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Functional dyspepsia — ESEGH MCQ

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EasyLuminal GIFunctional dyspepsiaESEGH

A 39-year-old woman has had 9 months of bothersome postprandial fullness, early satiation and intermittent epigastric burning. She has no heartburn, acid regurgitation, vomiting, dysphagia, gastrointestinal bleeding or unintentional weight loss. Full blood count, liver biochemistry and coeliac serology are normal. Helicobacter pylori testing is negative, and oesophagogastroduodenoscopy shows no structural abnormality. What is the most likely diagnosis?

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Correct answer: A — Functional dyspepsia

The diagnosis is **functional dyspepsia**. She has more than 8 weeks of cardinal dyspeptic symptoms—postprandial fullness, early satiation and epigastric burning—with no alarm features or explanatory structural abnormality. The meal-related pattern is compatible with postprandial distress syndrome, with overlapping epigastric pain syndrome features. Gastro-oesophageal reflux disease is less likely without predominant heartburn or acid regurgitation. A normal OGD excludes peptic ulcer disease and makes gastric adenocarcinoma untenable in this presentation. Negative coeliac serology and the absence of suggestive nutritional or bowel features argue against coeliac disease. Functional dyspepsia should be made as a positive symptom-based diagnosis after appropriate assessment, rather than merely being labelled unexplained abdominal discomfort.

Reference: British Society of Gastroenterology. Black CJ et al. British Society of Gastroenterology guidelines on the management of functional dyspepsia, section 'Classification and diagnostic criteria'. Gut. 2022;71:1697–1723. https://www.nice.org.uk/guidance/cg184/ifp/chapter/if-you-have-functional-dyspepsia-also-called-non-ulcer-dyspepsia