Symptoms and diagnosis of functional heartburn and functional dyspepsia

Functional heartburn is defined as the presence of heartburn (retrosternal burning or pain) that is unrelated to oesophageal acid exposure and is not caused by gastro-oesophageal refluxRome Foundation Inc., 2016.

Functional dyspepsia is characterised by predominant epigastric pain or burning (epigastric pain syndrome), or early satiety or discomfort after meals (postprandial distress syndrome)Rome Foundation Inc., 2016.

The aetiology of functional heartburn and functional dyspepsia is unknown. Symptoms may be due to abnormalities of upper gastrointestinal motor or sensory function, inflammation, or acute or chronic stress.

To diagnose functional heartburn or functional dyspepsia, symptoms must have been present for 6 months and investigated appropriately to exclude structural and metabolic causes. Investigations should be tailored to the patient and their clinical presentation (see Clinical features that warrant further investigation of gastrointestinal symptoms), but may include upper gastrointestinal endoscopy, testing for Helicobacter pylori and routine blood tests (eg full blood count, electrolytes, liver biochemistry, coeliac antibodies).