FUNCTIONAL DYSPEPSIA - OLD WINE IN NEW BO TTLES

Functional dyspepsia covers various symptoms associated by the physici an with the upper gastrointestinal tract without an identifiable organ ic cause. The existence of dyspepsia subgroups according to different symptom complexes, e.g. so-called ''ulcer-like dyspepsia'', has not be en proved. Gastro-esophageal reflux disease is a distinguishable indep endent entity. Little is known about the pathogenesis of this common s yndrome. Disturbances of gastric motility, especially postprandial ant ral hypomotility, are found in 50% of these patients but offer no expl anation of the dyspeptic symptoms. Neither abnormal gastric acid secre tion nor abnormal acid sensitivity has been proved in these patients. Furthermore, no relation between the symptoms and a Helicobacter pylor i infection or a functional disturbance of the biliary tract has been established. In some cases fatty foods can provoke dyspeptic symptoms. Unfavorable psychosocial factors can influence the decision to consul t a physician for dyspepsia. Recently, a lowered threshold of percepti on of stomach and small intestine distension in dyspeptics has been de monstrated. This disturbance of perception offers a new basis for furt her understanding and for possible treatment. Prokinetic agents can be of help in the treatment of functional dyspepsia. H-2-receptor antago nists are most effective in patients presenting symptoms of gastro-eso phageal reflux disease. Empiric therapeutic trials in this disease ent ity, which shows a high placebo response rate (between 30% and 60%), a re not of proven value.