Failed Therapy and Directions for the Future in Dyspepsia

Abstract

Functional gastrointestinal disorders including functional dyspepsia are highly prevalent. Their clinical course is benign without disease-associated mortality. On the other hand, the impact can be substantial for the affected patients with regard to the decrease of quality of life, and for society with regard to the economical implications. Functional dyspepsia is a clinical syndrome with various underlying pathophysiologies. Thus, it is understandable that there is no single cure available. Reassurance by ruling out relevant differential diagnoses, explanation, and general advice with regard to the underlying causes and dietary and life-style measures are important components of the management of these patients. Well established medical treatments include Helicobacter pylori eradication, acid inhibitory agents and prokinetics. The overall gain over placebo ranges from less than 5% for H. pylori eradication to 15% for antisecretory agents and prokinetics. Thus, even considering a substantial proportion of patients with spontaneous remissions (usually addressed as placebo response in clinical trials), there are 20 to 40% of patients who do not respond properly to these measures. In these patients, other treatment modalities need to be considered. These second- or third-line measures include herbal medicines and psychotropic agents. Some of the herbal preparations have been well studied in controlled clinical trials with sufficient scientific evidence to assume efficacy. Psychotropic drugs on the other hand have, as yet, not been specifically tested in functional dyspepsia. Medications such as clonidine, buspirone or octreotide can be helpful in few selected patients. However, a very careful assessment of potential risks and benefits needs to be undertaken on a case-by-case basis. Other evidence-based measures include psychological interventions such as psychotherapy and hypnotherapy.

A placebo‐controlled trial of an oral capsaicin load in patients with functional dyspepsia

“…The capsaicin test had good specificity for the diagnosis of functional dyspepsia, a fact that we have similarly seen in an open label study of the same test, 14 and in the case of a positive test, the likeliness of the diagnosis of functional dyspepsia was significantly increased. Thus, the test provides reliable results and might be a helpful adjunct in the diagnostic work‐up for the reassurance of patients and doctors, which is considered an important component of the management of this disease 37 …”

“…Thus, the test provides reliable results and might be a helpful adjunct in the diagnostic work-up for the reassurance of patients and doctors, which is considered an important component of the management of this disease. 37 The stimulatory properties of capsaicin, which give rise to a hot and painful sensation, are due to its activation of the transient receptor potential ion channel of the vanilloid type 1 (TRPV1), 38 a polymodal nocisensor on nociceptive afferent neurones that is expressed on sensory neurons distributed in all regions of the GI tract in myenteric ganglia, muscle layers, and mucosa. 39 The TRPV1 has been recognized to play an important role in visceral nociception.…”

Efficacy of acupuncture treatment for functional dyspepsia: A systematic review and meta-analysis

“…4 Functional dyspepsia can be treated with drugs based on various mechanisms of action, but satisfactory effects may not be achieved. 5 Acupuncture treatment (AT) is commonly used in Korea and other Asian countries to treat functional dyspepsia, and its effects have been investigated in Europe and America. [6][7][8] Assessing the effect of AT for functional dyspepsia will benefit patients with functional dyspepsia.…”

Anethole restores delayed gastric emptying and impaired gastric accommodation in rodents

“…However, for the treatment of FD patients using these drugs has resulted in -4 -unsatisfactory outcomes [9]. Given that their corresponding endogenous molecules regulate other physiological functions, however, the use of these drugs is restricted clinically due to potential adverse effects [10,11].…”