Controversies in dyspepsia

Even in the absence of visible lesions like an ulcer, cancer or oesophagiti s, patients with functional dyspepsia may complain of severe dyspeptic symp toms and have a poor quality of life. Characteristically, these patients al so often have a low estimate of their own health and have complaints from s everal organ systems. The cause of the disease is not known. Both central n ervous system and gastric disturbances appear to be involved, and their rel ative importance is controversial. There is no clear beneficial effect of a cid suppression or H. pylori eradication although effects of such therapy m ay be seen in minor subgroups. New findings emphasise the importance of dis tinguishing between functional dyspepsia and gastro-oesophageal reflux dise ase, which exhibit completely different gastric accommodation patterns to a meal and have very different therapeutic potential. The effect of drugs li ke glyceryl trinitrate, glucagon, sumatriptan and buspirone which all conco mitantly improve symptoms and gastric accommodation support the important r ole of abnormal gastric accommodation to meals in patients with functional dyspepsia. A hypothetical model for the pathogenesis of functional dyspepsi a is presented. It incorporates four established abnormalities: various psy chological abnormalities, low vagal tone, impaired gastric relaxation, and visceral hypersensitivity, in a logical interplay along the brain-gut axis.