Subdividing functional dyspepsia: a paradigm shift?
- Professor Nicholas J Talley, Mayo Clinic 4500 San Pablo Road, Davis 6-72E, Jacksonville, FL 3224, USA;
An understanding of functional dyspepsia (FD) has remained elusive in part because defining the condition has been so difficult.1–3 The term dyspepsia (or “bad digestion”) was simply derived from the Greek dys which means “bad” and peptein which means “to digest”.3 FD in 2008 is still a diagnosis of exclusion1; the synonyms endoscopy-negative or non-ulcer dyspepsia are arguably no more illuminating. To confound the situation further, the word dyspepsia is not understood by most patients, but remains a vague term in common medical parlance.1–3 There has been an evolution in thinking in terms of what symptoms should and should not comprise FD, but there remains a lack of global consensus despite the Rome working team reports.4 Thus, the recent National Institute for Health and Clinical Excellence (NICE) guidelines in the UK continued to lump symptoms of gastro-oesophageal reflux disease (GORD) in with all other upper abdominal complaints as “dyspepsia” in contrast to US guidelines.4 5
Prior to the Rome consensus process, dyspepsia was so poorly defined that the literature was arguably impossible to interpret.3 Many studies used the expression but failed to report what they meant by dyspepsia.6 7 The bandying around of fuzzy concepts persisted—for example, defining dyspepsia as that group of symptoms triggered when food digestion was disordered3 (but how does one know food digestion is truly disordered?). Dissimilar conditions were subsumed under this heading, including GORD and biliary pain, to name a few.3 The simple concept that dyspepsia should be restricted to refer to meal-related symptoms was largely dismissed because not all peptic ulcer patients reported clear-cut meal-related complaints.3 With the rapid disappearance of peptic ulcer disease in many parts of the Western world, there is now little interest in understanding …