Functional Dyspepsia

This chapter provides definition of functional dyspepsia (FD), evaluation, and diagnostic tests, methodology of clinical treatment trials with a focus on outcome measures used to determine the efficacy of treatments, and treatments including antacids, H 2 ‐receptor antagonists (H 2 ‐RAs), proton pump inhibitors (PPIs), prokinetic agents, anti‐Helicobacter therapy, antidepressant therapy, and psychological interventions. A problem in every day management of FD is that primary care physicians do not readily make a distinction between gastroesophageal reflux disease (GERD) and dyspepsia, as in both instances the most likely pharmacological therapy is to prescribe a PPI. Dividing FD into subgroups has become popular despite evidence of the existence of considerable overlap among them. The ROME II classification recognized four subgroups: ulcer‐like dyspepsia, reflux‐like dyspepsia, dysmotility‐like dyspepsia, and unclassified dyspepsia. The chapter summarizes the suggested treatment algorithm for FD. The evidence for use of tricyclic antidepressants, especially amitriptyline, is getting stronger and this also true for cognitive behavioral therapy.