Functional dyspepsia

Abstract

Dyspepsia is a common term used for a heterogeneous group of abdominal symptoms. Functional dyspepsia (FD) is the focus of this review. The 2006 Rome III criteria defined FD and its subgroups, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). FD is a very common condition with a high prevalence throughout the world, adversely affecting the quality of life of patients. The pathophysiology of FD has been under investigation during the past two decades. Multiple mechanisms such as abnormal gastric emptying, visceral hypersensitivity, impaired gastric accommodation, and central nervous system factors are likely involved. Several tests are available for the assessment of various physiologic functions possibly involved in the pathogenesis of FD, and some of these could be used in clinical practice, helping to understand the abnormalities underlining patients' complaints. Currently, the possibilities of pharmacological therapy for FD are still limited, however, experience of using prokinetics, tricyclic antidepressants, selective serotonin-reuptake inhibitors (SSRIs), proton-pump inhibitors (PPIs), and several alternative techniques has been accumulated. The different combinations of alterations in physiologic gastrointestinal and central nervous system functions result in the very heterogeneous nature of FD so combined approaches to these patients could be beneficial in challenging cases.

Keywords: drug therapy; functional dyspepsia; gastric motility; visceral hypersensitivity.

Figure 1.

Dyspepsia nomenclature. PDS, postprandial distress syndrome; EPS, epigastric pain syndrome.

Figure 2.

Pathophysiologic mechanisms in functional dyspepsia. H⁺, acid exposure.

Figure 3.

Management of functional dyspepsia. PPI, proton-pump inhibitors; SSRIs, selective serotonin-reuptake inhibitors.