Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2005; 11(42): 6577-6581
Published online Nov 14, 2005. doi: 10.3748/wjg.v11.i42.6577
Management of functional dyspepsia: Unsolved problems and new perspectives
Ahmed Madisch, Stephan Miehlke, Joachim Labenz
Ahmed Madisch, Stephan Miehlke, Medical Department I, Technical University Hospital Dresden, Germany
Joachim Labenz, Medical Department, Ev. Jung-Stilling-Hospital, Academic Teaching Hospital of the University of Bonn, Siegen, Germany
Author contributions: All authors contributed equally to the work.
Correspondence to: Ahmed Madisch, MD, Medical Department I, Technical University Hospital, Fetscherstrasse 74, D-01307 Dresden, Germany.
Telephone: +49-351-4584780 Fax: +49-351-4584394
Received: November 12, 2004
Revised: February 15, 2005
Accepted: February 18, 2005
Published online: November 14, 2005

The common characteristic criteria of all functional gastrointestinal (GI) disorders are the persistence and recurrence of variable gastrointestinal symptoms that cannot be explained by any structural or biochemical abnormalities. Functional dyspepsia (FD) represents one of the important GI disorders in Western countries because of its remarkably high prevalence in general population and its impact on quality of life. Due to its dependence on both subjective determinants and diverse country-specific circumstances, the definition and management strategies of FD are still variably stated. Clinical trials with several drug classes (e.g., proton pump inhibitors, H2-blockers, prokinetic drugs) have been performed frequently without validated disease-specific test instruments for the outcome measurements. Therefore, the interpretation of such trials remains difficult and controversial with respect to comparability and evaluation of drug efficacy, and definite conclusions can be drawn neither for diagnostic management nor for efficacious drug therapy so far. In view of these unsolved problems, guidelines both on the clinical management of FD and on the performance of clinical trials are needed. In recent years, increasing research work has been done in this area. Clinical trials conducted in adequately diagnosed patients that provided validated outcome measurements may result in better insights leading to more effective treatment strategies. Encouraging perspectives have been recently performed by methodologically well-designed treatment studies with herbal drug preparations. Herbal drugs, given their proven efficacy in clinical trials, offer a safe therapeutic alternative in the treatment of FD which is often favored by both patients and physicians. A fixed combination of peppermint oil and caraway oil in patients suffering from FD could be proven effective by well-designed clinical trials.

Keywords: Dyspepsia, Functional dyspepsia, Definition, Diagnosis, Management, Drug efficacy, Clinical trials, Outcome measurements, Herbal drugs