Brooks D. Cash, MD, FACP, FACG


December 12, 2002

In This Article


The diagnosis of functional dyspepsia necessarily implies that a diagnostic evaluation, including upper endoscopy, has been performed and that organic gastrointestinal disease has been excluded. As previously mentioned, this will be the case in the majority of patients with dyspepsia. There have been a variety of proposed pathophysiologic mechanisms to explain functional dyspepsia symptoms. Iatrogenic causes such as pill esophagitis or nonsteroidal anti-inflammatory drug intolerance are common and can typically be identified through a thorough history and review of systems. Other potentially valid but unproven mechanisms for functional dyspepsia include Helicobacter pylori (HP) infection, visceral hypersensitivity, gastric acid sensitivity, impaired upper gastrointestinal motility, and impaired proximal gastric accommodation.

HP infection has not been conclusively proven to be associated with functional dyspepsia. This conclusion is based in part on the discordant results regarding symptom relief after bacterial eradication in patients with functional dyspepsia and evidence of HP infection.[8] Some have hypothesized that HP infection induces changes in gastrointestinal motility and sensory thresholds that could be perceived by an individual patient as epigastric discomfort.[9,10,11] However, there is little evidence to confirm that such changes occur coincident with HP infection. Additionally, one would expect that such changes, if they did occur, would resolve with effective antibacterial therapy directed against HP.

Investigators have attempted to use symptom subgroups such as bloating to identify patients more likely to have abnormal motility patterns that may be more amenable to treatment with promotility agents. Unfortunately, such analyses do not indicate a relationship between symptoms and susceptibility to treatment, and so the usefulness of such diagnostic investigations as the water load test, gastric barostat evaluation, and gastric emptying studies are limited.[12,13]

Regardless of the etiology, patients with functional dyspepsia have been shown to have significantly impaired quality-of-life scores compared with patients with organic gastrointestinal disease and healthy controls.[14] The main clinical objective, once the diagnosis of functional dyspepsia has been made, should focus on effective therapy and symptom relief.