Functional dyspepsia

Abstract

| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

The effect of rikkunshito on gastrointestinal symptoms and gastric motor function: The first study in a Belgian functional dyspepsia population

“…5,9 Due to the heterogeneous nature of FD in terms of symptoms and underlying pathophysiology, finding effective treatment options for FD has been challenging. 5 Gastric accommodation, the relaxation reflex of the stomach upon food intake, is impaired in approximately 40% of FD patients and has been shown to be associated with early satiation and weight loss.…”

“…5,9 Due to the heterogeneous nature of FD in terms of symptoms and underlying pathophysiology, finding effective treatment options for FD has been challenging. Its putative benefit for European patients and mechanism of action has not been established.…”

Acotiamide affects antral motility, but has no effect on fundic motility, gastric emptying or symptom perception in healthy participants

“…Both subgroups are suggested to have different underlying pathophysiological mechanisms causing the symptoms . The heterogeneous character of FD in terms of symptoms and pathophysiological mechanisms makes it difficult to find treatment options that are effective for the majority of patients . The two main categories of drugs used to treat FD are acid suppressive drugs and prokinetic agents .…”

Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

“…Regulatory authorities such as the Federal Drug Administration (FDA) and the European Agency for the Evaluation of Medicinal Products rely on the Rome criteria when clinical trials are planned and assessed. Equally pharmaceutical companies rely on the Rome classification (or other accepted disease categories) and subsequent recommendations when they plan clinical trials and ultimately make substantial investment into new treatments that are now available or are under development 6. However, while these treatments may target the underlying pathophysiology in some patients, the gain over placebo is usually small7 and they have in common that—based on symptoms—even apparently homogenous FGID subgroups have a response to therapy that is at best difficult to predict.…”