Functional dyspepsia: Philosophers' stone or much ado about nothing

Does it make sense to diagnose functional dyspepsia? In 1998, a committee g athered in Rome recommended to diagnose functional dyspepsia in patients wi th persistent or recurrent pain or discomfort centered in the upper abdomen but no disease likely to explain the symptoms, which are not exclusively r elieved by defecation or associated with changed stool frequency or form. C areful history taking, physical examination and upper endoscopy during a sy mptomatic period off anti-secretory therapy are recommended as minimum work up. Functional dyspepsia thus is a diagnosis of exclusion. The term is unfo rtunate: It suggests the presence of a manifest or yet covert organ dysfunc tion and also a fundamental difference between disorders with defined and w ith unknown cause, only the former being serious. However, that a limited n umber of investigations failed to reveal a cause does not mean that there i s no cause. Further, functional often is used synonymous with vague and ide ology-ridden terms such as "organ neurosis", "vegetative dystonia" and "psy chosomatic disorder". There are no unequivocal data showing that patients w ith functional dyspepsia share pathophysiological, psychosocial or psychopa thological characteristics or that there is a specific therapy. In the indi vidual patient, therapy has to be tailored according to the symptoms. It th us seems doubtful whether the diagnosis functional dyspepsia can, for a pat ient's treatment or otherwise, be of value. If a categorization is deemed i nevitable, the term idiopathic dyspepsia would be preferable, as it unequiv ocally makes clear that the symptoms' cause is unrevealed.