**1. Introduction**

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12 Dyspepsia - Advances in Understanding and Management

Dyspepsia is currently defined by Rome III criteria for the diagnosis of functional gastroin‐ testinal disorders (FGIDs), as the presence of one or more of the following symptoms: both‐ ersome postprandial fullness, early satiation, epigastric pain and epigastric burning [1] These are symptoms thought to originate from the gastroduodenal region. Bloating and nausea often coexist with dyspepsia but are considered nonspecific and are thus not included in the Rome III criteria. However, there have been attempts by some researchers to broaden this definition to include more symptoms. The Asian consensus guideline includes bloating, nausea, vomit‐ ing and belching in the definition of dyspepsia [2]

Dyspeptic patients who have not undergone any investigations are defined as having unin‐ vestigated dyspepsia. An organic cause is found in only a minority who seek medical care [3, 4]. The remaining group is labeled as having functional dyspepsia (FD). Organic dyspepsia means there is a clear anatomic or pathophysiologic reason for the dyspeptic complaints, such as peptic ulcer or cancer. In contrast, when a diagnosis of functional dyspepsia has been made, it means that a number of investigations were performed including upper gastrointestinal endoscopy, and were found to be normal [5].

The need for more systematic description of FGIDs gave rise to the Rome process, which has evolved from Rome I in 1991 [6], Rome II in 1999 [7], to the most recent, which is Rome III [1]. According to Rome I and Rome II definitions, FD was defined as the presence of pain or discomfort centered in the upper abdomen, in the absence of organic disease that readily explained the symptoms [7]. While the meaning of pain is readily understood, the lack of an accurate definition for discomfort was a major limitation of Rome I. Rome I also included reflux symptoms in FD, and recognized a subgroup called "reflux-like dyspepsia". Rome II tried to correct this by excluding patients with predominant heartburn from the definition of FD. Rome

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I and Rome II criteria did not account for meal-related symptoms and this was the fundamental change in Rome III criteria [8, 9].

**3. Definitions of functional dyspepsia symptoms [1]**

patients may feel that tissue damage is occurring.

Epigastric pain syndrome:

**1.** Epigastric pain

**2.** Epigastric burning

the stomach.

Postprandial distress syndrome:

syndrome is thus questionable [11]

**4.1. Symptom-based diagnosis**

bowel syndrome. [13-22].

**4. Evaluating a patient with dyspepsia**

The Rome III committee proposed a distinction between meal-induced symptoms and mealunrelated symptoms to be pathophysiologically, clinically and therapeutically relevant.

Is Functional Dyspepsia Idiopathic? http://dx.doi.org/10.5772/56620 15

Epigastric refers to the region between the umbilicus and lower end of the sternum, and marked by the midclavicular lines. Pain refers to a subjective, unpleasant sensation; some

Epigastric refers to the region between the umbilicus and lower end of the sternum, and marked by the midclavicular lines. Burning refers to an unpleasant subjective sensation of heat.

**1. Postprandial fullness:** An unpleasant sensation like the prolonged persistence of food in

**2. Early satiation:** A feeling that the stomach is overfilled soon after starting to eat, out of proportion to the size of the meal being eaten, so that the meal cannot be finished. Previously, the term 'early satiety' was used, but satiation is the correct term for the

Recent research findings indicate that postprandial distress syndrome and epigastric pain syndrome overlap in majority of patients with FD [11]. The implication of this is that the value of dividing FD into the subgroups of postprandial distress syndrome and epigastric pain

The introduction of Rome criteria and Rome process was a milestone in the management of FGIDs. However, the high turnover of Rome criteria is a testimony to the fact that symptombased diagnosis has limitations. Symptoms may be perceived differently within different cultures and languages. It has been recommended that the current Rome III questionnaire be translated into local languages [12]. Symptoms are poor predictors of FD and significant overlaps are often seen with functional disorders including functional heartburn and irritable

One of the difficulties encountered in evaluating a patient with dyspepsia is that symptoms are nonspecific and cannot accurately differentiate an organic process from a functional

disappearance of the sensation of appetite during food ingestion.

Rome III criteria made a distinction between meal-induced symptoms and meal-unrelated symptoms, and this forms the basis of newly defined subcategories of FD:


The traditional definition of FD portrays it as an idiopathic condition [10]. However, recent studies suggest that this condition have some pathophysiologic correlates. A diversity of changes in gastrointestinal structure and function has been described in this heterogeneous disorder. In this chapter, the author attempts to provide an overview of structural and physiological alterations in FD beyond those demonstrable by conventional tests used to separate organic dyspepsia from its functional counterpart.
