Drug treatment of functional dyspepsia

The therapeutic principles that have been applied to patients with peptic ulceration have often also been applied to those with functional dyspepsia, who by definition have no evidence of a structural or biochemical explanation for their symptoms. Treatments offered have included prokinetic drugs, anticholinergics, antacids, H2-receptor antagonists, selective muscarinic M1-receptor blockers, sucralfate, bismuth, antibiotics, and even surgery. The large range of therapies prescribed reflects the uncertainty about pathogenesis and the lack of a satisfactory treatment. Patients with functional dyspepsia should not be lumped into one broad category; treatment needs to be individualized. Certain subgroups of patients with functional dyspepsia may respond to some drug classes, whereas others may not be efficacious, although this remains to be established. The results of therapeutic studies are critically evaluated in this review.