Functional Gastrointestinal Disorders: Functional Upper Gastrointestinal Disorders in Adults.

Functional upper gastrointestinal disorders are common and cause significant patient distress and health care cost. These disorders typically are classified as either esophageal or gastroduodenal. Functional esophageal disorders include functional heartburn, reflux hypersensitivity, and functional dysphagia. Functional gastroduodenal disorders include functional dyspepsia and cyclic vomiting syndrome. Cyclic vomiting syndrome should be suspected in any patient with multiple episodes of vomiting with no apparent cause that completely resolve between episodes. Evaluation often is dependent on clinical findings. Therefore, a thorough history and physical examination are required to rule out any structural organic etiologies of red flag signs and symptoms. Diagnosis is ultimately based on Rome IV criteria. Education about the condition and lifestyle modifications is an ideal initial management for all functional upper gastrointestinal disorders. When this strategy alone is ineffective, behavioral therapy and pharmacotherapy can be useful. For patients with functional dyspepsia, acid suppression therapy and Helicobacter pylori eradication may be effective for improving long-term symptomatology. For patients who do not benefit from initial medical treatment, antidepressants and bismuth may be useful.