Functional
dyspepsia includes one or more of four cardinal symptoms: postprandial fullness, early satiety,
pain or burning in the epigastrum. According to the Rome III diagnostic criteria for functional
dyspepsia, these symptoms must be present for the last 3 months with symptom onset at least 6 months prior to diagnosis. Functional
dyspepsia is not the result of an underlying structural abnormality, but rather the consequence of multiple pathophysiological mechanisms such as abnormal gastric motility, gastric and duodenal
hypersensitivity to
acid, Helicobacter pylori
infection. Dyspeptic patients over 50 or those with alarm symptoms should be investigated to detect any structural abnormality such as
cancer,
peptic ulcer or
esophagitis. After structural abnormalities and
gastroesophageal reflux disease are excluded the management of functional
dyspepsia consists of either a test and treat approach (non invasive detection of Helicobacter pylori
infection followed by eradication
therapy) or empirical
therapy. Although endoscopy was traditionally reserved for those patients without symptom relief after 6-8 weeks of
therapy, the significant percentage of patients with functional
dyspepsia with symptom breakthrough or relapse after antisecretory or prokinetic
therapy discontinuation makes an initial endoscopic study a logical choice.
Therapy with
proton pump inhibitors yields results especially in those patients with regurgitation and epigastric burning sensation, while prokinetic agents with no extrapyramidal side effects (such as
Domperidone and
Itopride) alleviate satiation, bloating and
nausea by accelerating gastric emptying. Second-line drugs with encouraging results in clinical trials which can be used in functional
dyspepsia are low-dose
tricyclic antidepressants as well as selective serotonine reuptake inhibitors.