Funktionelle Dyspepsie: Stein der Weisen oder viel Lärm um nichts?

Zusammenfassung

Ist mit der Stellung der Diagnose funktionelle Dyspepsie etwas gewonnen? 1998 empfahl eine in Rom zusammengetretene Arbeitsgruppe, diese Diagnose zu stellen bei anhaltenden oder rezidivierenden Schmerzen in Oberbauchmitte oder bei Sensationen wie vorzeitigem Sättigungsgefühl, Völlegefühl, Blähungen, Übelkeit, die im vergangenen Jahr mehr als 12 Wochen bestanden, weder durch Stuhlgang gelindert würden noch mit einer veränderten Stuhlfrequenz oder Stuhlkonsistenz einhergingen und sich kein zugrunde liegendes Leiden finde. Anamnese, physische Untersuchung und Ösophagogastroskopie wurden als Mindestaufwand empfohlen. Funktionelle Dyspepsie ist also eine Ausschlussdiagnose. Der Begriff ist unglücklich: Er suggeriert eine manifeste oder zu vermutende Funktionsstörung und dass zwischen Störungen definierter und solchen nicht eruierbarer Ursache ein grundlegender Unterschied bestünde - ernst zu nehmen wären nur die zuerst Genannten. Dass bestimmte Untersuchungen keine Ursache zutage brachten, bedeutet überdies nicht, dass keine existierte. Funktionell wird auch gleichbedeutend mit ideologiebefrachteten Begriffen wie Organneurose, Vegetative Dystonie und Psychosomatische Störung verwendet. Patienten mit funktioneller Dyspepsie weisen jedoch weder pathophysiologische, psychosoziale oder psychopathologische Charakteristika auf, noch gibt es eine spezifische Therapie. Diese hat sich nach den jeweiligen Symptomen zu richten. Es ist daher nicht zu erkennen, dass die Stellung der Diagnose funktionelle Dyspepsie für die Behandlung eines Patienten dienlich sein könnte. Wenn eine Kategorisierung wünschenswert erscheint, so brächte der Terminus idiopathische Dyspepsie klar zum Ausdruck, dass die Ursache der Beschwerden unerkannt ist.

Functional Dyspepsia: Philosophers' stone or much ado about nothing

Does it make sense to diagnose functional dyspepsia? In 1998, a committee gathered in Rome recommended to diagnose functional dyspepsia in patients with persistent or recurrent pain or discomfort centered in the upper abdomen but no disease likely to explain the symptoms, which are not exclusively relieved by defecation or associated with changed stool frequency or form. Careful history taking, physical examination and upper endoscopy during a symptomatic period off anti-secretory therapy are recommended as minimum workup. Functional dyspepsia thus is a diagnosis of exclusion. The term is unfortunate: It suggests the presence of a manifest or yet covert organ dysfunction and also a fundamental difference between disorders with defined and with unknown cause, only the former being serious. However, that a limited number of investigations failed to reveal a cause does not mean that there is no cause. Further, functional often is used synonymous with vague and ideology-ridden terms such as “organ neurosis”, “vegetative dystonia” and “psychosomatic disorder”. There are no unequivocal data showing that patients with functional dyspepsia share pathophysiological, psychosocial or psychopathological characteristics or that there is a specific therapy. In the individual patient, therapy has to be tailored according to the symptoms. It thus seems doubtful whether the diagnosis functional dyspepsia can, for a patient's treatment or otherwise, be of value. If a categorization is deemed inevitable, the term idiopathic dyspepsia would be preferable, as it unequivocally makes clear that the symptoms' cause is unrevealed.

Schlüsselwörter

Funktionelle Dyspepsie - funktionelle Störungen - Definition - Prävalenz - Diagnostik - auslösende Faktoren - Therapie - idiopathische Dyspepsie

Key words

Functional Dyspepsia - Functional Disorders - Definition - Prevalence - Diagnostics - Symptom-eliciting Factors - Therapy - Idiopathic Dyspepsia

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