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Review
. 2022 Feb;57(2):47-61.
doi: 10.1007/s00535-021-01843-7. Epub 2022 Jan 21.

Evidence-based clinical practice guidelines for functional dyspepsia 2021

Hiroto Miwa  1   2 , Akihito Nagahara  3 , Akihiro Asakawa  3 , Makoto Arai  3 , Tadayuki Oshima  3 , Kunio Kasugai  3 , Kazuhiro Kamada  3 , Hidekazu Suzuki  3 , Fumio Tanaka  3 , Kazunari Tominaga  3 , Seiji Futagami  3 , Mariko Hojo  3 , Hiroshi Mihara  3 , Kazuhide Higuchi  3 , Motoyasu Kusano  3 , Tomiyasu Arisawa  3 , Mototsugu Kato  3 , Takashi Joh  3 , Satoshi Mochida  3 , Nobuyuki Enomoto  3 , Tooru Shimosegawa  3 , Kazuhiko Koike  3
Affiliations
Review

Evidence-based clinical practice guidelines for functional dyspepsia 2021

Hiroto Miwa et al. J Gastroenterol. 2022 Feb.

Abstract

Background: Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. In Japan, FD became a disease name for national insurance in 2013, and has been gradually recognized, though still not satisfactory. Following the revision policy of Japanese Society of Gastroenterology (JSGE), the first version of FD guideline was revised this time.

Method: Like previously, the guideline was created by the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, the questions were classified to background questions (BQs, 24 already clarified issues), future research questions (FRQs, 9 issues cannot be addressed with insufficient evidence), and 7 clinical questions that are mainly associated with treatment.

Results and conclusion: These revised guidelines have two major features. The first is the new position of endoscopy in the flow of FD diagnosis. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. The second feature is that the drug treatment options have been changed to reflect the latest evidence. The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), and Japanese herbal medicine (rikkunshito). The second-line treatment includes anxiolytics /antidepressant, prokinetics other than acotiamide (dopamine receptor antagonists, 5-HT4 receptor agonists), and Japanese herbal medicines other than rikkunshito. The patients not responding to these treatment regimens are regarded as refractory FD.

Keywords: Algorithm; Antianxiety drug; Antidepressant; Chronic gastritis; Dyspepsia; Guideline; H. pylori eradication treatment; H. pylori-associated dyspepsia; Japanese traditional medicine; Prokinetics; Proton pump inhibitor.

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Conflict of interest statement

Any financial relationship with enterprises, businesses or academic institutions in the subject matter or materials discussed in the manuscript are as follows: (1) those from which the authors, the spouse, partner or immediate relatives of the authors have received individually any income, honoraria or any other type of remuneration; Astellas Pharma, AstraZeneca, Otsuka Pharmaceutical, Daiichi Sankyo, Takeda Pharmaceutical, Kobayashi Pharmaceutical, Mochida Pharmaceutical, Tsumura & CO., Fujifilm Medical, EA Pharma, Zeria Pharmaceutical, Sumitomo Dainippon Pharma, Mylan EPD, LIXIL, and (2) those from which the authors have received research grant: Taiho Pharmaceutical, Tsumura & CO, Bristol-Myers Squibb, Tosoh, and (3) those from which the authors have received scholarship; Astellas Pharma, AbbVie, EA Pharma, Eisai, MSD, Ono Pharmaceutical, Covidien Japan, Taiho Pharmaceutical, Takeda Pharmaceutical, Chugai Pharmaceutical, Novartis Pharma, Bayer Yakuhin, Asahi Kasei Pharma, Nippon Kayaku, Mochida Pharmaceutical, Zeria Pharmaceutical, Daiichi Sankyo, Taiho Pharmaceutical, Chugai Pharmaceutical, Eli Lilly Japan, Dainippon Pharma, Saisei Mirai Clinics, Welfare Kyushu Hospital, Kracie Pharmaceutical, Tsukasa Health Care Hospital, Tsumura & CO, Mitsubishi Tanabe Pharma, Fujifilm Medical, and (4) those from which the authors have received individually endowed chair; Kinshukai.

Figures

Fig. 1
Fig. 1
Algorithm for the diagnosis and treatment of functional dyspepsia (FD)
See this image and copyright information in PMC

References

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