Functional dyspepsia is a common disorder, most of the time of unknown etiology and with variable pathophysiology. Therapy has been and still is largely empirical. Data from recent studies provide new clues for targeted therapy based on knowledge of etiology and pathophysiologic mechanisms.
The role of Helicobacter pylori gastritis in the pathogenesis of functional dyspepsia has been defined: It is causative in a small minority of patients. Associations between (groups of) symptoms and pathophysiologic mechanisms have been established, but there is much overlap and interaction, and their relevance for the individual patient is uncertain, especially because of the variability of symptoms over time. Little progress has been made in pharmacotherapy of functional dyspepsia, but exploratory studies show interesting new options. Hypnotherapy seems a promising alternative.
For the time being, diagnostic strategies for patients with suspected functional dyspepsia continue to be directed at excluding other disorders, in particular peptic ulcer disease and gastroesophageal reflux disease. In the presence of reflux symptoms, acid inhibitory therapy, preferably with a proton pump inhibitor, is a rational choice; otherwise, therapy is still empirical. Hypnotherapy is an option that could be seriously considered.
aDepartment of Gastroenterology and Hepatology, University Hospital, Groningen, The Netherlands; and bDepartment of Gastroenterology, Bethesda Hospital, Hoogeveen, The Netherlands
Correspondence to J.H. Kleibeuker, Department of Gastroenterology and Hepatology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands Tel: +31 50 3613354; fax: +31 50 3619306; e-mail: firstname.lastname@example.org