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Functional dyspepsia in adults

Authors
George F Longstreth, MD
Brian E Lacy, MD, PhD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

INTRODUCTION

Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology [1]. It occurs in approximately 25 percent of the population each year, but most affected people do not seek medical care. Approximately 25 percent of patients with dyspepsia have an underlying organic cause. However, up to 75 percent of patients have functional (idiopathic or nonulcer) dyspepsia with no underlying cause on diagnostic evaluation [2-4]. This topic review will provide an overview of the pathophysiology and treatment of functional dyspepsia.

Our recommendations for the diagnosis and management of functional dyspepsia are largely consistent with the American College of Gastroenterology and American Gastroenterological Association guidelines [5,6]. The etiology, general approach to the evaluation, and management of the patient with uninvestigated dyspepsia are presented separately. (See "Approach to the adult with dyspepsia".)

EPIDEMIOLOGY AND PATHOPHYSIOLOGY

The prevalence of functional dyspepsia ranges from 5 to 11 percent worldwide [7]. The pathophysiology of functional dyspepsia is not well understood. However, several potential mechanisms have been suggested. These mechanisms may differ between subtypes of functional dyspepsia (postprandial distress syndrome and epigastric pain syndrome) [8]. (See 'Diagnostic criteria' below.)

Gastric motility and compliance – Functional dyspepsia has been associated with several motility disorders. These include mild delays in gastric emptying, rapid gastric emptying, antral hypomotility, gastric dysrhythmias, and impaired gastric accommodation in response to a meal [8-11]. However, these findings are noted in only a subset of patients with dyspepsia. As examples, delayed gastric emptying and antral hypomotility are found in approximately 25 to 35 percent of patients with dyspepsia while up to 10 percent of patients with dyspepsia have rapid gastric emptying [3,12-14]. (See "Gastroparesis: Etiology, clinical manifestations, and diagnosis".)

Visceral hypersensitivity – Visceral hypersensitivity is characterized by a lowered threshold for induction of pain in the presence of normal gastric compliance. Several studies have demonstrated visceral hypersensitivity in patients with functional dyspepsia that occurs independently of delayed gastric emptying [15-19]. Both mechanoreceptor dysfunction and aberrant processing of afferent input in the spinal cord or brain may play a role in the pathophysiology of visceral hypersensitivity [20,21]. In one study that included 270 patients with functional dyspepsia, 37 percent had hypersensitivity to gastric distension, and hypersensitive patients reported higher cumulative symptom scores as compared with normosensitive patients [8]. Patients with functional dyspepsia may also have increased chemosensitivity [17].

                 
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Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2017.
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