Clinical Practice Guidelines for Functional Dyspepsia in Korea

Abstract

Functional dyspepsia (FD) is a chronic upper gastrointestinal (GI) symptom complex that routine diagnostic work-up, such as endoscopy, blood laboratory analysis, or radiological examination, fails to identify a cause. It is highly prevalent in the World population, and its response to the various available therapeutic strategies is only modest because of the heterogenous nature of its pathogenesis. Therefore, FD represents a heavy medical burden for healthcare systems. We constituted a guideline development committee to review the existing guidelines on the management of functional dyspepsia. This committee drafted statements and conducted a systematic review and meta-analysis of various studies, guidelines, and randomized control trials. External review was also conducted by selected experts. These clinical practice guidelines for FD were developed based on evidence recently accumulated with the revised version of FD guidelines released in 2011 by the Korean Society of Neurogastroenterology and Motility. These guidelines apply to adults with chronic symptoms of FD and include the diagnostic role of endoscopy, Helicobacter pylori screening, and systematic review and meta-analyses of the various treatment options for FD (proton pump inhibitors, H. pylori eradication, and tricyclic antidepressants), especially according to the FD subtype. The purpose of these new guidelines is to aid the understanding, diagnosis, and treatment of FD, and the targets of the guidelines are clinicians, healthcare workers at the forefront of patient care, patients, and medical students. The guidelines will continue to be revised and updated periodically.

Keywords: Dyspepsia; Endoscopy; Evidence-based medicine; Guideline; Proton pump inhibitors.

Figure 1

Forest plot of randomized controlled trials comparing proton pump inhibitors (PPIs) with placebo in patients with functional dyspepsia.

Figure 2

Forest plot of randomized controlled trials comparing proton pump inhibitors (PPIs) with placebo in patients with functional dyspepsia according to the relief of global symptom.

Figure 3

Forest plot of randomized controlled trials comparing proton pump inhibitors (PPIs) with placebo in functional dyspepsia patients according to the treatment duration.

Figure 4

Forest plot of randomized controlled trials comparing proton pump inhibitors (PPIs) with placebo in functional dyspepsia patients according to the predominant symptom.

Figure 5

Forest plot of randomized controlled trials comparing Helicobacter pylori eradication with placebo antibiotics in H. pylori infected patients with functional dyspepsia. HP, Helicobacter pylori.

Figure 6

Forest plot of randomized controlled trials comparing tricyclic antidepressants (TCAs) with placebo in patients with functional dyspepsia.

Figure 7

Forest plot of adverse events in randomized controlled trials comparing tricyclic antidepressants (TCAs) with placebo in patients with functional dyspepsia.