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Definition, Pathogenesis, and Management of That Cursed Dyspepsia

  • Pramoda Koduru
    Affiliations
    Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
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  • Malcolm Irani
    Affiliations
    Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
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  • Eamonn M.M. Quigley
    Correspondence
    Reprint requests Address requests for reprints to: Eamonn M. M. Quigley, MD, 6550 Fannin Street, SM 1201, Houston, Texas 77030. fax: (713) 797-0622.
    Affiliations
    Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
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Published:September 09, 2017DOI:https://doi.org/10.1016/j.cgh.2017.09.002
      Dyspepsia is an umbrella term used to encompass a number of symptoms thought to originate from the upper gastrointestinal tract. These symptoms are relatively nonspecific; not surprisingly, therefore, a myriad of conditions may present with any one or a combination of these symptoms. Therein lays the clinician’s first challenge: detecting the minority who may have a potentially life-threatening disorder, such as gastric cancer, from a population whose symptoms are, for the most part, considered functional in origin. The second challenge lies in the definition and management of those individuals with functional dyspepsia (FD); the major focus of this review. The Rome process has addressed the issue of FD definition and a look back at the evolution of Rome criteria for this disorder illustrates the complexities that have so frustrated us. There has been no shortage of hypotheses to explain symptom pathogenesis in FD; initially focused on gastric sensorimotor dysfunction, these have now strayed well into the duodenum and have come to entertain such factors as immune responses and the microbiome. FD has proven to be an equally challenging area for therapeutics; while the staple approaches of acid suppression and eradication of Helicobacter pylori have some limited efficacy in select populations, strategies to ameliorate symptoms in the majority of sufferers based on presumed pathophysiology have largely foundered. Lacking a validated biomarker(s) FD continues to be an elusive target and is likely to remain so until we can better define the various phenotypes that it must surely contain.

      Keywords

      Abbreviations used in this paper:

      EPS (epigastric pain syndrome), FD (functional dyspepsia), GERD (gastroesophageal reflux disease), IBS (irritable bowel syndrome), PDS (post-prandial distress syndrome), PI (postinfectious)
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      Linked Article

      • That Cursed Dyspepsia
        Clinical Gastroenterology and HepatologyVol. 16Issue 10
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          Koduru et al1 are to be congratulated for their article regarding dyspepsia. The authors take a gargantuan beast and describe its shape, characteristics, habits, how it has grown and changed over many years, along with the best ways to understand it and deal with it.
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