Functional Dyspepsia: Chronic Indigestion, Normal Endoscopy

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Functional dyspepsia is chronic indigestion (upper belly pain, burning, or fullness after meals) that keeps coming back even though tests do not show an ulcer, inflammation, or another disease that would explain it. It is common, the symptoms are real, and a normal upper endoscopy is often how people first hear the name. This page is for adults in Arlington, Annandale, and the rest of Northern Virginia who live with ongoing indigestion, or who were told their endoscopy was normal and want to understand what comes next. It explains what functional dyspepsia is, how it is diagnosed, and the order of treatment that gastroenterology guidelines describe.

If upper belly pain or indigestion comes with pain in your chest, jaw, neck, or arm, or with shortness of breath, call 911. Heart problems can feel like indigestion. Our page on noncardiac chest pain explains why chest symptoms are treated as a heart problem until a clinician says otherwise.

This article is general education, not medical advice. It cannot tell you whether your own symptoms are functional dyspepsia.

What functional dyspepsia is

Dyspepsia is the medical word for indigestion. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes it as a group of symptoms that occur together, most often:

• Pain, burning, or discomfort in the upper abdomen
• Feeling full too soon while eating a meal
• Feeling uncomfortably full after eating a small amount
• Bloating, nausea, or belching

Indigestion is a symptom, not a diagnosis. Sometimes it comes from a specific disease, such as a peptic ulcer, gastritis, or, much less often, stomach cancer. NIDDK notes that most often, though, no such cause is found, and chronic indigestion without a disease that explains it is called functional dyspepsia.

NIDDK describes functional dyspepsia as a disorder of gut-brain interaction. That is the same family as irritable bowel syndrome: the problem lies in how the stomach, the nerves that serve it, and the brain work together, not in damage that a camera or biopsy can see. The 2017 American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guideline on dyspepsia defines functional dyspepsia as dyspepsia where endoscopy, and other tests where relevant, has ruled out a disease that explains the symptoms.

How common functional dyspepsia is

NIDDK reports that indigestion affects up to 20% of people in the United States each year, and that among people in the United States who see a doctor about it, about 7 in 10 are diagnosed with functional dyspepsia. A 2026 Rome Foundation survey of nearly 29,000 adults in 15 countries, published in the journal Gut, found functional dyspepsia in 8.1% of respondents, making it the most common disorder of the stomach and duodenum in that survey.

NIDDK lists several things that make indigestion more likely: being female, feeling stressed, smoking, having certain other health problems, and taking certain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.

The two types of functional dyspepsia

Gastroenterologists diagnose disorders of gut-brain interaction using criteria from the Rome Foundation. The fifth edition, Rome V, was published in the journal Gastroenterology in May 2026 and replaced Rome IV. It keeps the name functional dyspepsia and recognizes two subtypes, which can overlap. A 2026 review of what changed in Rome V explains that the subtype names are now the preferred terms:

Postprandial distress syndrome

"Postprandial" means after a meal. In this subtype the main complaints are bothersome fullness after eating or getting full very early in a meal. Rome V lowered the frequency needed for this subtype to at least 2 days a week, down from 3, based on patient focus groups, and defines "after a meal" as within 2 hours of eating. Upper belly pain, nausea, bloating, or belching that comes on after food can count as part of this subtype when the fullness symptoms are also there.

Epigastric pain syndrome

"Epigastric" refers to the center of the upper abdomen, above the navel. In this subtype the main complaint is bothersome pain or burning there, which can come with meals or happen on its own.

Rome V also draws two lines that matter for patients. When nausea or repeated vomiting is the main problem, the diagnosis to consider is chronic nausea and vomiting syndrome or gastroparesis, not functional dyspepsia; our page on chronic nausea and vomiting covers those. And when upper belly pain is reliably relieved by a bowel movement, the review notes that clinicians should consider a bowel disorder such as IBS.

What causes functional dyspepsia

In most cases the exact cause is not known. NIDDK lists factors that research suggests may play a role:

• Certain foods and drinks
• Problems in the duodenum, the first part of the small intestine, including inflammation and extra sensitivity to stomach acid
• A stomach that does not relax and expand normally when food arrives
• Pain from the normal work of the stomach
• Anxiety and depression
• Genes

Slow stomach emptying is part of the picture for some people, but not most. The ACG guideline states that 70% to 80% of people with functional dyspepsia have normal gastric emptying, and that when emptying is delayed, the delay is usually mild.

Other causes of indigestion to rule out

NIDDK lists medicines that can cause indigestion, including some antibiotics, NSAIDs, iron supplements, some osteoporosis medicines, corticosteroids, and GLP-1 medicines used for diabetes and weight loss. Our page on GLP-1 medications and endoscopy covers those drugs. NIDDK names peptic ulcers and infections, including Helicobacter pylori (H. pylori), as the most common disease-related causes. Do not stop a prescribed medicine on your own because of indigestion; ask the doctor who prescribed it.

Warning signs that need prompt care

Functional dyspepsia does not cause bleeding, weight loss, or trouble swallowing. NIDDK advises seeing a doctor right away if indigestion comes with any of the following:

• Pain in the chest, jaw, neck, or arm, or shortness of breath (call 911 for these)
• Difficulty swallowing or painful swallowing
• Frequent vomiting, or vomit with blood in it
• Severe, constant abdominal pain
• Long-lasting bloating or swelling of the abdomen
• Weight loss without trying, or loss of appetite
• Yellowing of the eyes or skin
• Black, tarry stools

NIDDK also says to see a doctor if indigestion simply does not get better. Our page on difficulty swallowing and our guide to when to see a gastroenterologist explain how those symptoms are triaged.

How functional dyspepsia is diagnosed

There is no single test that proves functional dyspepsia. NIDDK explains that a doctor may diagnose it from symptoms, history, an exam, and tests when no other cause is found. NIDDK gives the timing doctors often use: symptoms at least once a week over the last 3 months, starting at least 6 months ago, while noting that a doctor may make the diagnosis with a shorter history too.

History and exam

NIDDK lists the questions to expect: past indigestion and past H. pylori infection, whether symptoms come with meals, anxiety or depression, every medicine you take (especially NSAIDs, acid reducers, and calcium), and any family history of H. pylori or digestive cancer. The exam checks for bloating, tenderness, lumps, and yellowing of the skin or eyes.

H. pylori testing

For people under 60, the ACG guideline makes a strong recommendation for a noninvasive test for H. pylori, with treatment if it is positive. NIDDK describes the options: a stool test, a urea breath test, a blood test, or biopsies taken during an endoscopy. Our peptic ulcers and H. pylori page explains the tests in more detail.

When an upper endoscopy is recommended

An upper endoscopy, or EGD, uses a thin, flexible camera to look at the esophagus, stomach, and duodenum, with biopsies if needed. Guidance on who needs one has changed:

• Age 60 and older. The ACG guideline suggests an endoscopy for people 60 and older with dyspepsia, to rule out cancer of the upper digestive tract.
• Younger people at higher risk. The ACG guideline says an endoscopy could be offered at a younger age to people at higher risk of stomach cancer, such as those with a family history of it or who spent childhood in a country where stomach cancer is common.
• Warning signs under 60. The ACG guideline found that warning signs alone did a poor job of predicting cancer in younger patients, so it suggests deciding on an endoscopy case by case rather than automatically. NIDDK lists the situations where a doctor may recommend one: family history of cancer, current or past heavy alcohol use, difficulty swallowing, signs of bleeding, frequent vomiting, and weight loss.
• No warning signs or risk factors. Rome V states that an upper endoscopy is not required to diagnose functional dyspepsia in routine care for people without warning signs or other risk factors.

If an endoscopy is normal, the ACG guideline says biopsies should be taken to check for H. pylori if it has not already been tested. A normal result is not a dead end. For most people with ongoing symptoms, it is the step that makes the diagnosis of functional dyspepsia and opens the way to treatment.

Motility testing

The ACG guideline recommends against routine stomach motility tests for functional dyspepsia. It suggests them only for selected patients when gastroparesis is strongly suspected, for example with frequent nausea and vomiting.

How functional dyspepsia is treated

The ACG guideline lays out treatment as a sequence, moving to the next step if the one before does not help. The specific medicine, dose, and timing are decisions for your own gastroenterologist.

1. Treat H. pylori if it is present. The ACG guideline makes a strong recommendation to treat the infection in people with functional dyspepsia who test positive, and suggests allowing at least 4 weeks before judging whether symptoms have improved.
2. A trial of acid-reducing medicine. For people who do not have H. pylori, or who still have symptoms after it is treated, the ACG guideline makes a strong recommendation for a proton pump inhibitor (PPI). In the trials the guideline reviewed in people with indigestion that had not yet been investigated, half of those taking a PPI still had symptoms, compared with nearly three in four taking a placebo or antacid, so a PPI helps some people and not others. If a PPI does not help, there is little reason to keep taking it. Our guide to long term PPI use covers safety and stopping.
3. A low-dose nerve-calming medicine. For people who do not respond to the first two steps, the ACG guideline recommends a tricyclic antidepressant. NIDDK notes that antidepressants may ease the pain of indigestion. Being offered one does not mean a doctor thinks the symptoms are "in your head"; it is a standard step for a disorder of gut-brain interaction.
4. A medicine that helps the stomach move. If symptoms continue, the ACG guideline suggests a prokinetic, a medicine that helps the stomach empty. It places these after tricyclics because the evidence for them in functional dyspepsia is weaker.
5. Psychological therapies. For people whose symptoms do not respond to medicine, the ACG guideline suggests psychological therapies. NIDDK also mentions relaxation exercises, meditation, and counseling as ways to reduce stress.

Supplements and food in functional dyspepsia

The sources differ a little on supplements. NIDDK notes that a doctor may recommend peppermint oil or caraway oil and advises talking with your doctor before using any supplement. The ACG guideline does not recommend the routine use of complementary and alternative medicines for functional dyspepsia, because the research is too varied to draw firm conclusions.

On food, NIDDK says specific foods are not thought to cause indigestion, but some people with functional dyspepsia find that certain foods or drinks bring on symptoms. It lists carbonated drinks, grain and wheat products, caffeine, fruits and fruit juices, and fatty or greasy foods as common examples, and notes that triggers differ from person to person. NIDDK suggests working with your doctor or a registered dietitian rather than cutting out whole food groups on your own.

Functional dyspepsia compared with GERD, gastritis, and gastroparesis

Several upper GI conditions share symptoms, and people can have more than one.

• GERD centers on heartburn and acid coming up into the chest or throat. NIDDK notes that people with indigestion may also have heartburn, but that the two are separate conditions.
• Gastritis is inflammation of the stomach lining that can be seen on endoscopy or biopsy. In functional dyspepsia, the lining looks normal.
• Gastroparesis is clearly delayed stomach emptying, often with nausea and vomiting. Rome V says that when nausea or vomiting comes with delayed emptying, the diagnosis is gastroparesis.
• Chronic bloating and gas can be part of functional dyspepsia when it follows meals, but bloating lower in the belly or tied to bowel habits points elsewhere.

Living with functional dyspepsia

NIDDK notes that in most cases indigestion does not lead to other health problems, though it can affect quality of life, and the ACG guideline states that people with dyspepsia have a normal life expectancy. Treatment aims to reduce symptoms, and finding the right approach can take more than one step. It helps to keep a short record of when symptoms happen, how they relate to meals, and what has and has not helped, and to bring it to each visit.

New symptoms are a reason to check in again rather than assume they are part of the same condition. Any of the warning signs above, at any point, means prompt care.

Preparing for a visit about functional dyspepsia

The visit goes further when you bring:

• Any earlier endoscopy reports, biopsy results, H. pylori test results, and imaging
• A list of every medicine and supplement you take, including NSAIDs, aspirin, acid reducers, iron, and GLP-1 medicines
• Which treatments you have already tried, for how long, and whether they helped
• When symptoms started, how often they happen, and whether they come with meals
• Any family history of stomach cancer or H. pylori

Our page on what to expect at your first gastroenterologist visit covers the rest.

Care for functional dyspepsia at GC of NoVA

Gastroenterology Center of Northern Virginia sees adults across Arlington, Annandale, and the surrounding communities who have ongoing indigestion, including people who have already had a normal endoscopy and still have symptoms. Our five gastroenterologists review what testing has already been done, look for causes that need specific treatment, and work through the next steps with you. Upper endoscopies are performed at VHC Health, Inova Fairfax Hospital, and the Woodburn Endoscopy Center.

We see patients at our Arlington office at 1715 N George Mason Drive, adjacent to VHC Health, and our Annandale office at 3299 Woodburn Road in the Woodburn Medical complex. To schedule a visit, call Arlington at (703) 522-7476 or Annandale at (703) 560-6106, or learn more at gcofnova.com.

This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.