Functional Dyspepsia

Dyspeptic patients with no clear structural or biochemical explanation for their symptoms are considered to have functional dyspepsia. Functional dyspepsia is synonymous with the terms nonulcer and idiopathic dyspepsia. It is broadly defined as persistent pain or discomfort centered in the upper abdomen without organic explanation and not associated with bowel pattern (Talley et al, 1999). Rome II criteria specify that symptoms be present for 12 weeks in the preceding 12 months. Although this rigidity is not required in clinical practice, chronicity is an important feature of functional dyspepsia.

Functional dyspepsia is a heterogenous disorder, and currently favored mechanisms are shown in Table 30-1. Attempts to elicit meaningful etiologies have resulted in the creation of subgroups defined using various symptom criteria (Talley et al, 1999; Colin-Jones et al, 1988; Bytzer et al, 1997). The utility of classifying functional dyspeptics, whether based on symptom clusters or dominant symptoms, remains controversial, because evidence supporting improved clinical outcomes using such an approach is lacking. Perhaps the most relevant change is that the reflux-like subgroup has been abandoned. These patients should be regarded as having GERD until proven otherwise. It is worth noting that a subset of patients with GERD may present with upper abdominal pain or discomfort in the absence of classic heartburn. Currently, three functional dyspepsia subgroups are recognized according to Rome II criteria (Talley et al, 1999). Ulcer-like dyspepsia has pain as the predominant symptom. Dysmotility-like dyspepsia has an unpleasant nonpainful sensation, such as fullness, bloating, early satiety, or nausea as the predominant symptom. Finally, patients with unspecified dyspepsia do not fulfill criteria for either ulcer-like or dysmotility-like dyspepsia.

TABLE 30-1. Potential Etiologies in Functional Dyspepsia

Visceral hypersensitivity Impaired gastric emptying Impaired postprandial fundic relaxation Antral hypomotility Gastric dysrhythmias Small bowel dysmotility Vagal neuropathy Duodenal acid hypersensitivity Psychosocial disturbances

Constipation Prescription

Constipation Prescription

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