Functional dyspepsia: New insights into the pathophysiology

The pathogenesis of functional dyspepsia remains poorly understood. There i s increasing evidence pointing to a predominant role of gastroduodenal visc eral hypersensitivity in the pathogenesis, where patients have abnormally r educed gastric and small intestinal sensory thresholds. Motor abnormalities observed in subgroups of patients include delayed gastric emptying, antral hypomotility, gastric dysrhythmias, abnormal gastrointestinal reflexes and small intestinal dysmotility, but these may be secondary pheno nena. The c entral nervous system modifies peripheral visceral afferent pathways and, h ente, psychological factors may possibly alter symptom status. Other putati ve mechanisms include Helicobacter pylori gastritis and gastric acid hypers ecretion or sensitivity, but the role of these remain controversial.