Dyspepsia is the most common upper GI condition that people experience. It presents with:

• An excessive feeling of fullness
• Epigastric pain(Pain just below ribs)
• Discomfort
• Burning
• Nausea
• Belching
• Vomitting

These symptoms often occur acutely due to dietary exposures, consuming certain foods and such. But it can also be a recurring problem in some people.

When there is a cause, such as when there is an ulcer, treatment for dyspepsia involves treating the underlying issue. However, some people experience dyspepsia without an identifiable cause. This is called functional dyspepsia.

Think of functional dyspepsia as a form of chronic indigestion. Subcategories of functional dyspepsia include:

• Epigastric pain syndrome(EPS)-Pain below the ribs regularly, but not necessarily around meals
• Postprandial distress syndrome(PDS)-Excessive fullness and distress after meals

As seems to be the case with most functional gastrointestinal disorders, functional dyspepsia is more common in people with IBS. This makes fixing both tricky, because what is helpful for one may not be so helpful for the other.

An excellent paper gives a breakdown of the dietary treatment of dyspepsia, IBS, or both.

Differentiating between functional dyspepsia and IBS

Functional dyspepsia and IBS are different animals, but they pair together for a reason. As the name suggests, functional dyspepsia is a disorder of the stomach. Specifically, an impaired ability to accommodate larger meals and delayed emptying.

IBS, on the other hand, is more of a disorder of the small and large intestine. This gives a clue as to the time-related difference between the 2. Functional dyspepsia, specifically of the PDS variety, will occur soon after meals. On the other hand, symptoms of IBS come on much later.

But this doesn’t mean that the 2 aren’t related. Digestion is progressive, and failure at an earlier point in the process can affect later processes. We covered how important understanding this is in a video on our Youtube channel you can check out here:

Interestingly, people with functional dyspepsia present with an acidic oral microbiome, so consideration to oral health is also important. We covered how oral health affects the rest of the microbiome in our last video blog you can peep here.

Generally speaking, addressing health of one part of the gut improves function of another part. For example, carbohydrate breakdown starts in the mouth, comes to a halt in the stomach, and picks back up in the small intestine.

This on-in-the-mouth, off-in-the-stomach, back-on-in-the-small intestine is largely regulated by pH. More acidic pH decreases carbohydrate breakdown, so an acidic mouth can impact bloating in the small intestine.

Dietary treatment of dyspepsia and IBS

The conflicting nature of dietary approaches for people with functional dyspepsia and IBS creates some problems. First, people with IBS commonly have problems with carbohydrates. Specifically, FODMAPs which are rapidly fermentable carbohydrates.

On the other hand, both fats and proteins delay gastric emptying, and may be problematic for people with functional dyspepsia. Furthermore, the stomach pays an important role in regulating blood glucose, so sugars can also delay gastric emptying.

As a result, this puts someone with both in sort of a bind. What do they eat? How should they eat? And with seemingly numerous options, what works for one may not work for another.

The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework for addressing functional dyspepsia and IBS

Thankfully, a new paper provides an excellent framework for the treatment of dyspepsia with or without IBS. The guidelines are based on symptoms as well as how the patient reacts to different strategies.

Do tests show delayed gastric emptying?

Does the patient respond well to PPIs?

Does the patient improve when removing fats and regress on fat challenge?

Do they respond well to a low FOMDAP diet?

Are they diabetic or pre-diabetic?

Do they have an allergy, sensitivity, or intolerance to wheat?

Answering these questions helps move people along a treatment path that identifies a personalized diet for them. Unfortunately, many just take a generalist approach and cut things out of their diet that may be helpful.

For example, the insoluble fiber from wheat is helpful for functional dyspepsia. But, many people with IBS cut it out regardless of whether or not they have a problem with it. Consequently, for some, cutting out wheat is a bad idea.

Furthermore, specific types of FODMAPs lead to specific symptoms of IBS. For example, osmotic FODMAPs are more likely to lead to diarrhea, and may be problematic due to duodenal microbial dysbiosis.

If this is your major symptom, you don’t necessarily have to remove all FODMAPs. This comprehensive set of guidelines, known as the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework, is extremely effective for creating a personalized diet for the treatment of dyspepsia and IBS.

Conclusion

Problems with our gut generally accompany one another due to the progressive nature of digestion. When the mouth or stomach don’t adequately perform their job, this can cause problems in the small or large intestine.

When you have multiple problems going on in your gut, it can be difficult to address. Treatment of dyspepsia on its own is difficult due to the unknown and potentially numerous drivers.

When you also have IBS, this makes things much more difficult. Having a framework to go off of is important for long term success. The GRADE framework mentioned in this paper is incredibly useful for helping patients identify a personalized diet for the management of functional dyspepsia with or without IBS.

We’ll cover these guidelines a little more in depth in future videos on our Youtube channel. Subscribe to us on Youtube to get access to these videos as soon as they’re published. We also publish exclusive content on the channel that doesn’t make it to the blog.

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