Dear Editor,

The definition of dyspepsia is only based on symptoms and chronology ¹. When diagnostic tests are performed in order to find a cause, we talk about investigated dyspepsia. When we find an actual cause, we call it secondary or organic dyspepsia, and when every test is normal, functional dyspepsia (FD). There has been a huge effort since the establishment of the Rome I criteria (RC-I) until the present Rome IV (RC-IV) criteria ² to define and gather the dyspeptic symptoms into GERD, irritable bowel disease and FD.

Aziz et al. recently reported that around one in every ten people within the general population (GP) in the USA (12%), Canada (8%) and UK (8%) fulfilled the RC-IV criteria for FD (5,931 people studied), resulting in an uninvestigated dyspepsia. These results indicate an overestimation of the actual prevalence of the FD in the GP. Bearing in mind that the numbers would decrease after performing an upper endoscopy ², the prevalence of RC-IV FD is greater than the prevalence of actual FD. According to a previous study ⁴ of a random sample of 264 people from the GP (the prevalence of dyspepsia was 23.9% with CR-I), we found a pathological upper endoscopy in 28.6% of the dyspeptic individuals. Meaning that, 71.4% of cases had an FD and the prevalence of FD in our GP was 17.1% (RC-1). When we apply the RC-IV for DF, only 57.1% of the dyspeptic individuals and 13.6% of our GP fulfilled the criteria. The prevalence of FD in our GP was 9.5% (RC-IV) (Table 1). To conclude, the prevalence of FD in our GP was 17.1% (RC-I) or 9.5% (RC-IV), which means that we can assume a excluding rigidity (≈55% lower) with the actual RC-IV. The prevalence of dyspepsia and FD in different GP whose variability depends on epidemiologic factors and the rigidity of the applied criteria are shown in Table 1.

Table 1 Prevalence of dyspepsia and functional dyspepsia in different populations around the world (5) 

*Definition of dyspepsia: pain or upper abdominal discomfort, chronic or recurrent of at least 12 weeks duration, not necessarily consecutive, within the preceding 12 months (1). Figures from our study appear in parentheses.