Functional dyspepsia is a clinical syndrome defined by chronic or recurrent symptoms of pain or discomfort centred upon the upper abdomen without a cause being identified by conventional diagnostic means.1 The pathophysiology of functional dyspepsia is unknown but a number of mechanisms have been proposed, such as delayed gastric emptying, hypersensitivity to gastric distension, impaired accommodation to a meal, Helicobacter pylorigastritis, or central nervous system dysfunction.

Dyspeptic symptoms occur in approximately 25% of the general population and only about one quarter of these seek medical attention.2 The reasons underlying health care seeking behaviour in functional dyspepsia are unknown, and may relate both to symptom severity and psychological factors.2 Except for the possible involvement of H pylori, the symptom pattern and underlying mechanisms in non-consulters with dyspepsia have received little attention. Recent developments of less invasive techniques, such as gastric emptying breath tests or a caloric satiety test,3 may facilitate studies in non-consulting subjects in the general population.

Because of its presumed pivotal role in the occurrence of functional gastrointestinal disorders, visceral sensitivity and its modulation is a topic of intense ongoing research. In this issue ofGut, Holtmann and colleagues used a gastric barostat procedure …