Functional Dyspepsia

Dyspepsia is a constellation of symptoms referable to the gastroduodenal region of the upper gastrointestinal tract. Functional dyspepsia, a relapsing and remitting disorder, is the most common cause of these symptoms. The current standard for the diagnosis of functional dyspepsia is the Rome III criteria, developed by the Rome III Committees, a multinational group of experts in the field, first convened in 1990, that meets regularly to review and revise the diagnostic criteria for all functional gastrointestinal disorders. The Rome III criteria for functional dyspepsia consist of a sensation of pain or burning in the epigastrium, early satiety (inability to finish a normal-sized meal), fullness during or after a meal, or a combination of these symptoms (Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). Symptoms must be chronic, occurring at least weekly and over a period of at least 6 months, in the absence of an organic explanation. 1 The global prevalence of functional dyspepsia in the community according to this definition is between 5% and 11%.(2) Up to 40% of persons who have functional dyspepsia consult a physician,(3) and the condition negatively affects attendance and productivity in the workplace.(4) Functional dyspepsia has substantial financial implications for patients, health care organizations, and society as a whole; costs associated with the condition in the United States in 2009 were in excess of $18 billion.(5) It is therefore important that physicians be able to recognize functional dyspepsia, use investigations and diagnostic tests judiciously, and recommend effective treatments, in order to minimize the potential adverse social and economic effects of the condition.