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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Univ.-Prof. Dr. Georg Stacher
Psychophysiologisches Laboratorium
Währinger Gürtel 18-20
1090 Wien
Österreich
Email: georg.stacher@akh-wien.ac.at
