The Prevalence and Clinical Course of Functional Dyspepsia
The Prevalence and Clinical Course of Functional Dyspepsia
Aim: To examine the prevalence of functional dyspepsia in the general population, and to evaluate the natural history/clinical course of patients with functional dyspepsia.
Methods: Full-length published manuscripts during 1980-2002 were included if: (i) participants had uninvestigated or functional dyspepsia; (ii) dyspepsia was defined; (iii) for prevalence, population-based samples were evaluated; (iv) for prognosis, the total number of the inception cohort and the total number of individuals available at the end of follow-up were reported.
Results: Twenty-two studies (1976-2002) that examined the prevalence of dyspepsia fulfilled the inclusion and exclusion criteria; 17 studies examined more than 1000 participants, but only two studies provided information sufficient to calculate the prevalence of functional dyspepsia (11.5-14.7%). The prevalence of uninvestigated dyspepsia was in the range 10-40%. When the definition of dyspepsia was restricted to participants with upper abdominal pain, irrespective of the presence of heartburn or acid regurgitation, the prevalence rate estimate was 5-12%. Thirteen studies examined the clinical course of functional dyspepsia (seven retrospective and six prospective). Sample sizes were small (n = 35-209). A follow-up ascertainment of symptoms amongst individuals in the original cohorts was obtained in 92.5-98.2% of prospective studies and in 67.7-82.2% of retrospective studies. The follow-up duration was in the range 1.5-10 years for prospective studies and 5-27 years for retrospective studies; the median follow-up duration for all studies was approximately 5 years. A variable prognosis was reported. An outcome of symptom improvement or becoming asymptomatic was reported in at least one-half of patients in 10 of the 13 studies, and in at least two-thirds of patients in six of the 13 studies. Prognostic factors were inconsistent and, in general, poorly described.
Conclusions: Functional dyspepsia is prevalent world-wide, but the prognosis remains poorly defined. There is a need for population-based studies to examine the prevalence and clinical course of documented functional dyspepsia.
Dyspepsia is a common complaint, but the definition of dyspepsia has evolved over the past 50 years. Despite consensus meetings that have proposed standardized definitions for dyspepsia, there remains controversy, particularly about the overlap between heartburn and upper abdominal pain or discomfort. Cultural differences have been identified in terms of what constitutes abdominal pain vs. discomfort, which also continue to confound the field. Other difficulties are created by the fact that dyspepsia is not a term usually understood by patients, and is not measurable as a self-reported item. Ascertaining the presence of dyspepsia requires the assessment of multiple symptoms that may be variably interpreted by the physician.
Dyspepsia, however it is defined, can have multiple causes, including, most frequently, gastro-oesophageal reflux disease, peptic ulcer or functional dyspepsia. Functional dyspepsia is a disorder characterized by the presence of chronic or recurrent symptoms of upper abdominal pain or discomfort in the absence of any known specific structural cause.
Functional dyspepsia is generally a non-life-threatening disorder that is not associated with a need for surgery or a reduction in survival. The impact of functional dyspepsia can be partly measured in terms of its prevalence, natural history and clinical course. A previous systematic review reported the prevalence of uninvestigated dyspepsia up to 1997, but the prevalence of functional dyspepsia was not specifically examined and remains poorly defined. The prognosis of functional dyspepsia also remains relatively poorly described. In particular, the periodicity of symptoms and the rates of persistence of symptoms have not been well characterized, in part because the use of terminology has been relatively inconsistent in the literature. A previous systematic review by Janssen et al. suggested surprisingly diverse outcomes in studies up to 1997. Further studies have since been published, which may shed more light on the heterogeneity previously identified.
We have performed a systematic review of the literature to examine the prevalence of functional dyspepsia, and to evaluate the natural history and clinical course of patients with documented functional dyspepsia.
Aim: To examine the prevalence of functional dyspepsia in the general population, and to evaluate the natural history/clinical course of patients with functional dyspepsia.
Methods: Full-length published manuscripts during 1980-2002 were included if: (i) participants had uninvestigated or functional dyspepsia; (ii) dyspepsia was defined; (iii) for prevalence, population-based samples were evaluated; (iv) for prognosis, the total number of the inception cohort and the total number of individuals available at the end of follow-up were reported.
Results: Twenty-two studies (1976-2002) that examined the prevalence of dyspepsia fulfilled the inclusion and exclusion criteria; 17 studies examined more than 1000 participants, but only two studies provided information sufficient to calculate the prevalence of functional dyspepsia (11.5-14.7%). The prevalence of uninvestigated dyspepsia was in the range 10-40%. When the definition of dyspepsia was restricted to participants with upper abdominal pain, irrespective of the presence of heartburn or acid regurgitation, the prevalence rate estimate was 5-12%. Thirteen studies examined the clinical course of functional dyspepsia (seven retrospective and six prospective). Sample sizes were small (n = 35-209). A follow-up ascertainment of symptoms amongst individuals in the original cohorts was obtained in 92.5-98.2% of prospective studies and in 67.7-82.2% of retrospective studies. The follow-up duration was in the range 1.5-10 years for prospective studies and 5-27 years for retrospective studies; the median follow-up duration for all studies was approximately 5 years. A variable prognosis was reported. An outcome of symptom improvement or becoming asymptomatic was reported in at least one-half of patients in 10 of the 13 studies, and in at least two-thirds of patients in six of the 13 studies. Prognostic factors were inconsistent and, in general, poorly described.
Conclusions: Functional dyspepsia is prevalent world-wide, but the prognosis remains poorly defined. There is a need for population-based studies to examine the prevalence and clinical course of documented functional dyspepsia.
Dyspepsia is a common complaint, but the definition of dyspepsia has evolved over the past 50 years. Despite consensus meetings that have proposed standardized definitions for dyspepsia, there remains controversy, particularly about the overlap between heartburn and upper abdominal pain or discomfort. Cultural differences have been identified in terms of what constitutes abdominal pain vs. discomfort, which also continue to confound the field. Other difficulties are created by the fact that dyspepsia is not a term usually understood by patients, and is not measurable as a self-reported item. Ascertaining the presence of dyspepsia requires the assessment of multiple symptoms that may be variably interpreted by the physician.
Dyspepsia, however it is defined, can have multiple causes, including, most frequently, gastro-oesophageal reflux disease, peptic ulcer or functional dyspepsia. Functional dyspepsia is a disorder characterized by the presence of chronic or recurrent symptoms of upper abdominal pain or discomfort in the absence of any known specific structural cause.
Functional dyspepsia is generally a non-life-threatening disorder that is not associated with a need for surgery or a reduction in survival. The impact of functional dyspepsia can be partly measured in terms of its prevalence, natural history and clinical course. A previous systematic review reported the prevalence of uninvestigated dyspepsia up to 1997, but the prevalence of functional dyspepsia was not specifically examined and remains poorly defined. The prognosis of functional dyspepsia also remains relatively poorly described. In particular, the periodicity of symptoms and the rates of persistence of symptoms have not been well characterized, in part because the use of terminology has been relatively inconsistent in the literature. A previous systematic review by Janssen et al. suggested surprisingly diverse outcomes in studies up to 1997. Further studies have since been published, which may shed more light on the heterogeneity previously identified.
We have performed a systematic review of the literature to examine the prevalence of functional dyspepsia, and to evaluate the natural history and clinical course of patients with documented functional dyspepsia.
