icine- O ed pe M n l A a c n c r e e s t s n I Internal Medicine: Open Access Mehboob, et al., Intern Med 2015, 5:3 DOI: 10.4172/2165-8048.1000192 ISSN: 2165-8048 Review Article Open Access Functional Dyspepsia: An Unresolved Issue Mukhtar Mehboob*, Muhammad Zubair, Rubina Naz, Shahina Tabassum and Muhammad Ashraf Achackzai Department of General Surgery, Mohtarma Shaheed Benazir Bhutto Hospital, Quetta, Pakistan *Corresponding author: Mukhtar Mehboob, Department of General Surgery, Mohtarma Shaheed Benazir Bhutto Hospital, Quetta, Pakistan, Tel: 0092-03148138528; E-mail: [email protected] Received date: February 11, 2015, Accepted date: April 14, 2015, Published date: April 22, 2015 Copyright: © 2015 Mehboob M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Functional dyspepsia (FD) is one of the commonest medical problems which affect the quality of life. Due to its global presentation variety of symptoms recorded, therefore no global consensus developed. The recorded symptoms of functional dyspepsia are nonspecific and the pathophysiology is diverse. The role of genetics in the susceptibility of FD is still not well established. The last Rome III criteria defined the FD as symptoms of epigastric pain or discomfort, early satiety and postprandial fullness with in the last three months with symptoms not less than six months. Patient cannot have any evidence of structural disease and predominant Gastro esophageal reflux symptoms. Failure to respond to ‘test and treat approach’ is also categorize as FD. A universally effective treatment for functional dyspepsia remains elusive. The purpose of this paper is to highlight the details in perspective of functional dyspepsia. Keywords: Functional dyspepsia; Epigastric pain; Ischemic bowel criteria [8]. With the data that is available the true prevalence of disease functional dyspepsia globally is estimated between 11.5-29.2% [9]. The misconception about the dyspepsia is that it turns into cancer. Introduction It is estimated that 10% of all health care expenditure in the U.K go Dyspepsia is a Greek word having two components ‘Dys’ means towards treating dyspepsia. In the USA the cost of treating the dysfunction and ‘Pepsia’ means related to digestion. The term was first dyspepsia was more than 2 Billion Dollars/year. In USA an average used in mid-18th century and then it was used widely. It was thought patient cost $ 698/year [10]. to be a nervous disorder and is associated with hysteria and hypochondria. Historically the term ‘dyspepsia’ was used for a Demography of functional dyspepsia heterogeneous group of abdominal symptoms. The functional Age: Majority of the surveys conducted to determine the prevalence dyspepsia was defined as symptoms or set of symptoms related to the of dyspepsia show no relation to the age. The previous record of upper gastrointestinal tract without organic lesion. It is characterized functional dyspepsia in Balochistan showed the most common age by upper abdominal discomfort or pain, feeling of upper abdominal group was 31-40 years [7]. The functional dyspepsia in Chinese fullness, early satiety, belching and nausea. There is an overlap of population was recorded in majority of people between the ages of symptoms, therefore a standardize definition that is acceptable to all 41-50 years [11] In Japan the most common age group recorded was populations remains controversial [1,2]. This review article highlights 50-59 years [6]. the different aspects of functional dyspepsia. Gender: A study conducted in Balochistan showed males (77.9%) Prevalence of functional dyspepsia and females (22.1%) were suffering from functional dyspepsia [7]. Many studies all over the world revealed that there is predominance of The true prevalence of functional dyspepsia is difficult to determine female, who suffered from dyspepsia [4,12]. Studies conducted in in the population, due to difficulties in excluding organic disease in Taiwan and Australia revealed that females were more sufferer of large number of people. The very few studies are country based, while functional dyspepsia as compared to the male [8,12]. Why female majority of them are city or community based. In the USA (one gender is more prone to functional dyspepsia needs to be elaborated. institution based study) 29.2% of the general population have the problem of dyspepsia with reflux symptoms and 15% without reflux Ethnicity: Most of the studies in different parts of the world on symptoms [3]. In the U.K (national based study) the prevalence of dyspepsia were almost a single nation or ethnic group. No single functional dyspepsia was 23.8% [4]. In a Norwegian (one municipality nation or ethnic group found to have more predominance of based survey) the dyspepsia was recorded in 14.7% [5]. In Japan (one functional dyspepsia. Future studies are needed to find the differences city based study) the prevalence of functional dyspepsia recorded in functional dyspepsia between various populations will enhance the during the screening program of carcinoma of breast was recorded to global understanding of the condition and better inference will be be 17% [6]. In Balochistan a hospital based study revealed that the drawn [13]. functional dyspepsia was recorded in 38.9%. [7] In Taiwan (health Dietary factors: The different studies in different regions of the check attendees based study) the prevalence of functional dyspepsia world revealed various dietary factors as an etiological cause of recorded was 23.8% using Rome 1 criteria, while 11.8% using Rome II functional dyspepsia. In Chinese study bad dietary factors was the significant risk factor [11]. In an Indian study the consumption of Intern Med Volume 5 • Issue 3 • 1000192 ISSN:2165-8048 IME, an open access journal Citation: Mukhtar M, Zubair M, Naz R, Tabassum S, Achackzai MA (2015) Functional Dyspepsia: An Unresolved Issue. Intern Med 5: 192. doi: 10.4172/2165-8048.1000192 Page 2 of 5 vegetables, meat, spicy food and fried food had no significant In 2006, Rome III criteria were formulated because there were correlation [14]. In surveys conducted in USA and Western countries certain draw backs in Rome I and Rome II criteria. The criteria for the excessive use of tea and coffee has not been related to the dyspepsia epigastric pain and discomfort were varying. Some patient with little [3,15]. Canadian study revealed that heavy intake cola was associated pain had exaggerated feeling, while other patients did not. The concept with increase dyspepsia [16]. Still more studies are needed to establish of predominant symptoms as suggested by Rome II is easily picked by the role of diet in dyspepsia. the patients due to predominance of more than one symptom. The Rome III criteria were formulated as Socioeconomic Status: A study conducted in the USA revealed a strong relationship among the low socioeconomic class, increase Bothersome post prandial fullness: Occurring after ordinary sized number of family members with high prevalence of functional meal, atleast several times per week. dyspepsia [17]. Similar results were also recorded in studies of China Early satiety: Finishing the regular meal early, at least several times [11]. In another study it was concluded that dyspepsia in population of per week. developing countries is mostly organic, while functional dyspepsia is more prevalent in Western nations [18]. Epigastric burning or pain: Pain in the epigastrium of at least moderate severity once a week. The pain is intermittent, not Clinical diagnosis of functional dyspepsia generalized, not radiating, and not relieved by passage of flatus and no association with Hepatobiliary symptom. No evidence of structural The clinical diagnosis of functional dyspepsia has passed through diseases, excluded by upper gastrointestinal endoscopy. The symptoms different evolutionary phases. The clinical diagnosis from 18th century must be present at least three months with onset at least six months to till date is still under debate. Over the last 20 years the definition of prior. functional dyspepsia changed many times. In Rome III criteria, the various presentations of patients were Rome I committee in 1991, describe dyspepsia as persistent or further classified which were labelled as functional gastroduodenal recurrent upper gastrointestinal discomfort. It was further classified as: disorders. There was an overlap of symptoms of Gastro-Esophageal Dyspepsia with identifiable cause such as chronic peptic ulcer, Reflux Disease (GERD) and Irritable Bowel Syndrome (IBS). Finally reflux esophagitis, upper gastrointestinal malignancy and the Rome III criteria the term epigastric discomfort was replaced by Hepatobiliary disease. the terms of post prandial fullness or early satiety. Later these collectively termed as ‘post prandial distress syndrome’. The epigastric Dyspepsia with an identifiable cause of uncertain origin such as H. pain with its typical characteristic called as ‘epigastric pain syndrome’ pylori gastritis, duodenitis, idiopathic Gastropariesis, gastric [19-21]. It is finally concluded that it is a complex condition without dysrhythmias and small bowel dismotility. Dyspepsia with no organic lesion, characterized by upper abdominal discomfort or pain, explanation identified. feeling of upper abdominal fullness, early satiety, belching and nausea In Rome I dyspepsia with no explanation