• Acid-related diseases
• Barrett's oesophagus
• clinical decision making
• dyspepsia
• endoscopy
• functional dyspepsia
• gastro-oesophageal reflux disease
• non-ulcer dyspepsia
• proton pump inhibition
• 13C-urea breath test

“Hope is a good breakfast but a bad supper”

Francis Bacon (1561–1626)

Functional dyspepsia (FD) has been defined as persistent or recurrent symptoms of unknown cause thought to originate in the proximal gastrointestinal tract. Symptom patterns may vary but usually include epigastric pain or burning. Non-painful dyspeptic symptoms such as early satiation, nausea, postprandial fullness and vomiting suggest an underlying abnormality in gastroduodenal motility. The Rome III consensus committee suggests that FD is subdivided into an epigastric pain syndrome and a postprandial distress syndrome based on symptom patterns.1 These terms have replaced the previous categories of ‘ulcer-like’ and ‘dysmotility-like’ dyspepsia. Dyspeptic symptoms are very common in the general population with prevalence rates of 20–40%, and although FD is not associated with increased mortality or morbidity the symptoms have a major impact on health-related quality of life, utilisation of healthcare resources and work productivity.2

FD is probably a multifactorial disorder. Acid, Helicobacter pylori infection, visceral hypersensitivity, disturbances in gastric motility or accommodation and various psychosocial factors have all been implicated. Empiric antisecretory therapy, H pylori eradication or prokinetics remain the mainstay of treatment for FD, even though meta-analyses have shown limited or no symptomatic effects,3 4 and to date, …