With functional dyspepsia (dyspepsia means indigestion), sometimes called an irritable stomach (in German: Reizmagen), you keep getting symptoms in your upper abdomen — a feeling of fullness, feeling full early, pain or burning in the pit of the stomach — yet a gastroscopy and basic tests show no disease that would explain them.¹,²
According to the internationally recognised Rome IV criteria, functional dyspepsia is present when the symptoms have occurred during the last three months, began at least six months earlier and noticeably affect everyday life.¹ Today it is classed as one of the disorders of gut-brain interaction: none of the parts are broken, but the interplay between stomach, nerves and brain is out of step.
“No findings” does not mean “imagined”. The symptoms are real and measurable — for example as an oversensitive stomach wall or disturbed stomach emptying. The usual tests simply do not show this. A normal gastroscopy is therefore not an all-clear in the sense of “nothing wrong”, but a diagnosis with its own treatment path.
Functional dyspepsia is common, often comes in waves and is not dangerous: it does not shorten life and does not turn into cancer. It can, however, considerably reduce your quality of life.
2. Types and how to tell it apart
Rome IV distinguishes two types, which often overlap:¹
Postprandial distress syndrome (PDS) — the symptoms are linked to meals: an unpleasant feeling of fullness after eating, feeling full after even small portions. The more common type.
Epigastric pain syndrome (EPS) — pain or burning in the pit of the stomach, also regardless of meals.
It is important to distinguish it from conditions with similar symptoms — and from irritable bowel syndrome, which often occurs together with functional dyspepsia.³
Symptoms tend to be in the middle and lower abdomen and change with bowel movements
Gallstones
Colicky attacks of pain in the upper right abdomen
Come in attacks lasting hours; visible on ultrasound
Gastroparesis (stomach paralysis)
Nausea, vomiting, feeling full early
Clearly delayed stomach emptying, for example with diabetes or due to medicines
Table scrolls to the right
3. Symptoms and warning signs
Feeling of fullness after eating — as if there were a stone in your stomach, often for hours.
Feeling full early — you can no longer finish a normal portion.
Pain or burning in the pit of the stomach — between the lower edge of the ribs and the navel.
Accompanying symptoms — nausea, belching, a bloated upper abdomen.
The symptoms fluctuate, improve over weeks and then come back. Stress, infections or large meals often make them worse.
Warning signs — then it is not functional dyspepsia until proven otherwise. Have the following checked by a doctor promptly: unintended weight loss, difficulty swallowing, repeated vomiting, anaemia, a lump you can feel, stomach cancer in the family or new symptoms from about the age of 50 to 55. Go to the emergency department immediately with black, tarry stools, vomiting blood or vomit that looks like coffee grounds, or sudden, extremely severe abdominal pain.
4. Causes: what works differently in functional dyspepsia
There is no single cause. Several mechanisms interlock, in a different mix for each person:¹,⁴
Oversensitive stomach wall — normal stretching from food is felt as pressure or pain (visceral hypersensitivity).
Impaired adaptation of the stomach — the upper part of the stomach does not relax enough when you eat, so the space runs out sooner.
Delayed stomach emptying — in some of those affected, often with nausea.
After a gastrointestinal infection — some people develop functional dyspepsia following an infection; subtle inflammatory reactions in the duodenum are being discussed.
Gut-brain axis — stress, anxiety and depression amplify signal processing. They are not “the cause”, but an important amplifier.
Helicobacter pylori — in some of those affected, this stomach bacterium can trigger the symptoms.
Check medicines as a cause. Medicines can trigger similar symptoms: painkillers such as ibuprofen, diclofenac or aspirin, bisphosphonates, iron supplements, metformin, antibiotics, opioids — and GLP-1 agents such as semaglutide, which deliberately slow down stomach emptying. Before functional dyspepsia is diagnosed, the medication list needs to be on the table; more in the guide Stomach problems from medications.
5. Diagnosis: how the diagnosis is reached
Functional dyspepsia is not proven by a single test, but by the typical pattern of symptoms and by ruling out other causes. The aim is a confident positive diagnosis — not an endless search.⁴,⁵
Consultation: type, duration and triggers of the symptoms, bowel habits, weight, family history — and all medicines, including over-the-counter ones.
Blood tests: full blood count (anaemia?), depending on the situation inflammation, liver and pancreas values; if the symptoms fit, a test for coeliac disease.
Helicobacter test: breath or stool test, or a tissue sample. Acid blockers usually have to be paused two weeks beforehand and antibiotics four weeks beforehand — otherwise false-negative results are possible.
Gastroscopy: strictly speaking a prerequisite for the diagnosis; essential with warning signs or with new symptoms at an older age. In younger people without warning signs, the practice may first test and treat for Helicobacter.
Abdominal ultrasound: to rule out gallstones, for example.
Gastric emptying study: only if nausea and vomiting are the main symptoms.
Once the diagnosis has been made, repeated gastroscopies without new warning signs are generally not useful. They provide short-term reassurance but do not change the treatment.
6. Treatment: the foundations
First, an honest assessment: there is no medicine that reliably cures functional dyspepsia. Most treatments help some of those affected, often only moderately better than placebo — which in turn has a considerable effect in functional dyspepsia. The realistic goal is noticeable relief, not freedom from symptoms at any cost.⁴
FoundationUnderstanding, lifestyle, Helicobacter
Explaining the gut-brain axis
Understanding why your stomach reacts can reduce worry and unnecessary doctor visits — and it is the foundation of any further treatment.
Smaller meals, less fat, exercise
Several small portions, less fatty food, regular endurance exercise. Plausible and low-risk, but the evidence is weak.
Helicobacter eradication if positive
A combination of an acid blocker and antibiotics for one to two weeks. Only a smaller proportion become symptom-free as a result — but they then often stay that way. In addition, the risk of ulcers and stomach cancer falls.⁵
First lineTime-limited trial of acid suppression
Proton pump inhibitors (PPIs) for about four to eight weeks
For example pantoprazole or omeprazole at a standard dose. Tends to work better for the pain type; the overall effect is moderate. No benefit: stop. Benefit: reduce to the lowest effective dose or take it as needed.
Second lineNeuromodulators and psychotherapy
Low-dose tricyclic antidepressants
Above all amitriptyline, at a fraction of the dose used for depression. It dampens the transmission of pain signals between stomach and brain — according to the British guideline, the best-evidenced second-line option.⁴
Gut-brain psychotherapy
Cognitive behavioural therapy or hypnotherapy for persistent symptoms. Limited evidence, but no side effects.
Which steps make sense and in which order is decided by your treating practice together with you — depending on the type of functional dyspepsia, your other conditions and the rest of your medication.
7. Medicines for functional dyspepsia
Acid blockers: more habit than effect?
PPIs are the most frequently prescribed medicines for functional dyspepsia. For the fullness type, however, their benefit is small, because acid is hardly the cause there. That is why the rule is: test for a limited time, assess the effect, then decide.⁴,⁶ An alternative with a similarly moderate effect is H2 blockers such as famotidine.
Amitriptyline: not an antidepressant “for the mind”
At a low dose, amitriptyline acts as a neuromodulator on pain processing — you are not given it because someone thinks your symptoms are “all in your head”. Typical side effects are tiredness, dry mouth and constipation; taking it in the evening makes use of the tiredness. An effect often only appears after a few weeks. With heart disease and at an older age, an ECG is usually done beforehand. For early fullness with weight loss, mirtazapine is sometimes used — the evidence for this is limited.
Prokinetics: hardly any role left
Medicines that speed up stomach emptying sound logical for a feeling of fullness. However, metoclopramide is now only approved for a few days because of the risk of involuntary movement disorders, and domperidone only in a very limited way against nausea because of heart rhythm disorders.⁷ Neither is an option for the long-term treatment of functional dyspepsia.
Do not stop acid blockers abruptly. After several weeks of PPIs, the stomach temporarily produces more acid than before if they are stopped suddenly (acid rebound). The symptoms then come back more strongly — and are easily taken as proof that you cannot manage without them. Agree an attempt to stop with your practice, often with a gradual reduction or taking them as needed; more in the guide Stopping medications.
An eight-week PPI trial — and then?
brite reminds you to take your doses and records whether your symptoms really improve.
8. Long-term PPI use: when stomach protection becomes a habit
Many people have been taking an acid blocker for years — started as “stomach protection” in hospital, during a course of painkillers or as a trial for functional dyspepsia, and never reviewed. In the short term, PPIs are well tolerated. With long-term use, however, risks have been described that are listed in the summaries of product characteristics:⁶
Vitamin B12 and magnesium deficiency: magnesium becomes relevant especially if diuretics (water tablets) or digoxin are taken at the same time.
Gut infections: less stomach acid means less protection against germs, such as Clostridioides difficile.
Interactions: omeprazole and esomeprazole can weaken the effect of clopidogrel — pantoprazole is usually preferred here. The absorption of iron, levothyroxine and some antifungal and HIV medicines can change.
Not every association is definitely causal, and for many people — for example with reflux disease or when taking blood thinners together with painkillers — long-term use clearly makes sense. With functional dyspepsia and no proven benefit, on the other hand, there is little to be said for it. Every PPI deserves a review once a year; how this works is explained in the guide Reviewing long-term medication.
9. Herbal remedies and what does not help
In Germany, combination herbal products are widely used for functional dyspepsia. For a mixture of nine plant extracts and for the combination of peppermint and caraway oil, there are placebo-controlled studies showing a moderate effect; however, they come largely from research linked to the manufacturers. Products containing greater celandine carry a warning about liver damage. “Herbal” can also mean side effects and interactions — see herbal medicines.
Option
Assessment according to current evidence
Long-term PPIs without a noticeable benefit
No gain, but long-term risks — discuss an attempt to stop
IgG tests for “food intolerances”
Not meaningful; lead to unnecessarily strict diets
Gluten-free diet without coeliac disease
No proven benefit for functional dyspepsia
Probiotics, “gut cleansing”
Evidence thin and inconsistent
Antispasmodics such as hyoscine butylbromide
Can relieve individual cramping pains, hardly studied for functional dyspepsia
Repeated gastroscopies without new warning signs
Reassure briefly, do not change the treatment
Table scrolls to the right
10. Everyday life with functional dyspepsia
Eat small and slowly — five small meals instead of three large ones, chew well, and in the evening do not eat too late or too much fat.
Find your own triggers instead of blanket bans — some people tolerate coffee, alcohol, spicy food or fizzy drinks poorly, others without any problem. A symptom diary kept for a few weeks reveals patterns.
Exercise — regular endurance activity, ideally including a walk after meals.
Take stress seriously — relaxation techniques, sleep and breaks play a part via the gut-brain axis.
Choose painkillers carefully — ibuprofen, diclofenac and aspirin irritate the stomach; if you need them often, discuss alternatives with your practice or pharmacy.
Put a time limit on treatment trials — note every new medicine with a start date and a review date, so that nothing that does not help carries on indefinitely.
Functional dyspepsia is a nuisance, but it is not dangerous. Accepting the diagnosis often gains you more quality of life than any additional medicine — because the fear that something has been overlooked, which itself amplifies the symptoms, falls away.
Which meal, which symptoms?
Record symptoms, doses and triggers in your health history — the basis for every conversation with your doctor.
No. Functional dyspepsia does not shorten life and does not turn into cancer, but it can severely reduce quality of life. What matters is that warning signs such as unintended weight loss, difficulty swallowing, blood in vomit or black stools have been ruled out — these always need to be checked by a doctor.
In gastritis, the stomach lining is inflamed, which can be detected in a tissue sample. In functional dyspepsia there is no such cause; the symptoms arise from disturbed function and signal processing. In everyday language the two terms are often mixed up, and even with gastritis, findings and symptoms do not always match.
They help some of those affected, especially with pain and burning in the pit of the stomach. The effect is moderate overall and rather small for a feeling of fullness alone. A time-limited trial of about four to eight weeks is recommended; if there is no benefit, the acid blocker should be stopped again after discussion with your practice.
Low-dose tricyclic antidepressants such as amitriptyline dampen the transmission of pain signals between stomach and brain. The dose is far below the one used for depression. The prescription does not mean the symptoms are imagined — it targets the disturbed signal processing.
After several weeks of use, better not abruptly. After a sudden stop, the stomach temporarily produces more acid, and the symptoms then come back more strongly. Talk to your practice about a gradual reduction or taking it as needed, especially if the acid blocker is not needed for another condition.
There is no special diet with a proven effect. Several small meals, less fatty food and eating slowly have proved helpful. Which foods disagree with you personally is shown better by a symptom diary than by blanket lists of banned foods or IgG tests.
The symptoms often come in waves, with phases of few symptoms lasting weeks or months. In some people they disappear completely; in others they keep coming back. With explanation, adapted eating habits and targeted treatment trials, quality of life can usually be improved considerably.
Stanghellini V et al.: Gastroduodenal Disorders (Rome IV criteria). Gastroenterology 2016;150:1380–1392. theromefoundation.org
gesund.bund.de (German Federal Ministry of Health): Functional dyspepsia (irritable stomach) — German source. Accessed 2026. gesund.bund.de
German S3 guideline on irritable bowel syndrome, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) and German Society for Neurogastroenterology and Motility (DGNM), 2021 — German source. awmf.org
Black CJ et al.: British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut 2022;71:1697–1723. bsg.org.uk
German S2k guideline on Helicobacter pylori and gastroduodenal ulcer disease, German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), 2022 — German source. awmf.org
Summaries of product characteristics for proton pump inhibitors (including pantoprazole, omeprazole, esomeprazole), sections on warnings and interactions — German source. Accessed 2026. fachinfo.de
European Medicines Agency (EMA): recommendations restricting the use of metoclopramide (2013) and domperidone (2014). ema.europa.eu
Stomach medicines under control, not forever — with brite
Dose reminders, interaction checks and a record of every attempt to stop. Free.
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Unintended weight loss, difficulty swallowing, repeated vomiting or anaemia should be checked promptly; if you have black stools, vomit blood or have sudden severe abdominal pain, call 112 (emergency number in Germany). Do not stop acid blockers abruptly after taking them for a long time — the choice of medicine and its dose is always decided individually by the treating practice. Last updated: September 2026.
