[When you get a gut feeling...].

Functional disorders like functional dyspepsia, irritable bowel syndrome and non-cardiac chest pain are common diseases. No organic lesion can be found to explain the often disabling symptoms. Typical features of functional dyspepsia are anxiety, depression, neuroticism, visceral hypersensitivity, abnormal autonomic nerve activity with a weak vagal and an higher sympathetic tone, and impairment of gastric accommodation. This last abnormality may be due to weak vagal tone and poor adaptive relaxation of the proximal stomach. The degree of dysfunction of the variables is sometimes correlated, suggesting that the pathogenetic factors may be interacting in a viscious circle. Medical therapy is often unsuccessful, but extensive research in the field has given better insight into the pathophysiological mechanisms, giving hope for new therapeutic modalities, including visceral analgesics. It may still be difficult, however, to distinguish organic from functional disorders. Reliable tests of visceral hypersensitivity would be helpful in this respect.