Can normal acidity pain be referred to as gastritis or should it be termed as functional dyspepsia?

Terminology for Upper Abdominal Pain Without Endoscopic Findings

Pain in the upper abdomen with normal endoscopy findings should be termed "functional dyspepsia," not "gastritis," because gastritis is a histological diagnosis requiring inflammation on biopsy, whereas functional dyspepsia is a clinical syndrome defined by symptoms without structural abnormalities. 1

Why "Gastritis" is Incorrect Terminology

• Gastritis requires histological evidence of inflammation on gastric mucosal biopsy and cannot be diagnosed by symptoms alone or even by endoscopic appearance 1, 2
• The term "gastritis" is frequently misused in clinical practice to describe upper abdominal pain, but this perpetuates diagnostic confusion 3, 4
• Most patients undergoing endoscopy for dyspepsia are found to have functional dyspepsia, not true gastritis with inflammatory changes 1
• Even when endoscopic abnormalities suggest gastritis (enlarged areae gastricae, nodularity, thickened folds), biopsy confirmation is required for diagnosis 5

Functional Dyspepsia: The Correct Term

Functional dyspepsia is defined as chronic or recurrent pain or discomfort centered in the upper abdomen without evidence of structural disease on endoscopy. 1

Diagnostic Criteria

• Upper abdominal pain or discomfort present for at least 3 months 1
• Normal endoscopy (or only minor abnormalities that don't explain symptoms) 1
• No evidence of peptic ulcer, malignancy, or other structural pathology 1

Two Clinical Subtypes

1. Epigastric Pain Syndrome (EPS): Predominant epigastric pain or burning 1, 3
2. Postprandial Distress Syndrome (PDS): Predominant postprandial fullness or early satiation 1, 6

The Gastritis-Functional Dyspepsia Overlap Problem

A critical pitfall is that many patients diagnosed with "functional dyspepsia" by Rome III criteria actually have chronic gastritis with H. pylori infection when biopsies are examined. 3

• In one study, 37.7% of patients diagnosed with functional dyspepsia had H. pylori infection and 36.3% had neutrophil infiltration (indicating active gastritis) on biopsy 3
• H. pylori-positive patients with epigastric pain syndrome are more likely to have "active gastritis under microscope" and benefit most from eradication therapy 3
• This explains why H. pylori eradication has a small but statistically significant effect on symptom relief in functional dyspepsia—some of these patients actually have H. pylori gastritis 7

Practical Clinical Approach

When to Use "Functional Dyspepsia"

• Use this term when endoscopy is normal or shows only minor non-specific findings 1
• Patient has chronic upper abdominal pain/discomfort for >3 months 1
• No alarm features (weight loss, dysphagia, bleeding) 1, 5

When to Suspect Actual Gastritis

• H. pylori testing is positive (test all dyspepsia patients) 1
• Endoscopy shows mucosal abnormalities suggestive of inflammation 5
• NSAID use or alcohol consumption history 5
• Always obtain biopsies if gastritis is suspected endoscopically 3

Management Algorithm

1. Test for H. pylori in all patients with dyspepsia (breath test or stool antigen preferred) 1, 8
2. If H. pylori positive: Eradicate with appropriate antibiotic therapy 1, 8
3. If H. pylori negative or symptoms persist after eradication: Treat as functional dyspepsia with PPI therapy (omeprazole 20-40 mg daily for 4-8 weeks) 1, 5, 8
4. For patients ≥55 years or with alarm features: Perform endoscopy with biopsy to exclude peptic ulcer disease and malignancy 1, 5, 9

Critical Distinction for Documentation

Never use "gastritis" as a clinical diagnosis based on symptoms alone—this is medically inaccurate and can lead to inappropriate management. 3, 4 If you mean upper abdominal pain without proven inflammation, use "functional dyspepsia" or "dyspepsia." If biopsies confirm mucosal inflammation, then "chronic gastritis" is appropriate. 1, 2