holds that patients with FD perceive sensations in the
stomach or intestines as painful that most people
experience as ordinary or do not feel at all.
FD is a motility disorder. FD may result from a
decreased ability of the digestive system to contract
and push food through the system. This, in turn,
causes lower than normal stomach emptying.
FD is caused byHelicobacter pyloriinfection.H.
pyloriis a spiral-shaped bacterium that is the only
known microorganism that can live in the acidic
environment of the stomach. It is now known to be
a cause of peptic ulcers, but doctors do not yet agree
on its role in functional dyspepsia.Description
The Rome criteria for FD specify that the patient
must have had 12 weeks (not necessarily consecutively)
of the following symptoms in the previous 12 months:
Persistent or recurrent pain or discomfort centered in
the upper abdomen.
No evidence of an organic disease (including the
findings from an endoscopy of the upper digestive
tract) that is likely to explain the symptoms; and
No evidence that the dyspepsia is relieved exclusively
by defecation or associated with the onset of a
change in bowel habits.
The Rome criteria specify three subtypes of FD
based on the most bothersome symptom: ulcer-likedyspepsia (pain in the upper abdomen); dysmotility-
like dyspepsia (an unpleasant but nonpainful feeling
of bloating, fullness, or nausea); and unspecified dys-
pepsia (patient’s digestive discomfort does not fit
either of the first two categories).
FD is widespread in the general population, how-
ever, the subtypes identified by the Rome working group
appear to show slight gender differences. Ulcer-like
dyspepsia appears to be more common in men and
dysmotility-like dyspepsia more common in women.
FD is equally widespread in all racial and ethnic groups.
Some medications other than aspirin and other
over-the-counter pain relievers may cause dyspepsia:
alendronate (Fosamax); codeine and aspirin fortified
with codeine;ironsupplements; metformin (Gluco-
phage); oral antibiotics, particularly erythromycin;
orlistat(Xenical); corticosteroids, especially predni-
sone; and theophylline. Patients should consult their
doctors before discontinuing these drugs or changing
the dosage.Treatment
Dietary
Dietary treatment for dyspepsia generally consists
of cutting down on alcohol intake; avoiding fatty or
highly spiced foods; and avoiding any other food that
appears to trigger episodes of dyspepsia. Therapeutic
fasting, which is thought to give the digestive system aKEY TERMS
Autointoxication—A belief, now discredited, that
the contents of the intestine are toxic and
produce poisons that can damage other body
organs.
Endoscope—A special tube-shaped instrument that
allows a doctor to examine the interior of or perform
surgery inside the stomach or intestines. An exami-
nation of the digestive system with this instrument is
called an endoscopy.
Gastroenterologist—A doctor who specializes in
diagnosing and treating disorders of the digestive
system.
Gastroesophageal reflux disease (GERD)—A disor-
der caused by the backward flow of stomach acid
into the esophagus. It is usually caused by a tempo-
rary or permanent change in the sphincter that sep-
arates the lower end of the esophagus from the
stomach.Helicobacter pylori—A spiral-shaped Gram-
negative bacterium that lives in the lining of the
stomach and is known to cause gastric ulcers.
Placebo effect—A term that describes the improve-
ment in symptoms that some patients experience
when they are given a placebo (sugar pill or other
inert substance that does not contain any medica-
tion) as part of a clinical trial. Patients with functional
dyspepsia show a high rate of placebo effect in trials
of new medications for the disorder.
Prokinetic drugs—A class of medications given to
strengthen the motility of the digestive tract.
Rome criteria—A set of guidelines for defining and
diagnosing functional dyspepsia and other stomach
disorders, first drawn up in the mid-1980s by a group
of specialists in digestive disorders meeting in Rome,
Italy. The Rome criteria continue to be revised and
updated every few years.Dyspepsia