Asian consensus report on functional dyspepsia

Abstract

Background/aims: Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia.

Methods: Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group.

Results: Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added.

Conclusions: This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.

Keywords: Asia; Diagnosis; Epidemiology; Functional dyspepsia; Management; Pathophysiology.

Figure 1

Diagnostic algorithm for functional dyspepsia in Asian primary care settings. ^aDyspepsia refers to a symptom or set of symptoms that are considered to originate from the gastroduodenal region. The dyspeptic symptoms are epigastric pain, epigastric burning, postprandial fullness, early satiation and other symptoms including bloating in the upper abdomen, nausea, vomiting and belching. Chronic dyspeptic symptoms can be continuous, intermittent or recurrent. More than two thirds of the consensus members agreed that symptom duration of 3 months or longer might be enough. ^bThe alarm features are unintended weight loss, progressive dysphagia, recurrent or persistent vomiting, evidence of gastrointestinal bleeding, anemia, fever, family history of gastric cancer, new onset dyspepsia in the subjects over 40 years of age in population with high prevalence of upper gastrointestinal malignancy and over 45 and 50 years in populations with intermediate and low prevalence, respectively. ^cThe appropriate choice from the three options depends on patient's symptom profiles, patient's wish, local risk of Helicobacter pylori infection and gastric cancer as well as local health care or re-imbursement system. H. pylori, Helicobacter pylori.

Figure 2

Management algorithm for functional dyspepsia in Asian primary care settings. ^aWhere socio-economic conditions allow, Helicobacter pylori test and eradication should be part of the management strategy for all patients presenting with dyspepsia in Asia. ^bSpecific food ingredients may provoke dyspeptic symptoms. Dietary modification can be considered in functional dyspepsia but data are lacking. ^cWhere there is any available herbal medication previously validated, it may be tried. H. pylori, Helicobacter pylori.