Motility-like dyspepsia. Current concepts in pathogenesis, investigation and management

Motility-like dyspepsia, a clinical subgroup of functional dyspepsia, refers to the cluster of symptoms which suggests an underlying motility disturbance of the upper gut. Characteristic symptoms, in addition to upper abdominal pain or discomfort, are nausea, vomiting, early satiety, anorexia, postprandial abdominal bloating and excessive repetitive postprandial belching. Patients with concomitant symptoms of irritable bowel syndrome are currently excluded from this clinical entity. Delayed gastric emptying of solids and/or liquids, postprandial antral hypomotility and antroduodenal incoordination, gastric myoelectrical arrhythmias and dysfunction of visceral afferents are the major alterations in upper gut sensorimotor activity which have been described. An empirical trial of medical therapy is warranted if there are no "alarm" symptoms at presentation. If symptoms are not relieved after 2-4 weeks, then investigations of the upper gastrointestinal tract, preferably by endoscopy, to exclude the presence of organic disease, is advisable. Management approaches are then reassurance, dietary manipulations and attention to psychosocial aspects. Prokinetic agents appear to be useful as short-term medical therapy in some patients, but optimum long-term treatment strategies, including the use of medications which may improve a diminished tolerance to gut distension, are not established.