Therapeutic Options for Functional Dyspepsia

Abstract

Functional dyspepsia (FD) is defined by the presence of chronic gastroduodenal symptoms in the absence of organic or systemic disease that explains them, and a negative upper endoscopy. According to the Rome III consensus, FD can be subdivided into PDS (postprandial distress syndrome) and EPS (epigastric pain syndrome). In patients with mild symptoms, reassurance and lifestyle adjustments are often sufficient. Pharmacotherapy, for those with more severe or persisting symptoms, includes the use of proton pump inhibitors (PPIs), prokinetics and psychotropic agents. In those diagnosed with Helicobacter pylori infection, eradication is recommended, although the symptom impact is often limited. PPIs are the initial therapy of choice for EPS, while prokinetics can be used in PDS. Tricyclic antidepressants can be used for refractory symptoms, especially in EPS. Emerging therapies include the novel gastroprokinetic agent acotiamide for PDS, fundus-relaxing 5-HT_1A agonists in patients with PDS/early satiation and mirtazapine for FD with weight loss.

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

“…Mirtazepine therapy in a small randomized trial appeared to be superior to placebo in FD, but more data are needed [63]. Importantly, negative results in limited trials do not exclude a positive result with other antidepressants, and further studies are awaited [58].…”

Rapport sur l’utilisation des inhibiteurs de la pompe à protons : les recommandations françaises sont-elles respectées ?

“…Ainsi, certaines études européennes recommandent un traitement d'épreuve par IPP dans la dyspepsie fonctionnelle et le recours aux examens endoscopiques seulement en cas de persistance des symptômes [19][20][21]. De même, on note que si les IPP n'ont pas l'indication dans la prévention de l'ulcère de stress, certains facteurs de risques, tels qu'une intubation avec ventilation mécanique prolongée (> 48 heures) et la présence de troubles de la coagulation, pourraient justifier leur utilisation en réanimation, telle qu'observée dans 13 de nos observations, pourtant jugées « non conformes » faute d'AMM réglementaire [12,22].…”

Systematic review: Disease‐specific instruments to assess gastrointestinal symptoms in functional dyspepsia

“…Therefore, subdivision of patients into 2 diagnostic categories was proposed by the ROME IV criteria: (i) postprandial distress syndrome (PDS; presence of postprandial fullness and/or early satiety) and (ii) epigastric pain syndrome (EPS; presence of epigastric pain and/or epigastric burning) . The rationale for dividing patients into PDS and EPS subgroups was that classification might help to guide therapy, that is, prokinetics for patients with PDS and acid suppressive medication for patients with EPS . However, treatment of FD remains unsatisfactory in many patients for several reasons.…”

“…1,6 The rationale for dividing patients into PDS and EPS subgroups was that classification might help to guide therapy, that is, prokinetics for patients with PDS and acid suppressive medication for patients with EPS. 6,7 However, treatment of FD remains unsatisfactory in many patients for several reasons. First, development of novel therapies is hindered by the incompletely understood multifactorial pathophysiology.…”