Systematic approach toward the clinical diagnosis of functional dyspepsia

Functional dyspepsia (FD) is the most common condition in patients consulti ng with upper gastrointestinal tract symptoms, resulting in up to 5% of vis its to family physicians. By definition, patients with FD have no clinical, biochemical or endoscopic evidence of an organic disease that is likely to explain their symp toms. The process to be used in a structured interview for establishing a clinical diagnosis of FD is presented. The steps are as follows: determine the duration and the course of the disease; characterize the current syndrome and review the alarm symptoms; elicit the patient-per ceived dominant symptom and/or condition; and identify the patient's reason for consulting and address the psychosocial factors. According to the clin ical characteristics of the three most frequent causes of dyspepsia (peptic ulcer, gastroesophageal reflux and FD) and acknowledging that these condit ions may coexist rather than overlap in some patients, an algorithm is sugg ested for establishing a working diagnosis of FD and indications for invest igation, and initiating a management strategy.