Functional dyspepsia: a review of scientific and policy issues

Functional dyspepsia can be defined as chronic or recurrent upper abdominal pain or discomfort, for which no focal lesion or systemic disease can be found. It is a common complaint seen by physicians and, although it does not cause death or severe disability in the majority of cases, represents an important and costly health problem. It is estimated that each year the total pharmaceutical cost for function dyspepsia ranges from £4.88 million to £41.84 million in England and Wales. The effect of treatment with various agents for function dyspepsia has not been convincingly evaluated, mainly because of lack of validated outcome measures and heterogeneity in patients. However, evidence from clinical trials suggests that prokinetic agents may help to improve symptoms in the short term among patients with dysmotility-like dyspepsia. The role of anti-secretory agents and treatment of Helicobacter pylori is less clear. Antacids do not relieve symptoms of functional dyspepsia more effectively than placebo. Due to great heterogeneity in patients with functional dyspepsia and the uncertainty of treatment effects, a variation in clinical management of dyspepsia is to be expected. Because there is a large pool of patients with dyspepsia, the potential growth of demand for investigation and treatment services for dyspepsia is great.