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 17 October 2017

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GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

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Testing drugs in functional dyspepsia

The management of functional (non-ulcer) dyspepsia remains controversial. Furthermore, identifying useful predictors of the treatment response remains a key goal, in order to target therapy more effectively in practice.

In a large randomized controlled trial of 1262 patients, the overall therapeutic gain of the proton pump inhibitor omeprazole versus placebo was only 10% (Aliment Pharmacol Ther 1998; 12: 1055-65).

However, a priori specification of the predominant symptom, as recorded by a physician on a checklist (in ulcer-like dyspepsia: epigastric pain; in dysmotility-like dyspepsia: discomfort, bloating, nausea, fullness or early satiety), demonstrated that the response was different across these subgroups, as shown in the figure.

This clinical trial data, as well as epidemiological and clinical data, led the Rome II Working Team to recommend sub-division of functional dyspepsia based on the predominant symptom in the most recent classification of functional dyspepsia.

It remains to be prospectively established that asking patients to rank their most predominant complaint will predict response to other therapy, but seems worthy of pursuit.

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Roy Pounder (London)

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Walter Peterson (Dallas)

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Gastroenterology

Miles Allison (Newport)
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Colin Howden (Chicago)

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Richard Hunt (Hamilton)

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Samuel Klein (St Louis)

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Richard Logan (Nottingham)

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Irvin Modlin (New Haven)

  
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Nick Talley (Sydney)

Hepatology

William Balistreri (Cincinnati)
Andrew
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Burroughs (London)

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Amar Dhillon (London)

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John Gollan (Omaha)

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Ray Koff (Framingham)

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Juan Rodés (Barcelona)

Endoscopy

Sydney Chung
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Rob Hawes (Charleston)

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Charlie Lightdale (New York)

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Thomas Röesch (Munich)

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Joseph Sung

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Jerome Waye (New York)

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