[Functional dyspepsia in primary care: therapeutic variety or helplessness?]

BACKGROUND: About 5% of all GP consultations are made for symptoms of functional dyspepsia. The definition of functional dyspepsia is in a state of flux, pathophysiology is poorly understood, and current diagnostic and therapeutic algorithms are not available.

AIM: Evaluation of the frequency and the practical procedure in the diagnosis and therapy of functional dyspepsia in German GP surgeries.

METHOD: Family physicians working in Germany (general practitioners, primary care internists) were contacted via postal survey. The frequency of patients with functional dyspepsia per week, the symptom spectrum complained of and the therapy strategy were inquired.

RESULTS: Data from 322 doctors from all over Germany could be evaluated. The majority of physicians cared for 6-10 RMS patients per week (44.1%). The most common symptoms reported by patients were postprandial fullness (81.7%), epigastric pain or burning (77.3%) and regurgitation (75.0%). Heartburn (50.0%), nausea/vomiting (42.5%) and premature satiety (15.8%) were reported less frequently. The most commonly prescribed drugs were phytotherapeutics (88.2%), proton-pump inhibitors (PPI, 73.6%) and prokinetics (61.5%). The frequency of prescribing antacids, digestive enzymes of the stomach and pancreas was 10-20%. There was a trend towards symptom-dependent differential therapy: phytotherapeutics and prokinetics in postprandial fullness and premature satiety, PPI in epigastric pain/burning. The treatment failure rate was estimated at 21-40%. For further diagnostics patients are often referred to gastroenterologists and psychotherapists.

CONCLUSION: Functional dyspepsia is common in primary care practice. Current recommendations for diagnosis and differential therapy are often not implemented. The rate of treatment failure is considerable.