Current treatments in functional dyspepsia

Abstract

By nature of the definition of functional dyspepsia (FD), organic causes have to be ruled out before therapy can be directed. However, in uninvestigated dyspepsia in the absence of alarm features, Helicobacter pylori "test and treat" or an empiric trial of acid suppression therapy for 4 to 8 weeks is reasonable. If alarm symptoms or signs are present, or if the dyspepsia symptoms first occur in those aged greater than 55 years, prompt esophagogastroduodenoscopy is mandatory to exclude serious disease and positively diagnose FD. Empiric acid suppression with H(2)-receptor antagonists or proton-pump inhibitors is superior to placebo in treatment of FD, but those patients with meal-related symptoms are least likely to respond. Helicobacter pylori eradication in FD benefits a minority of cases but is worthwhile, as response may be maintained. There is increasing evidence that some prokinetics may be superior to placebo in treatment of FD, but probably only a minority respond; those with meal-related symptoms may have the best response. Antidepressant therapy may have a place in management of difficult cases, but adequate randomized controlled trials are unavailable.

Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials

“…The management of functional dyspepsia (FD) remains challenging 1 2. FD, defined as unexplained epigastric pain or meal-related symptoms, may affect as many as one in six in the general population 3.…”

Evaluation of Helicobacter pylori eradication and drug therapy in patients with functional dyspepsia

“…Certain prokinetics may also be effective in the treatment of FD; patients with meal-related symptoms have the best response. Antidepressant therapy may also have a place in the management of difficult cases; however, adequate randomized controlled trials are unavailable (21). According to the study by Talley et al , targeted drugs that inhibit eosinophil production or eosinophil-derived products, including leukotriene-receptor antagonists, humanized monoclonal antibody against inter-leukin-5 and histamine 1 and 2 antagonists, may be effective for the treatment of FD (13).…”

“…In general, the approach to treating patients with FD based on their main symptom is practical and effective. Proton-pump inhibitors (PPIs), prokinetics, H. pylori eradication and antidepressant drugs are the common choices for the treatment of FD (21). …”