Diagnostic Criteria for Functional Dyspepsia

Definition and Symptoms

The primary symptom of functional dyspepsia is bothersome epigastric pain or discomfort, which must be the predominant symptom according to the Rome criteria, as recommended by the American Gastroenterological Association 1, 2, 3
The Rome IV diagnostic criteria establish that functional dyspepsia must include one or more of the following bothersome symptoms (sufficiently severe to affect daily activities): bothersome epigastric pain, bothersome epigastric burning, as stated by the European Society of Gastrointestinal Motility 4, 5
The American College of Gastroenterology recommends that these symptoms must be present for at least 3 months, with an onset at least 6 months before diagnosis, and without evidence of structural disease on endoscopy that explains the symptoms 4, 5

The Epigastric Pain Syndrome (EPS) must include at least 1 day per week of either bothersome epigastric pain or burning, sufficiently severe to affect daily activities, according to the Rome criteria, as supported by the National Institute of Diabetes and Digestive and Kidney Diseases 4, 5
The Postprandial Distress Syndrome (PDS) must include at least 3 days per week of either bothersome postprandial fullness or early satiation, sufficiently severe to affect daily activities, as defined by the European Society of Gastrointestinal Motility 4, 5

The American Gastroenterological Association states that heartburn (acidity) is not a dyspeptic symptom, although it may frequently coexist, and that the predominant symptom in functional dyspepsia is epigastric pain or discomfort, whereas in gastroesophageal reflux disease (GERD) heartburn is the predominant symptom 1, 2, 3, 4, 5
A significant overlap exists in clinical practice: 63-66% of patients with heartburn also have coexisting epigastric pain, and 19% of patients with dyspepsia cannot select their predominant symptom, as reported by the National Institute of Diabetes and Digestive and Kidney Diseases 2, 6

The American College of Gastroenterology recommends that persistent vomiting suggests another disorder and should be investigated, as it is not characteristic of functional dyspepsia, and that unintentional weight loss, rectal bleeding, dysphagia, and a family history of gastric or esophageal cancer are warning signs that require immediate investigation 4, 5