This review critically evaluates the current status of dyspepsia and, in particular, recent advances in epidemiology, pathophysiology and management. The very definition of dyspepsia and of functional dyspepsia, in particular, continues to generate controversy; the Rome III redefinition of functional dyspepsia remains to be proven to be of clinical value. Overlap with gastroesophageal reflux and irritable bowel syndrome further complicate clinical definitions.Most studies of pathophysiology continue to focus on gastric sensory and motor functions, though some intriguing early data raise the possibility of an infective or immunological contribution. There have been few, if any, major breakthroughs in treatment; most recent studies address instead the niceties of Helicobacter pylori eradication and acid suppressive strategies.This continued lack of progress in the area can only lead one to question some very basic concepts in this disorder, such as does functional dyspepsia, as we have come to know it, really exist as a distinct entity?