Whither dyspepsia? A historical perspective of functional dyspepsia, and concepts of pathogenesis and therapy in 2009

Abstract

Functional dyspepsia is a highly prevalent but heterogeneous disorder; multiple pathogenetic mechanisms are likely involved but the underlying causal pathways in functional dyspepsia remain obscure. The term functional dyspepsia was popularized by the famed Walter Alvarez at the Mayo Clinic early last century. Prominent Australian gastroenterologists who have contributed to our understanding of functional dyspepsia include Peter Baume, Barry Marshall, Douglas Piper, Nick Talley, John Kellow, and Gerald Holtmann. Specific dyspeptic symptoms have not generally correlated very well with any particular physiologic disturbance, although gastric disaccommodation and duodenal eosinophilia have been linked to early satiety in this condition. Genetic markers have been tentatively identified, and functional dyspepsia can follow bacterial gastroenteritis. No objective diagnostic tools for functional dyspepsia are currently agreed upon, although meal induction of symptoms appears reproducible and may have diagnostic utility. The symptomatic criteria for functional dyspepsia (Rome III criteria) are based on expert consensus and the exclusion of organic causes. Various therapeutic modalities for functional dyspepsia have been explored; however, empirical approaches are still employed for the treatment of functional dyspepsia. Better approaches for functional dyspepsia are likely to follow an improved understanding of the underlying pathophysiological abnormalities.

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

“…The distinction is made between meal-induced symptoms of postprandial fullness and early satiation (diagnostic category postprandial distress syndrome, PDS), and symptoms characterized by epigastric pain or burning which may or may not be meal related (diagnostic category epigastric pain syndrome, EPS) [2]. FD was recognized when it became clear patients with ulcer-like symptoms did not always have a peptic ulcer [4]; this was originally termed 'non-ulcer dyspepsia' and is closest to the current EPS category of FD. It is now recognized PDS is commoner than EPS [5].…”

Dyspepsia in the community: value of a community-based mailed survey to identify potential participants for a randomized clinical trial

“…Lastly, a number of individuals had symptoms of dyspepsia but had not received that diagnosis or had received a diagnosis of gastroesophageal reflux disease (GERD) despite ongoing dyspepsia symptoms after treatment for GERD. The symptoms of FD can be nonspecific making the diagnosis of FD and differentiation from GERD potentially difficult (2, 6). …”

“…Studies suggest that dyspepsia is very common in the United States (US) with as many as one in four reporting symptoms of dyspepsia (3, 7–9). Currently, effective treatment options are limited and outcomes are heterogeneous (2, 10–13). Pharmacological treatment often includes antisecretory agents or if available prokinetics, but results are often unsatisfactory leading to the use of largely unproven alternatives, including antidepressants (1, 11, 12).…”

Usefulness of a Slow Nutrient Drinking Test for Evaluating Gastric Perception and Accommodation

“…Alteration of gastric motility, visceral hypersensitivity, impaired accommodation of meals, gastritis induced by Helicobacter pylori infection and dysfunction of the central nervous system have all been implicated in the pathophysiology of FD [2,3]. A pathophysiology-based treatment strategy has been recommended; therefore, acceptable tests for measuring gut function have been intensively investigated.…”