Functional dyspepsia: philosopher's stone or much noise about nothing?

Abstract

Does it make sense to diagnose functional dyspepsia? In 1998, a committee gathered in Rome recommended to diagnose functional dyspepsia in patients with persistent or recurrent pain or discomfort centered in the upper abdomen but no disease likely to explain the symptoms, which are not exclusively relieved by defecation or associated with changed stool frequency or form. Careful history taking, physical examination and upper endoscopy during a symptomatic period off anti-secretory therapy are recommended as minimum workup. Functional dyspepsia thus is a diagnosis of exclusion. The term is unfortunate: It suggests the presence of a manifest or yet covert organ dysfunction and also a fundamental difference between disorders with defined and with unknown cause, only the former being serious. However, that a limited number of investigations failed to reveal a cause does not mean that there is no cause. Further, functional often is used synonymous with vague and ideology-ridden terms such as "organ neurosis", "vegetative dystonia" and "psychosomatic disorder". There are no unequivocal data showing that patients with functional dyspepsia share pathophysiological, psychosocial or psychopathological characteristics or that there is a specific therapy. In the individual patient, therapy has to be tailored according to the symptoms. It thus seems doubtful whether the diagnosis functional dyspepsia can, for a patient's treatment or otherwise, be of value. If a categorization is deemed inevitable, the term idiopathic dyspepsia would be preferable, as it unequivocally makes clear that the symptoms' cause is unrevealed.