Brooks D. Cash, MD, FACP, FACG

Disclosures

December 12, 2002

In This Article

Introduction

Dyspepsia is defined by the Rome II Committee on functional gastrointestinal disorders as chronic or recurrent pain or discomfort centered in the upper abdomen.[1] Discomfort means different things to different people, but typically encompasses symptoms such as bloating, abdominal fullness, early satiety, or nausea. Dyspepsia is an extremely common disorder in an otherwise healthy population. It has been estimated that as many as 25% to 40% of adults will experience dyspepsia in a given year.[2,3,4] Although most individuals who experience dyspepsia symptoms do not seek medical attention, approximately 25% do seek treatment, making the condition responsible for 4% to 5% of all primary care physician visits.[2,5,6] Due to the prevalence of the condition and the significant direct and indirect costs with which it is associated, dyspepsia is a major healthcare concern in the United States.

Dyspepsia may be indicative of organic diseases such as acid-mediated conditions or motility disorders in up to 20% to 40% of patients. The majority of patients, however, will be classified as having nonulcer, or functional, dyspepsia. The etiology of functional dyspepsia is not clear, but it appears to be similar to other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), based on epidemiologic patterns and clinical response to various classes of therapy. The current consensus is that these disorders represent a complex interplay of disturbed motility, visceral hypersensitivity, and maladaptive psychological responses that manifest as gastrointestinal symptoms. As with other functional gastrointestinal disorders, there is no universally accepted therapeutic agent or approach for dyspepsia. Individual patients respond differently to available therapies, and multiple trials of various agents must often be attempted before symptom relief is achieved.

Prior attempts to classify dyspepsia based on symptom predominance (reflux-like, ulcer-like, or dysmotility-like) have not met with substantial success in defining an optimal diagnostic or therapeutic approach to the condition.[7] Purists would contend that reflux-like dyspepsia is in fact consistent with gastroesophageal reflux disease and therefore should not be considered a dyspepsia subgroup. Regardless, it is well recognized that there is substantial overlap of patients between the symptom groups and that a large proportion of patients defy classification (unspecified dyspepsia). The most recent Rome II consensus recommends that symptom subgroups should be based on the single most bothersome symptom, rather than clusters of complaints.[1] Treatment should then be targeted, much like IBS therapies, toward relief of these predominant symptoms. However, this approach remains unproven and requires validation in clinical practice.

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