[Chronic upper abdominal pain: Diagnostic and therapeutic algorithm].

Between 20% and 40% of the population have chronic or recurrent upper abdominal pain, frequently in combination with other dyspeptic symptoms. In about 50% of patients, who visit a doctor because of these complaints, symptoms are caused by an organic disease, whereas the other patients suffer from functional disturbances. Currently, the Rome III-criteria are established for diagnosis of functional dyspepsia. They request epigastric pain burning, bothersome postprandial fullness and/or early satiety and absence of structural disease that is likely to explain the symptoms. These criteria need to have been fulfilled for the previous 3 months with symptom onset at least 6 months before diagnosis. For exclusion of organic disease performance of an upper endoscopy is required. Some experts also recommend to investigate routine laboratory parameters and to perform an abdominal ultrasound investigation. Only in young patients who present with typical and moderate symptoms and have no alarm symptoms, probatory therapy without previous technical investigations and, thus, without final establishment of the diagnosis, may be considered. If they do not respond adequately within 4 weeks, these patients also have to undergo further diagnostic testing. Therapeutic options for functional dyspepsia are limited. They include the clear explanation of the diagnosis, consideration of factors that trigger or ameliorate symptoms and application of drugs such as certain herbal remedies, acid suppressing drugs and/or prokinetics.