THE CONSTIPATED STOMACH - AN UNDERDIAGNOSED PROBLEM IN PATIENTS WITH ABDOMINAL-PAIN

The number of dyspeptic patients with upper abdominal pain that are re ferred for investigation is increasing and will undoubtedly continue t o increase, because these days peptic ulcer disease is increasingly be coming a primary care management issue, the specialist being left to d eal with the patients who cannot be helped by antibiotics and antisecr etory drugs prescribed by their general practitioner. Many of these pa tients are referred for an upper endoscopy to rule out organic disease . Carefully taken history, however, shows that a great number of those dyspeptics, on the basis of their clinical manifestations, do have a functional gastrointestinal disorder, representing the 'irritable gut' . A probable better term reflecting the direct relation is the syndrom e of 'the constipated stomach'. In our opinion these patients are an i mportant and increasing clinical problem for general practitioners, ga stroenterologists, surgeons and physicians. The aim of this article is to make the practitioner aware of advancements in understanding patho physiologic and psychosocial processes, as well as to give an overview of the great overlap between many functional gastrointestinal disorde rs, the important role of history-taking and some insights into the fu nctional rectal outlet syndrome.