The prevalence and clinical course of functional dyspepsia


  • H. B. El-Serag,

    1. Sections of Gastroenterology and Health Services Research, Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, TX, USA
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  • N. J. Talley

    1. Division of Gastroenterology and Hepatology, and Center for Enteric Neurosciences and Translational Epidemiological Research (CENTER), Mayo Clinic, Rochester, MN, USA
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Dr H. B. El-Serag, Houston Veterans Affairs Medical Center (152), 2002 Holcombe Blvd., Houston, TX 77030, USA.


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.