Functional Dyspepsia

N Engl J Med. 2026 Jan 8;394(2):166-176. doi: 10.1056/NEJMcp2501860.

Abstract

Functional dyspepsia is a common but serious medical syndrome that can induce weight loss and food aversion and may be associated with increased risks of hospitalization and death. It probably comprises several different and as yet incompletely characterized disorders. Patients with local mucosal microinflammation driven by an aberrant Th2 response may represent an important subgroup. There is overlap with other gastrointestinal syndromes, particularly irritable bowel syndrome and gastroesophageal reflux disease, and patients with overlap have more severe symptoms. There is no approved drug for functional dyspepsia. Treatment is empirical and directed at symptoms and consists of acid suppressants and low-dose tricyclic antidepressants (and other neuromodulators) along with appropriate nutritional and psychological support.

Publication types

  • Review

MeSH terms

  • Antidepressive Agents, Tricyclic / therapeutic use
  • Dyspepsia* / diagnosis
  • Dyspepsia* / etiology
  • Dyspepsia* / physiopathology
  • Dyspepsia* / therapy
  • Gastroesophageal Reflux* / complications
  • Gastroesophageal Reflux* / diagnosis
  • Gastroesophageal Reflux* / physiopathology
  • Gastroesophageal Reflux* / therapy
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Irritable Bowel Syndrome* / complications
  • Irritable Bowel Syndrome* / diagnosis
  • Irritable Bowel Syndrome* / physiopathology
  • Irritable Bowel Syndrome* / therapy
  • Nutritional Support
  • Practice Guidelines as Topic
  • Proton Pump Inhibitors / therapeutic use

Substances

  • Antidepressive Agents, Tricyclic
  • Proton Pump Inhibitors
  • Histamine H2 Antagonists