[New considerations in the treatment of functional dyspepsia]

Functional dyspepsia is a clinical syndrome defined by chronic or recurrent pain or discomfort in the upper abdomen of unknown origin. Dyspepsia is a very common condition, with a high prevalence in the general population. The multifactorial pathogenesis of dyspeptic symptoms is poorly defined. However, several factors have been identified as relevant, including the role of gastric acid secretion, gastroduodenal dysmotility, visceral hypersensitivity and also the effects of stress and psychological factors. The role of Helicobacter pylori infection is more controversial, the infection plays only an irrelevant role in the pathophysiology of functional dyspepsia, nevertheless in a subgroups of patients eradication therapy is generally accepted as a preventive tool. The need for positive diagnosis is emphasized. The management of dyspeptic patients has a considerable impact on health services. As the costs of initial investigation are high, most patients receive empirical management (prescribing without a proven diagnosis), at least initially. Subgrouping of functional dyspepsia according to its predominant symptom into ulcer-like, dysmotility-like and non-specific dyspepsia has been attempted to tailor its treatment accordingly. This review aims to summarize the new aspects of pathophysiology, investigation and management strategies of functional dyspepsia.