Emerging concepts in functional dyspepsia

Functional dyspepsia is a clinical syndrome defined by upper abdominal symptoms without identifiable cause by conventional diagnostic means. Recent studies have established that functional dyspepsia is a heterogeneous disorder, where different pathophysiological disturbances underlie different symptom profiles. Delayed gastric emptying is associated with postprandial fullness, nausea and vomiting; impaired accommodation is associated with early satiety and weight loss and hypersensitivity to gastric distension with epigastric pain, belching and weight loss. The pathogenesis of functional dyspepsia is unknown, but may be post-infectious in a subgroup of patients. The role of psychological disturbances and of duodenal hypersensitivity requires further studies. Treatment of the underlying pathophysiological abnormality seems a logical approach, but options for pharmacotherapy are currently limited to acid suppression, prokinetic drugs and antidepressants. Psychotherapy can be considered for refractory patients. Several novel drug therapies are under evaluation.