PATHOPHYSIOLOGY AND TREATMENT OF FUNCTIONAL DYSPEPSIA

Functional dyspepsia (or 'non-ulcer') is usually defined as chronic or intermittent upper abdominal symptoms for which no organic cause can be found. Division of functional dyspepsia into subgroups such as refl ux-like, ulcer-like, dysmotility-like and non-specific dyspepsia has b een proposed, but lacks a scientific basis. Gastric acid hypersecretio n, Helicobacter pylori-associated gastritis, gastric and small intesti nal motor disorders, psychological and neurohormonal factors all might play a role in the pathogenesis. The heterogeneity of the underlying abnormalities makes it unlikely that one single treatment modality wil l ever be beneficial to all patients. In general practice, a therapeut ic trial, with either a prokinetic or an acid secretion inhibiting dru g, is usually carried out before diagnostic procedures are performed t o exclude organic abnormalities. In the choice of the initial therapy, some guidance can be derived from the prominent symptoms. In a study in 30 H. pylori-negative patients with functional dyspepsia ranitidine (150 mg bid) significantly reduced the severity of heartburn. The eff ect was most pronounced in patients of the reflux-like subgroup.