Therapeutic options in nonulcer dyspepsia

Dyspepsia, defined as pain or discomfort centered in the upper abdomen, aff ects an estimated 25% of the U.S. population each year; accounts for up to 5% of all visits to primary care physicians, and generates over $1.3 billio n in prescription drug costs annually. in the majority of patients evaluate d, no clear cause of symptoms can be identified, and the condition is terme d functional or nonulcer dyspepsia (NUD). The pathophysiology of NUD remain s unclear, but disturbances in gastrointestinal motility or sensation are o ften found. Clinically, NUD can be subdivided into dysmotility-like (in whi ch discomfort, fullness, bloating, early satiety, or nausea [but not pain] predominate) or ulcer-like (in which epigastric pain is predominant). In ul cer-like NUD, antisecretory therapy is useful, but in dysmotility-like NUD, acid suppression is not superior to placebo. Cisapride accelerates gastric emptying and enhances gastric accommodation but probably does not blunt pe rception. Although cisapride relieves symptoms of dyspepsia without the adv erse central nervous system effects often associated with metoclopramide, i ts cardiac toxicity has led to disuse. Antidepressants are of uncertain eff icacy but are widely used. New prokinetics and other enteric neuromodulatin g agents are being tested in NUD and are likely to find an important place in clinical practice in the future.