[Functional dyspepsia. The physician and the patient]

Functional dyspepsia is defined by the presence of pain/discomfort in the upper abdomen without evident of organic disease which explain it; it must not be relief by defecation and its onset must not be related to changes in freqfrecuentlyuency or consistency feces. Diagnosis also requires pain or discomfort to be present for 12 weeks, not necessarily consecutives, in the last year. It is classified in three subgroups: ulcer-like, dysmotility-like and unspecified). Functional dyspepsia represents not only a diagnostic challenge but also a therapeutic problem, since no specific drug is available. An appropriate management of functional dyspepsia should consider patient's personality, diagnostic work-up, therapeutic alternatives and patient-doctor relationship. Many patients "live" their disease as the center of their life, sometimes creating great problems to physicians. Doctors should dedicate enough time to the patient, show interest in patient's problems, make a rigorous physical examination, and perform an appropriate work-up individualized for each patient. Regarding therapeutic decisions, it is important to reassure patients about the absence of organic disease. However it should be avoid to tell them that no disease exist at all; instead, the functional nature of the disease must be emphasized, explaining what and how upper GI tract is malfunctioning; Patients should know that doctor understand their symptoms are true symptoms; also, they must be informed bout the excellent outcome, without changes in life expectancy and a natural trend to improve with time; doctor should help patients to recognize that emotional situation have a great impact in disease course; and a therapeutic plan should be discussed and agreed with patients.