[Functional dyspepsia. Old wine in new bottles?]

Area of Science:

• Gastroenterology
• Functional Gastrointestinal Disorders

Background:

• Functional dyspepsia (FD) encompasses upper gastrointestinal symptoms without identifiable organic causes.
• Pathogenesis of FD remains poorly understood, with no clear links to gastric motility, acid secretion, Helicobacter pylori, or biliary dysfunction.
• Gastro-esophageal reflux disease (GERD) is a distinct entity, separate from FD.

Purpose of the Study:

• To review the current understanding of functional dyspepsia.
• To explore potential pathophysiological mechanisms and therapeutic approaches for FD.
• To highlight recent findings regarding altered visceral perception in FD.

Main Methods:

• Literature review of studies on functional dyspepsia.
• Analysis of findings related to gastric motility, acid secretion, H. pylori, biliary function, and psychosocial factors.
• Examination of recent research on visceral sensitivity and perception.

Main Results:

• No evidence supports distinct dyspepsia subgroups like "ulcer-like dyspepsia".
• Gastric motility disturbances (e.g., postprandial antral hypomotility) are common but do not fully explain symptoms.
• A lowered threshold for stomach and small intestine distension perception is a newly identified factor in FD.

Conclusions:

• Functional dyspepsia is a complex condition with multifactorial origins.
• Altered visceral perception presents a promising new avenue for understanding and treating FD.
• Prokinetic agents may benefit FD, while H2-receptor antagonists are indicated for GERD; empiric trials in FD have limited proven value due to high placebo response.