What is the long-term outcome of the different subgroups of functional dyspepsia?


Dr. M. Heikkinen, Department of Medicine, Unit of Gastroenterology, Kuopio University Hospital, Fin-70210 Kuopio, Finland.
E-mail: markku.heikkinen@kuh.fi


Background : Functional dyspepsia is often a long-lasting disorder that accounts for substantial healthcare costs. It has been classified into subgroups assuming that it can guide management of dyspepsia.

Aim : To evaluate the clinical significance of subgrouping functional dyspepsia in a long-term perspective study.

Methods : Consecutive patients with dyspepsia identified by general practitioners were investigated. Those patients with functional dyspepsia (n = 201) were enrolled in this study. Initially, patients were divided into five subgroups (ulcer-like, dysmotility-like, reflux-like, unspecified, and irritable bowel syndrome-like). Patients' medical histories were reviewed after 6–7 years, and the number and outcome of repeated investigations were analysed. At the end of follow-up, patients filled in a questionnaire similar to that at baseline, and were invited for gastroscopy.

Results : Only 2% of patients developed peptic ulcer during follow-up, none of them were in the ulcer-like subgroup. When referrals to hospital and examinations during follow-up were registered, no statistically significant differences existed between subgroups. Patients with reflux-like dyspepsia made fewer revisits than others (P = 0.02), but had used antidyspepsia drugs during the previous year more often (P = 0.036). Stability of the subgroups over time was poor.

Conclusions : Functional dyspepsia is a long-lasting disorder with a very good prognosis. Subgroups of functional dyspepsia play only a minor role in prediction of the long-term outcome, and their usefulness in clinical practice is also hampered by subgroup instability over time.