How organic is “functional” dyspepsia?: Current understanding and approach to management

Dyspepsia is a common upper gastrointestinal symptom characterized by upper abdominal pain or discomfort, with an estimated global prevalence of 20%. The etiology for dyspepsia is multifactorial. The initial evaluation of a patient with dyspepsia should focus on identifying the underlying cause of the symptoms. A detailed history of alarm symptoms and physical examination should be performed to assess the patient’s risk factors for other serious conditions. If the history and physical examination are not diagnostic, further testing may be indicated. The management of dyspepsia is based on the underlying cause of the symptoms, which included proton-pump inhibitors (PPIs) for peptic ulcers, and a combination of antibiotics and PPIs for Helicobacter pylori infection. In the absence of any structural abnormality or organic causes, it is labeled as functional dyspepsia (FD). Treatment for FD is aimed at relieving symptoms and improving quality of life. Medications that may be helpful include PPIs, prokinetics, and neuromodulators. Lifestyle changes, such as avoiding foods that trigger symptoms, eating smaller meals more often, and losing weight, may also be helpful. The prognosis for dyspepsia is generally good. Most patients with dyspepsia can be successfully treated with the appropriate therapy. Dyspepsia can be effectively managed by establishing a physician–patient relationship and a shared understanding.