Pathophysiology of functional dyspepsia

Abstract

Functional dyspepsia is a symptom complex characterised by postprandial upper abdominal discomfort or pain, early satiety, nausea, vomiting, abdominal distension, bloating, and anorexia in the absence of organic disease. Gastrointestinal motor abnormalities, altered visceral sensation, and psychosocial factors have all been identified as major pathophysiological mechanisms. This perspective has now replaced the earlier view that the condition was the result of a sole motor or sensory disorder of the stomach. Future therapeutic strategies should be aimed at reducing nociception as well as enhancing the accommodation response.

Figure 1

Gastric accommodation in healthy controls and in patients with functional dyspepsia (FD). In patients, reduced accommodation was not influenced by Helicobacter pylori status (Hp+ or Hp-). Reproduced with permission from Thumshirn and colleagues.⁵

Figure 2

Effect of gastric relaxation and pain perception. Clonidine reduced pain perception at a 0.1 mg dose in the presence of modest gastric relaxation (A) whereas nitroglycerin did not affect pain despite significant gastric relaxation (B). Reproduced with permission from Thumshirn and colleagues.²³