title: Functional dyspepsia, H. pylori and post infectious FD.
abstract: BACKGROUND
  Functional dyspepsia has been defined by Rome III as the presence of one or more chronic dyspepsia symptoms in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Delayed gastric emptying, antral hypomotility and altered intestinal motility, decreased gastric accommodation, H.pylori infection, enhanced visceral sensitivity, abnormal duodenal sensitivity to acid, carbohydrate maldigestion and psychological factors have all been identified in subgroups of patients with functional dyspepsia. RELATIONSHIP BETWEEN H.PYLORI, FD AND POST INFECTIOUS FD:  The relationship between H. pylori infection and functional dyspepsia is controversial. H.pylori infection is present in a minority of patients with FD. Symptoms and abnormalities of function such as gastric emptying have not been consistently shown to be related to H.pylori infection. However, meta-analysis has shown that H.pylori eradication therapy in FD results in a small but statistically significant effect in H.pylori positive FD (relative risk reduction 10%). Guidelines for Helicobacter pylori infection have therefore strongly recommended H.pylori eradication therapy in H.pylori positive FD patients. Post-infectious dyspepsia has been described as a distinct clinical entity, based on a large retrospective study that showed a subset of dyspeptic patients who had a history suggestive of post-infectious dyspepsia. In a prospective study, investigators in Spain have found that development of dyspepsia was increased fivefold at 1 year after acute Salmonella gastroenteritis. In post-infectious FD patients, early satiety, weight loss, nausea, and vomiting are frequently reported together with a higher prevalence of impaired gastric accommodation. More recently, infectious FD has been found to be associated with persisting focal T-cell aggregates, decreased CD4+ cells and increased macrophage counts in the duodenum for several moths after acute infection. This suggests impaired ability of the immune system to terminate the inflammatory response after acute insult.
  
  
  CONCLUSIONS
  In conclusion, H. pylori infections, as well as other gut infections, have been associated with a subset of FD patients. Treatment of underlying infections can potentially lead to improvement in this group of patients.
authors: Department of Gastroenterology, Changi General Hospital, Singapore. kwong_ming_fock@cgh.com.sg
authors: Kwong Ming
authors: KM
authors: Fock
mesh_terms: D004415:Dyspepsia / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D005759:Gastroenteritis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D012307:Risk Factors