United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

Lucas Wauters¹, Ram Dickman², Vasile Drug³, Agata Mulak⁴, Jordi Serra⁵, Paul Enck⁶, Jan Tack¹; ESNM FD Consensus Group; Anna Accarino⁷, Giovanni Barbara⁸, Serhat Bor⁹, Benoit Coffin¹⁰, Maura Corsetti¹¹, Heiko De Schepper¹², Dan Dumitrascu¹³, Adam Farmer¹⁴, Guillaume Gourcerol¹⁵, Goran Hauser¹⁶, Trygve Hausken¹⁷, George Karamanolis¹⁸, Daniel Keszthelyi¹⁹, Carolin Malagelada⁷, Tomislav Milosavljevic²⁰, Jean Muris²¹, Colm O'Morain²², Athanassos Papathanasopoulos²³, Daniel Pohl²⁴, Diana Rumyantseva²⁵, Giovanni Sarnelli²⁶, Edoardo Savarino²⁷, Jolien Schol¹, Arkady Sheptulin²⁵, Annemieke Smet²⁸, Andreas Stengel^{29

30

31

32}, Olga Storonova²⁵, Martin Storr³⁰, Hans Törnblom³³, Tim Vanuytsel¹, Monica Velosa³⁴, Marek Waluga³⁵, Natalia Zarate³⁶, Frank Zerbib³⁷

Affiliations

¹ Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
² Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel.
³ University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania.
⁴ Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
⁵ University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.
⁶ Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
⁷ CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain.
⁸ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁹ Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey.
¹⁰ Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France.
¹¹ NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
¹² Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
¹³ 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁴ Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
¹⁵ Physiology Department, Rouen University Hospital, Rouen, France.
¹⁶ Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia.
¹⁷ Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway.
¹⁸ Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁰ Department of Gastroenterology, Euromedik Hospital Belgrade, Belgrade, Serbia.
²¹ Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands.
²² Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland.
²³ Private Practice, Ioannina, Greece.
²⁴ Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
²⁵ I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.
²⁶ Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
²⁷ Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
²⁸ Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
²⁹ Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany.
³⁰ Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
³¹ Center of Endoscopy, Starnberg, Germany.
³² Ludwig-Maximilians-University, Munich, Germany.
³³ Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
³⁴ Sheba Medical Center, Tel Hashomer, Israel.
³⁵ Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
³⁶ Gastrointestinal Physiology Unit, University College London Hospital, London, UK.
³⁷ CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France.

PMID: 33939891
PMCID: PMC8259261
DOI: 10.1002/ueg2.12061

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

Lucas Wauters et al. United European Gastroenterol J. 2021 Apr.

. 2021 Apr;9(3):307-331.

doi: 10.1002/ueg2.12061.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
² Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel.
³ University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania.
⁴ Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
⁵ University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.
⁶ Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
⁷ CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain.
⁸ Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
⁹ Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey.
¹⁰ Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France.
¹¹ NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
¹² Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
¹³ 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
¹⁴ Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
¹⁵ Physiology Department, Rouen University Hospital, Rouen, France.
¹⁶ Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia.
¹⁷ Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway.
¹⁸ Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
²⁰ Department of Gastroenterology, Euromedik Hospital Belgrade, Belgrade, Serbia.
²¹ Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands.
²² Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland.
²³ Private Practice, Ioannina, Greece.
²⁴ Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
²⁵ I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.
²⁶ Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
²⁷ Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
²⁸ Laboratory of Experimental Medicine and Pediatrics and InflA-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.
²⁹ Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany.
³⁰ Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
³¹ Center of Endoscopy, Starnberg, Germany.
³² Ludwig-Maximilians-University, Munich, Germany.
³³ Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
³⁴ Sheba Medical Center, Tel Hashomer, Israel.
³⁵ Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland.
³⁶ Gastrointestinal Physiology Unit, University College London Hospital, London, UK.
³⁷ CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France.

PMID: 33939891
PMCID: PMC8259261
DOI: 10.1002/ueg2.12061

Abstract

Background: Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis.

Methods: A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements.

Results: The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable.

Conclusions and inferences: A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.

Keywords: consensus; endoscopy; evidence-based medicine; functional dyspepsia; proton pump inhibitors.

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Conflict of interest statement

Drafted consensus questions, drafted literature review sections, set up the voting and summaries access, participated in voting, summarized voting outcomes, reviewed and corrected the manuscript: L. Wauters. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: R. Dickman. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: V. Drug. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: A. Mulak. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: J. Serra. Co‐initiated the process, obtained funding , drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected manuscript content: P. Enck. Co‐initiated the process, drafted consensus questions, drafted literature review sections, wrote manuscript sections, participated in voting, wrote manuscript, reviewed and corrected content: J. Tack. Drafted consensus questions, wrote manuscript sections, participated in voting, reviewed and corrected content: All members of the ESNM FD consensus group (A. Accarino, G. Barbara, S. Bor, B. Coffin, M. Corsetti, H. De Schepper, D. Dumitrascu, A. Farmer, G. Gourcerol, G. Hauser, T. Hausken, G. Karamanolis, D. Kestzhelyi, C. Malagelada, T. Milosavljevic, J. Muris, C. O'Morain, A. Papathanasopoulos, D. Pohl, D. Rumyantseva, G. Sarnelli, E. Savarino, J. Schol, A. Sheptulin, A. Smet, A. Stengel, O. Storonova, M. Storr, H. Törnblom, T. Vanuytsel, M. Velosa, M. Waluga, N. Zarate, F. Zerbib).

Figures

**FIGURE 1**
Schematic representation, in an algorithm‐like fashion, of the outcome of the consensus on functional dyspepsia management. The blue arrows depict the diagnostic and therapeutic flow of the patient. Green arrows refer to risk or pathophysiological factors. The circles depict the % of agreement, using a green color for ≥80% consensus, light orange for consensus between 70% and 80%, and dark orange for lower levels of consensus

See this image and copyright information in PMC

References

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United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

Affiliations

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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MeSH terms

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LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical