Patient handout

Functional Dyspepsia (Rome IV; postprandial distress syndrome / epigastric pain syndrome / overlap; H. pylori-associated dyspepsia; FD-GERD/IBS overlap)

PRODUCTION

1. Your condition

This handout is for functional dyspepsia (rome iv; postprandial distress syndrome / epigastric pain syndrome / overlap; h. pylori-associated dyspepsia; fd-gerd/ibs overlap). Your care team identified this based on: bothersome postprandial fullness and/or early satiation — postprandial distress syndrome (pds) (rome iv; stanghellini 2016 pmid 27147122).

Other reasons your team may use this plan: bothersome epigastric pain and/or epigastric burning — epigastric pain syndrome (eps) (rome iv); known functional dyspepsia on problem list (refractory-symptom / therapy-review visit) (acg/cag 2017); dyspeptic symptoms with positive non-invasive h. pylori test — h. pylori-associated dyspepsia (maastricht vi 2022 pmid 35944925).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
h_pylori_test_and_treat_strategy	—	—	—	ACG/CAG 2017 PMID 28631728 — non-invasive urea breath test / stool antigen, eradicate if positive; potentially curative subset (Ford 2022 PMID 35022266 — eradicated NNT 4.5)
diet_lifestyle_small_low_fat_meals	small frequent low-fat meals; reduce caffeine/alcohol/late meals	dietary	ongoing	ACG/CAG 2017 — dietary modification reduces meal-related symptoms; duodenal-eosinophilia mechanism supports dietary effect (Wauters 2021 PMID 33346007)
discontinue_nsaid_aspirin_iron_bisphosphonate	—	—	—	ACG/CAG 2017 — medication-induced dyspepsia must be excluded; stop/replace the offending agent before labelling functional

Plan: Functional dyspepsia stepwise subtype-directed therapy (ACG/CAG 2017 + AGA white paper 2017 — PDS/EPS tiers)

3. When to call your provider

Contact your care team if any of the following happen:

New alarm feature or age ≥60 new onset → upper endoscopy / GI referral (ACG/CAG 2017)
Refractory after H. pylori eradication + PPI + a neuromodulator → GI/neurogastroenterology referral (ACG/CAG 2017)
Significant unintentional weight loss / dehydration / persistent vomiting → organic workup / acute care (ACG/CAG 2017)
Severe psychological comorbidity / positive PHQ-9 Q9 suicidality → psychiatry, safety plan (ACG/CAG 2017)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Any alarm feature — unintentional weight loss, dysphagia, odynophagia, GI bleeding/iron-deficiency anaemia, persistent vomiting, palpable mass/lymphadenopathy, family history upper-GI cancer — OR age ≥60 with new-onset dyspepsia (ACG/CAG 2017 PMID 28631728)
Severe depression/anxiety or positive PHQ-9 item 9 (suicidality) in an FD patient (ACG/CAG 2017; bidirectional gut-brain axis)
Significant unintentional weight loss, dehydration, or persistent vomiting in a dyspeptic patient (ACG/CAG 2017)
Acute dystonia, akathisia, parkinsonism, or tardive-dyskinesia features in a patient on metoclopramide (FDA boxed warning) (ACG/CAG 2017)

5. Follow-up

Mild disease: review at 4-8 weeks then as needed with self-management education and return precautions (new alarm feature). Moderate-severe / refractory: structured follow-up q4-12 weeks during stepwise escalation; reinforce diet/lifestyle (small low-fat meals, reduce caffeine/alcohol, weight-bearing meals), the chronic relapsing-remitting natural history, and multidisciplinary coordination (dietitian, psychology, neurogastroenterology). Reassess the diagnosis if response is atypical or alarm features emerge (ACG/CAG 2017; AGA white paper 2017 PMID 28529164)

6. Sources

Guideline: ACG/CAG 2017 Dyspepsia Clinical Guideline (Moayyedi AJG 2017) + AGA White Paper Functional Dyspepsia + Rome IV gastroduodenal disorders (Stanghellini 2016) + ACG H. pylori 2024 (Chey) + Maastricht VI/Florence H. pylori 2022