Is this a reflux patient or is it a patient with functional dyspepsia with additional reflux symptoms?
Patients with pyrosis or regurgitation as the dominating symptoms have gastro-oesophageal reflux disease (GORD). However, patients with more atypical symptoms may also suffer from it. The disease is usually chronic and patients who have additional oesophagitis are at risk of developing complications. The therapeutic goals in GORD are symptom relief, healing of lesions, prevention of complications, and omittance of adverse effects at the lowest possible costs. Patients with functional dyspepsia usually have symptoms of less severe intensity and as, per definition, no organic substrate is demonstrable, complications do not develop in these patients. Therefore, in patients with GORD and functional dyspepsia, treatment of GORD should have the highest priority. Pharmacologic treatment of GORD comprises H2 receptor antagonists, proton-pump inhibitors and cisapride. The pharmacologic treatment of functional dyspepsia is less documented and in most studies the symptomatic pattern could not predict the pharmacologic principle of clinical benefit. This may be because a separation between presence of symptoms and presence of symptoms as a major problem has not been taken into account. Cisapride is the drug that has been proven clinically useful in most randomized studies. This does not, however, rule out that other drugs are better in subgroups of patients with functional dyspepsia.
Dept. of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Denmark.
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Funch-Jensen
D003937:Diagnosis, Differential; D004415:Dyspepsia / Q000175:diagnosis* / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000628:therapy; D006801:Humans