A subset of functional dyspepsia (FD) patients report meal-related symptoms, possibly representing a pathophysiologically homogeneous subgroup. Our aim was to establish the time-course of symptoms in relation to meal ingestion, and to assess the relationship between self-reported meal-related symptoms and pathophysiological mechanisms in FD. Methods: 218 FD patients (149 women, mean age 39±1) filled out a symptom questionnaire, including meal-induced aggravation. All patients underwent a gastric emptying breath test with severity (0-4) scoring of 6 symptoms (pain, fullness, bloating, nausea, burning and belching) at each sampling (15 min interval for 4 hrs). In 129 patients, gastric sensitivity and accommodation were assessed by barostat. Results: The intensity of each FD symptom was significantly increased 15 minutes after the meal, compared to the pre-meal score, and remained elevated until the end of the measurement period (all p<0.05). Time course of individual symptoms varied, with early peaks for fullness and bloating, intermediate peaks for nausea and belching, and late peaks for pain and burning. Meal-induced aggravation was reported by 79% of patients, and in these patients postprandial fullness, which peaked early, was the most intense symptom. In patients without self-reported meal-induced aggravation, epigastric pain, which had a delayed peak, was the most intense symptom and they had a lower prevalence of gastric hypersensitivity (27.5 vs. 7.7%). Conclusion: Meal ingestion aggravates FD symptoms in the vast majority of patients, with symptom-specific time courses. Postprandial fullness is the most severe symptom in patients reporting meal aggravation, while it is pain in those not reporting meal-related symptoms.