Reassessment of functional dyspepsia: From the editor

Abstract

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TEXT

Functional dyspepsia (FD) is a heterogeneous disorder of yet unsure etiology. Commonly encountered, it poses a substantial social and economic burden. It can be classified into different subgroups based on the most predominant symptom. Early studies seem to suggest that such sub-classifications correlate to different etiological factors. However, the most important pathogenetic factor appears to be that of visceral hypersensititivity; the stomach seems to be more sensitive to distension, acid and to nutrients. Whether this hypersensitivity is due to the peripheral receptors itself or to altered interactions at any level of the brain-gut axis is still unknown. Alterations in brain processing of pain, perception and affective responses may be important in the pathogenesis of dyspeptic symptoms. Both the central serotonergic, and adrenergic systems play important roles in this interaction. A biopsychosocial model to explain FD has been proposed whereby biological, psychological, and social factors interact to account for patient's symptoms, behavioral response, and disease outcome. The brain gut axis plays a central role in mediating this interaction. FD can then be seen as a result of dysregulation of intestinal motor, sensory, and CNS activity resulting from interruptions at some level of the brain gut axis. Newer agents are now available to us for the treatment of this chronic relapsing disorder, but in most cases patients should first be adviced on a healthy lifestyle. Drug treatment should be used for a sufficient time period and repeated when symptoms recurs; when H pylori is present, it should first be eradicated. Whether drug therapy can be continued on a long-term basis is still unsure. For the more severe cases, combine drug treatment or psychiatric co-management should be considered.

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2667 Sub types of functional dyspepsia

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2672 Functional dyspepsia: The role of visceral hypersensitivity in its pathogenesis

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2677 Role of Helicobacter pylori in functional dyspepsia

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