Chin Med J (Taipei) 1998;61:S93.

Functional Dyspepsia and Helicobacter Pylori

Full-Young Chang, M.D.

Div. of Gastroenterology, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC.

Abstract

Dyspepsia is an episodic or persistent upper abdominal pain / discomfort, centrally localized to the epigastrium or upper abdomen, where the upper gastrointestinal tract is most likely the source of this disorder. In addition to this dominant symptom, other major symptoms included in the family of dyspepsia are fullness, early satiety, anorexia, nausea, vomiting and heartburn. At least half patients showing dyspepsia without an identified nature originated from proximal gut have been non-ulcer dyspepsia or functional dyspepsia (FD), while the latter gradually replaces the former. FD refers to a heterogeneous group of patients with more than one underlying pathophysiological mechanism. According to their major symptoms, four main subgroups, e.g. "ulcer-like dyspepsia", reflux-like dyspepsia", "dysmotility-like dyspepsia" and "unspecified dyspepsia" have been proposed. These subgroups in FD are probably to reflect their underlying etiologies. Instead, the real etiology of FD remains unresolved. No clear association has been demonstrated with dietary, environmental or psychosocial factors or acid hypersecretion. Studies failed to show any significant increase in the prevalence of either chronic gastritis or H. pylori (HP) infection in FD patients compared with symptomless controls. The reports regarding with HP infection and specific symptom cluster in FD patients are disputable even eradication does not necessarily associate with improved dyspeptic symptoms. However, some FD patients ultimately experience the long-term symptom free after HP eradication treatment. Moreover, impaired gastric emptying, antral hypomotility and decreased visceral sensation have been the common mechanisms leading to FD. It is unknown whether a stomach motor or sensory disturbance is definitely responsible for these FD symptoms only in a small subgroup. The diagnosis of FD must base on a detailed history taking and a variety of complete procedures including thorough inspection of upper gastrointestinal tract to exclude any organic origin. The major concern is an underlying organic disease for dyspeptic symptoms. Hence the FD diagnosis must be born in mind since the occurrence of major pathology, namely peptic ulceration or gastric tumor, is very common in elders. Patients with FD may or may not need any specific management. Many FD patients can accept their mild symptoms once they are reassured that no serious pathology is present and advised regarding in avoidance of some precipitating factors. For these with intractable symptoms, various trials including antacids, H2 blockers, PPI and prokinetics have been effective. The symptomatic subgroups may be employed as a basis for the targeted treatment although their efficacies are questionable due to the large overlap of symptoms between them. The long-term efficacies of these agents remain to be established, however, some recent publications indicate the good effect after anti-HP regimen even it persists for one year. A large scale word-wide study looks needed to confirm the long-term effect of HP eradication for FD patients. In conclusion, when and how to investigate the dyspeptic patients is an issue that requires careful analysis, several key decisions must be considered on a case-by-case basis, the role of HP mediating FD appears important while a therapy just to this particular factor remains controversial.

Keywords: Dyspepsia, Helicobacter pylori, gastrointestinal motility

[Chin Med J (Taipei) 1998;61:S93.]