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Abstract
The article provides a characterization of functional gastrointestinal disorders and highlights their prevalence. The prevalence of dyspepsia varies significantly across populations, which is attributed to differences in symptom interpretation and severity, diagnostic criteria, environmental factors, and the local prevalence of organic diseases such as ulcers or stomach cancer. Attention is drawn to the classification of these disorders, including functional gastrointestinal disorders (dyspepsia, chronic nausea and vomiting, bloating, rumination); functional esophageal disorders (functional chest pain, functional heartburn, reflux esophagitis, hypersensitivity, globus, functional dysphagia); functional bowel disorders (irritable bowel disease, functional bloating, functional constipation, functional diarrhea); and functional anorectal disorders (anorectal pain, functional defecation disorders).
Given that functional dyspepsia (FD) is one of the most common gastrointestinal conditions, the authors focus on the definitions and diagnosis of FD in accordance with the Rome IV criteria. It is emphasized that the Rome Committee proposed refining the definition of FD through more detailed symptom characterization. The diagnosis of "FD" is recommended for conditions of non-organic origin accompanied by a typical syndrome of dyspeptic complaints (epigastric pain, early satiety, postprandial fullness, epigastric burning) persisting for at least 12 weeks (not necessarily consecutive) over the last six months and not caused by an organic pathology that could explain these symptoms.
Attention is drawn to the classification of patients based on the presence of postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and the overlap of PDS and EPS symptoms, which is crucial for determining pharmacological treatment. The role of risk factors in tailoring individual treatments is also emphasized, particularly in cases of small intestinal bacterial overgrowth syndrome, which can persist in FD patients and contribute to pharmacotherapy resistance due to disruptions in the gut microbiome, necessitating changes in treatment algorithms.
The article underscores that H. pylori infection is considered a possible causative factor of FD only if eradication therapy is successful. Environmental influences, psychosocial factors, and gut-brain axis dysregulation are also discussed as contributing to the development and persistence of symptoms. The authors elaborate on pathophysiological mechanisms such as gastric emptying, impaired gastric accommodation, hypersensitivity (gastric and duodenal, triggered by distention, acid, etc.), persistent low-grade duodenal inflammation, increased mucosal permeability, and the role of dietary antigens.
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