Functional (non-ulcer) dyspepsia: unexplained but not unmanageable

Functional dyspepsia - defined as chronic or recurrent pain or discomfort centred in the upper abdomen, with no clinical or endoscopic evidence of known organic disease - is very common and causes considerable morbidity and loss of productivity. A first priority in management is reassuring patients that they do not have a serious disorder. Few drugs have established benefit and the choice depends on which symptoms predominate - prokinetic drugs may be most beneficial in those in whom discomfort (rather than pain), bloating or nausea is the most bothersome complaint and antisecretory drugs in those with predominant epigastric pain.