The Diagnosis and Treatment of Functional Dyspepsia

Abstract

Background: Functional dyspepsia (FD) is one of the more common functional disorders, with a prevalence of 10-20%. It affectsthe gastrointestinal tract.

Methods: This article is based on publications retrieved by a selective search of PubMed, with special attention to controlled trials, guidelines, and reviews.

Results: Typical dyspeptic symptoms in functional dyspepsia include epigastric pain, sensations of pressure and fullness, nausea, and early subjective satiety. The etiology of the disorder is heterogeneous and multifactorial. Contributory causes include motility disturbances, visceral hypersensitivity, elevated mucosal permeability, and disturbances of the autonomic and enteric nervous system. There is as yet no causally directed treatment for functional dyspepsia. Its treatment should begin with intensive patient education regarding the benign nature of the disorder and with the establishment of a therapeutic pact for long-term care. Given the absence of a causally directed treatment, drugs to treat functional dyspepsia should be given for no more than 8-12 weeks. Proton-pump inhibitors, phytotherapeutic drugs, and Helicobacter pylori eradication are evidence-based interventions. For intractable cases, tricyclic antidepressants and psychotherapy are further effective treatment options.

Conclusion: The impaired quality of life of patients with functional dyspepsia implies the need for definitive establishment of the diagnosis, followed by symptom-oriented treatment for the duration of the symptomatic interval.

Figure 1

Definition of functional dyspepsia according to the Rome IV criteria (1)

Figure 2

Diagnostic procedure in patients with dyspeptic symptoms (1, 28). H.p., Helicobacter pylori; EGD, esophagogastroduodenoscopy

Figure 3

Treatment algorithm for dyspepsia, modified from (1)