Dyspepsie

Functional dyspepsia is a chronic and polymorphic disorder with a prevalence of approximately 10% in the adult population. Management of this disease represents a considerable economic burden worldwide. Functional dyspepsia is defined as a pain or a sensation of discomfort located in the upper abdomen, according to the Rome II criteria. A dyspepsia subgroup classification based on the predominant symptom has been proposed: dysmotility-like dyspepsia, ulcer-like dyspepsia and non-specific dyspepsia. In patients with alarm symptoms, upper endoscopy has to be performed. In the absence of alarm features, the patient needs to be reassured and psychotherapy must be discussed. Then, empirical therapy with proton pump inhibitors (ulcer-like dyspepsia) or domperidone (dysmotility-like dyspepsia) may improve symptoms in some cases. Efficacy of Helicobacter pylori eradication in dyspepsia is probably poor; on the other hand, treatment of Helicobacter pylori infection could reduce the prevalence of gastric cancer but further investigations are needed to clarify this point. Pathophysiology of dyspepsia remains unclear. The psychological factors are not the only involved in this functional disorder. The identification of the mechanisms that lead to symptom generation should facilitate the development of newer and more effective therapeutic strategies in functional dyspepsia.