GERD vs Functional dyspepsia
How to tell GERD and Functional dyspepsia apart when a board question makes them look alike.
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Acid regurgitation into the throat strongly favors GERD over functional dyspepsia.
Side by side
Predominant retrosternal burning and acidic regurgitation after meals or when supine favors GERD.
Postprandial fullness or epigastric pain with normal endoscopy and no structural disease favors functional dyspepsia.
Transient lower esophageal sphincter relaxation permits reflux of gastric contents into the esophagus.
Visceral hypersensitivity and altered gastric accommodation drive upper abdominal symptom perception.
Typical GERD without alarm features is diagnosed clinically and often improves after an 8-week proton pump inhibitor trial; erosive esophagitis on endoscopy confirms disease.
Functional dyspepsia requires no structural lesion on upper endoscopy and may include normal basic labs with negative H pylori testing or post-eradication persistent symptoms.
The trap
Treating persistent dyspepsia indefinitely as reflux without evaluating alarm signs can miss serious pathology. Dysphagia, weight loss, bleeding, anemia, or age-risk should trigger early endoscopy.
The repair move
Next best step: start lifestyle reflux measures and omeprazole 20 mg daily 30 minutes before breakfast for 8 weeks, then reassess. If symptoms are primarily epigastric fullness with normal endoscopy and negative alarm evaluation, treat functional dyspepsia with H pylori test-and-treat strategy and consider low-dose tricyclic therapy.
Try a free question
CoreA 29-year-old patient has postprandial heartburn and sour regurgitation for 3 months without alarm features. What is the next best step in management?
Show answer and explanation
Answer: A. Begin an 8-week proton pump inhibitor trial. Typical uncomplicated GERD is managed initially with lifestyle adjustment and PPI trial.
Why the other choices are tempting
- B. Wrong. Surgical exploration is not indicated.
- C. Wrong. Opioids worsen GI motility and are inappropriate.
- D. Wrong. Persistent symptoms deserve treatment and reassessment.
- E. Wrong. Steroids are not standard GERD therapy.
Flashcards
Tap a card to flip it.
Which symptom most specifically supports GERD rather than functional dyspepsia?
Acidic regurgitation with positional heartburn.
What finding is required before diagnosing functional dyspepsia?
No structural explanation on endoscopy or targeted workup.
Quick answers
What is the fastest way to tell GERD from Functional dyspepsia?
Acid regurgitation into the throat strongly favors GERD over functional dyspepsia.
What is the key clue for GERD?
Predominant retrosternal burning and acidic regurgitation after meals or when supine favors GERD.
What is the key clue for Functional dyspepsia?
Postprandial fullness or epigastric pain with normal endoscopy and no structural disease favors functional dyspepsia.
What is the common trap with GERD vs Functional dyspepsia?
Treating persistent dyspepsia indefinitely as reflux without evaluating alarm signs can miss serious pathology. Dysphagia, weight loss, bleeding, anemia, or age-risk should trigger early endoscopy.