Functional dyspepsia: a practical approach to diagnosis

Functional dyspepsia (FD) is a common disorder characterized by chronic or recurrent upper abdominal pain or discomfort without structural abnormalities in the gastrointestinal tract. It is classified into two subgroups based on symptoms: postprandial distress syndrome and epigastric pain syndrome. Its pathophysiology involves several mechanisms, including delayed gastric emptying (30% of patients with FD), impaired gastric accommodation (especially in the postprandial distress syndrome) and visceral hypersensitivity (characterized by a reduced pain threshold and/or an exaggerated response to a painful stimulus). The prevalence of clinically significant endoscopic findings in subjects with uninvestigated dyspepsia is low, but the high number of affected patients is relevant. Less than 10% of patients have a peptic ulcer, and less than 1% have gastroesophageal cancer. Thus, based on endoscopic findings, a systematic review and meta-analysis found that more than 70% of subjects with dyspeptic symptoms meet the criteria for a diagnosis of FD. Treatment options include dietary modifications, establishing a patient-provider relationship, proton pump inhibitors, prokinetics, neuromodulators, and behavioral therapies. Severe and refractory cases may require combination of therapies or experimental treatments.