Feeling heavy after meals, bloating, cramps, a “balloon-like” stomach, and unstable stools are among the most common reasons patients come to see me. Yet many people live for years with diagnoses like “chronic gastritis,” “biliary dyskinesia,” or “chronic pancreatitis” — diagnoses that are often not justified and may lead to ineffective treatment.
In modern gastroenterology, these symptoms are most commonly explained by functional dyspepsia and irritable bowel syndrome (IBS) — conditions in which the issue lies not in organ structure, but in their regulation and sensitivity.
Functional dyspepsia is not a “weak stomach” or “chronic gastritis,” but a set of symptoms in the upper abdomen with no structural abnormalities:
- heaviness and fullness after a usual amount of food
- early satiety (“I’m full after half a plate”)
- burning or pain in the upper abdomen
- sometimes — bloating and mild nausea
Irritable bowel syndrome (IBS) is chronic abdominal pain or discomfort related to bowel movements, in the absence of inflammation:
- cramps or abdominal pain associated with defecation
- changes in stool frequency (constipation, diarrhea, or both)
- changes in stool consistency
Many patients experience symptoms of both dyspepsia and IBS at the same time.
What actually changes in functional GI disorders?
In these conditions, the stomach and intestines are structurally healthy, but the following can change:
- motility (how the organs move and propel food)
- sensitivity to stretching and gas
- the interaction between the nervous system and the GI tract
- the function of the brain–gut axis
The brain–gut axis is a two-way communication system between the nervous system and the gut. It is influenced by:
- emotional state
- the microbiome
- immune mechanisms
Research shows that in people with functional dyspepsia and IBS, the brain processes signals from the GI tract differently. This can amplify sensitivity to normal stretching, gas, food, or stress. Understanding these mechanisms has led to the recognition that functional dyspepsia and IBS are disorders of the brain–gut axis — a more accurate term that has gradually replaced the older concept of “functional gastrointestinal disorder.” This explains why a person may feel genuinely unwell even when ultrasound and endoscopy appear “normal.”
Why old labels can be harmful?
In the past, diagnoses like “chronic gastritis,” “biliary dyskinesia,” or “reactive/chronic pancreatitis” were used as universal answers for any abdominal pain.
Today we know that:
- gastritis on biopsy correlates poorly with symptom severity
- “diffuse pancreatic changes” on ultrasound do not equal chronic pancreatitis
- “dyskinesia” does not exist as a diagnosis in international classifications
Such labels mislead the patient, lead to unnecessary medications, and do not bring us closer to solving the problem. Quality diagnostics start not with a long list of tests, but with a conversation.
- Detailed history and physical examination
We discuss:
- when and how symptoms began
- family history of GI and systemic diseases
- “red flags” (weight loss, blood in stool, night-time pain, persistent vomiting, anemia)
- relationship to food, bowel movements, stress, sleep, travel
- medications and supplements
Often, it becomes clear at this stage that we are dealing with a functional disorder.
- Only necessary tests — not “check everything”
We may recommend:
- complete blood count and basic biochemistry
- H. pylori testing (stool antigen; biopsy if needed during endoscopy)
- abdominal ultrasound
- gastroscopy/colonoscopy when clinically indicated
We do not recommend routinely:
- stool microscopy (“coprogram”)
- “dysbiosis tests” or microbiome “panels”
- repeating gastroscopy “just in case” or because someone previously labeled you with “chronic gastritis” without proper grounds
The goal of treatment is not a “perfect ultrasound,” but better well-being and quality of life
The plan may include:
- treating H. pylori (if detected)
- acid-suppressive therapy when appropriate
- gentle nutrition and lifestyle adjustments
- managing constipation/diarrhea (psyllium, etc.)
- low-dose antidepressants for persistent or severe symptoms
- psychotherapy when indicated
We avoid:
- promises to “cure forever” in chronic but manageable conditions
- endless courses of enzymes, antispasmodics, or bile agents
- “treating test results” instead of treating the person
When you should see a doctor?
Seek medical evaluation if you notice:
- regular heaviness or pain after meals
- unstable stools for more than a few weeks
- cramps related to bowel movements
- fear of eating or avoiding foods because of symptoms
- persistent worry about a serious illness
If you have weight loss, blood in stool, night-time symptoms, pronounced weakness, or anemia — urgent evaluation is recommended.
Functional GI disorders are not “in your head” and not a life sentence. They are well-studied conditions, and with modern, careful, evidence-based care, most people feel significant improvement. At A CLINIC, we aim to ensure that behind every diagnosis there is a clear plan and a doctor who will support you at every step.