Functional
dyspepsia (FD) includes a heterogeneous group of patients suffering from a variety of different conditions. The
Dyspepsia Project has been implemented in 14 GI Units since 1984, in order to epidemiologically test the discriminating power of the Working Teams definitions and of standardized questionnaires. Five per cent of admitted subjects were subclassified as
sphincter of Oddi dysfunction or biliary
dyspepsia (BD), defined as biliary
pain associated or not to
bilirubin or
alkaline phosphatase elevation, in the abscence of ultrasonographic evidence of
gallstone disease or bile duct dilatation. The more useful symptoms in favour of the diagnosis of biliary
dyspepsia were found to be
pain in the right hypochondrium, radiating to the shoulder, or to the back, initiated by food, and eventually associated with
constipation, or epigastric postprandial discomfort. Interestingly, symptoms suggesting biliary
dyspepsia are partially shared by dysmotility-like
dyspepsia. The placebo response in functional
dyspepsia is variable, between 6 and 80% of patients, reflecting variations in the kind and severity of the diseases in different studies. That represents a considerable difficulty in evaluating
drug efficacy, even in the case of biliary
dyspepsia. A therapeutic double-blind trial in functional
dyspepsia using tauro-
ursodeoxycholic acid is discussed.