British Society of Gastroenterology guidelines on the management of functional dyspepsia

Abstract

Functional dyspepsia (FD) is a common disorder of gut–brain interaction, affecting approximately 7% of individuals in the community, with most patients managed in primary care. The last British Society of Gastroenterology (BSG) guideline for the management of dyspepsia was published in 1996. In the interim, substantial advances have been made in understanding the complex pathophysiology of FD, and there has been a considerable amount of new evidence published concerning its diagnosis and classification, with the advent of the Rome IV criteria, and management. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based diagnosis and treatment of patients. The approach to investigating the patient presenting with dyspepsia is discussed, and efficacy of drugs in FD summarised based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of pairwise and network meta-analyses. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system. These provide both the strength of the recommendations and the overall quality of evidence. Finally, in this guideline, we consider novel treatments that are in development, as well as highlighting areas of unmet need and priorities for future research.

Diagnostic yield of upper gastrointestinal endoscopy in patients attending a UK centre with symptoms compatible with Rome IV functional dyspepsia

“…Of interest, our study found limited testing for H.pylori, and a relatively low use of neuromodulators, which if addressed can be effective in treating FD. [21][22][23] In summary, there is a drive to curb unnecessary endoscopies and our data will help support such decision-making policies.…”

“…Of note, recent British, European, and North American guidelines do suggest that patients with dyspepsia can be managed without endoscopy if there are no alarm symptoms or risk factors. [21][22][23] They acknowledge that the diagnostic yield of upper GI endoscopy in this cohort is minimal and not costeffective. In such instances, the British guidelines commit to a positive diagnosis of FD and recommend a clear explanation with patient-centred discussion followed by a step-wise treatment algorithm.…”

“…In such instances, the British guidelines commit to a positive diagnosis of FD and recommend a clear explanation with patient-centred discussion followed by a step-wise treatment algorithm. 21 However, European and North American guidelines classify them as having uninvestigated dyspepsia, albeit propose treatments tailored to FD. 22,23 Arguably, using the term uninvestigated dyspepsia does not clearly inform the patient and could imply diagnostic uncertainty.…”

Bibliometric analysis of functional dyspepsia research trends over the past 20 years

“…In addition, patients with postprandial distress syndrome or bloating were better treated with the FODMAP diet. However, the latest guidelines of the British Society of Gastroenterology on FD pointed out that there is currently insufficient evidence to support dietary therapy ( 28 ). In future research, we should try our best to carry out large-scale RCT experiments of FD diet therapy and explore personalized dietary treatment plans, so as to obtain reliable and real data from large samples to provide guidance for clinical treatment.…”

“It’s a helluva journey”: A qualitative study of patient and clinician experiences of nausea and vomiting syndromes and functional dyspepsia

“…An incomplete understanding of the underlying pathology, heterogeneous symptom presentation, and lack of organic biomarkers for these disorders poses challenges to clinical diagnosis 2,[10][11][12] . Although a number of international guidelines exist for the management of NVS and FD, these often lack quantitative evidence-based data, resulting in controversy regarding how these conditions are defined and clinically managed 13,14 . An absence of multidisciplinary approaches and limited availability of pharmacological treatments have been identified as key challenges to the management of these conditions 15 .…”