Preface

Chapter 9 **Functional Gastrointestinal Symptoms in Women with Pelvic**

Chapter 10 **Dyspepsia and Opioid–Induced Bowel Dysfunction: The Role of**

**Opioid Receptor Antagonists 183**

**Endometriosis 169** Yves Muscat Baron

**VI** Contents

Wojciech Leppert

Dyspepsia suggests impaired digestion but when chronic, implies recurrent upper abdomi‐ nal pain or fullness that may follow a meal. Functional dyspepsia lacks evidence of a struc‐ tural basis, yet is a common disorder that often profoundly impacts the patient's quality of life. Many clinicians have a relatively poor understanding of factors that play a role in this disorder. Differentiation between organic disease and functional dyspepsia is often difficult. Further confounding this is their occasional co-existence. Management of patients with func‐ tional dyspepsia can be frustrating, particularly as symptoms are frequently refractory.

This textbook is specifically written for clinicians involved in managing patients with dys‐ pepsia. It is a practical guide with up-to-date suggestions on evaluation, diagnosis, and management from experts from around the world. Each chapter is a succinct review of cur‐ rent topics that play a role in the pathogenesis and management of this disorder. Special populations such as pediatrics, those with cardiovascular disease and women's health are specifically examined.

*Dyspepsia: Advances in Understanding and Management* is essential reading for those who wish to advance their understanding of this complex and often challenging disorder.

We dedicate this book to our significant others, our families and those suffering from func‐ tional dyspepsia.

> **Eldon Shaffer** Professor of Medicine Division of Gastroenterology and Hepatology, University of Calgary Canada

#### **Michael Curley**

Consultant Gastroenterologist and clinical assistant professor Division of Gastroenterology and Hepatology University of Calgary Canada

**Chapter 1**

**Diagnostic Testing for Functional Dyspepsia**

Dyspepsia is defined as predominantly midline pain or discomfort located in the upper abdomen [1]. Discomfort refers to a subjective, negative feeling that is not "painful". Dyspepsia can incorporate a variety of symptoms including early satiety or upper abdominal fullness. Although the term implies a relationship with eating and the majority of patients have symptoms worsened by food, this is no longer necessary to diagnose dyspepsia [2]. During the investigation of dyspepsia, three major structural causes are readily identifiable: peptic ulcer disease (10%), gastroesophageal reflux (20%) (with or without esophagitis), and malig‐ nancy (2%) [3]. Thus, most (50%-70%) patients with chronic dyspepsia do not have a significant focal or structural lesion found at endoscopy. When symptoms are chronic or recurrent (table 1) but without an identifiable structural cause using standard diagnostic tests (usually endoscopy), the condition is usually labelled functional or functional dyspepsia [4, 5]. Hence functional dyspepsia is a diagnosis of exclusion, the implication being that symptoms have

Functional dyspepsia is not life-threatening and is not associated with any increase in mortal‐ ity. However, the impact of this condition on patients and health care services is considerable. In a recent community survey of several European and North American populations, 20% of people with dyspeptic symptoms had consulted either primary care physicians or hospital specialists; more than 50% of dyspepsia sufferers were on medication most of the time and approximately 30% reported taking days off from work or school due to their symptoms [5, 6]. Patients with functional dyspepsia have a significantly reduced quality of life when

The Rome III criteria for diagnosing functional dyspepsia are persistent or recurrent upper abdominal pain or discomfort for a period of 12 weeks, which need not be consecutive, in the preceding 12 months, with symptoms present more than 25 percent of the time, and an absence

> © 2013 Sabih and Rahim; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

been investigated without demonstrating an organic or anatomical cause [5].

Durre Sabih and Muhammad Kashif Rahim

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/57088

compared to the general population [7].

**1. Introduction**
