Pain versus discomfort - is differentiation clinically useful?

Functional dyspepsia is highly variable in its clinical presentation and mu ltifactorial in its underlying causes. Since many of the symptoms included in the definition of dyspepsia are intuitively suggestive of different path ogenic mechanisms, it has been proposed that patients with functional dyspe psia be divided into distinct dyspepsia sub-groups according to symptom clu sters. The goal was to classify patients more homogeneously for research pu rposes as well as to target treatment. However, recent epidemiological, pathophysiological, and clinical studies i ndicate that a priori definitions based on the presence/absence of symptoms or clusters of symptoms have no clinical utility due to the considerable o verlap between symptoms, as well as the poor correlation between pathogenic factors and responses to treatment. Attention is now focused on identifying predominant symptoms. Recent studie s suggest that the analysis of predominant symptoms, demographic features, and overlapping digestive syndromes can help to identify dyspepsia sub-grou ps with different underlying pathophysiological features and aid in selecti ng appropriate treatment. The utility of this approach has been demonstrated in gastro-oesophageal re flux disease, which can be reliably diagnosed and managed on the basis of t he presence and severity of the predominant symptom, heartburn. It is likel y that precise symptom definitions and history-taking will be of pivotal im portance in management strategies for functional dyspepsia.