 5 · GP or psychologistGut-directed hypnotherapy or CBTRetrains the gut–brain loop.
- Works
- Good evidence in IBS, promising in dyspepsia
- Cost
- Medicare rebates for some sessions with a GP plan; apps available
- How long
- 6–12 sessions
- Watch for
- Step 6 · SpecialistProkinetics or buspironeHelp the stomach relax and empty.
- Works
- Modest benefit for fullness-type symptoms
- Cost
- Script costs
- How long
- Weeks
- Watch for
- Domperidone can affect heart rhythm; metoclopramide isn’t for long-term use.
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- IgG food intolerance testsThey measure normal exposure, not intolerance. No value for dyspepsia.
- Removing the gallbladder for normal-gallbladder painDoesn’t help functional dyspepsia unless there’s proven gallbladder disease.
- Repeated scopesOnce a good gastroscopy is normal, repeating it rarely changes anything.
Common questions
What is functional dyspepsia?
Ongoing upper tummy pain, burning or early fullness with normal tests such as a gastroscopy. It’s caused by an oversensitive, slow-to-relax stomach and gut–brain signalling, not by an ulcer or cancer.
How is functional dyspepsia treated?
Small, low-fat meals, H. pylori treatment if positive, a short course of acid tablets, and if needed low-dose amitriptyline, gut-directed hypnotherapy or medicines that help the stomach empty.
Is functional dyspepsia serious?
It doesn’t cause cancer or shorten life, but it can affect quality of life. New symptoms after 60, weight loss, vomiting, bleeding or anaemia need checking.
Helpful resources
- Gastroenterological Society of Australia (GESA)Patient information on gut conditions. Free.
Evidence and more information
- Ford AC et al. Functional dyspepsia (Lancet 2020)
- Moayyedi P et al. ACG and CAG clinical guideline: management of dyspepsia (2017)
maladywise.com/functional-dyspepsia/