Causes and treatment of functional dyspepsia

Abstract

Functional dyspepsia is a clinical syndrome defined by upper abdominal symptoms without identifiable cause by conventional diagnostic means. Recent studies have established that functional dyspepsia is a heterogeneous disorder in which different pathophysiologic disturbances underlie different symptom profiles. Delayed gastric emptying is associated with postprandial fullness, nausea, and vomiting; impaired accommodation is associated with early satiety and weight loss; and hypersensitivity to gastric distention is associated with epigastric pain, belching, and weight loss. The pathogenesis of functional dyspepsia is unknown but may be postinfectious in a subgroup of patients. The role of psychological disturbances and of duodenal hypersensitivity requires further study. Treatment of the underlying pathophysiologic abnormality seems logical, but options for pharmacotherapy are limited to acid suppression, prokinetic drugs, and antidepressants. Psychotherapy can be considered for refractory patients. Several novel drug therapies are under evaluation.

Aktuelle Konzepte zur funktionellen Dyspepsie

“…Somit resultiert eine beschleunigte Magenpassage [31]. Diese Störung der gastralen Funktion kann mittels entsprechender Diagnostik identifiziert und quantifiziert werden.…”

Therapeutic strategies for functional dyspepsia and the introduction of the Rome III classification

“…47,48 Drugs that relax the gastric fundus [e.g., tegaserod, cisapride, sumatriptan, buspirone, clonidine, some selective serotonin reuptake inhibitors (SSRIs), and nitric oxide (NO) donors] may theoretically improve some symptoms of dysmotility-like dyspepsia (e.g., early satiety), but adequate RCTs are lacking. 49 In 2002, Hallerback et al 50 compared the efficacy of mosapride, a 5-hydroxytryptamine 4 (HT 4 )-receptor agonist, compared with placebo in the treatment of FD (Table 2) in a double-blind, prospective, multicenter, multinational study and found that treatment of FD with mosapride was not superior to placebo. On the other hand, Otaka et al 51 evaluated the efficacy of an H 2 RA (famotidine) and mosapride by randomizing FD patients to receive famotidine (20 mg/day) or mosapride (15 mg/day) for 4 weeks and demonstrated that both famotidine and mosapride had beneficial effects regardless of FD subtype or age and sex of the patient, with no significant difference in the efficacy of these two drugs in relieving FD symptoms.…”

Modelo Procesual del estrés de la Dispepsia Funcional : implicaciones para la evaluación y el tratamiento

“…La creciente evidencia en torno a la interrelación de diferentes factores psicosociales en la DF apoya incluir dentro de la intervención médica de esta enfermedad, la evaluación y el tratamiento psicológi-co, con el fin de incidir positivamente en la curación de los síntomas y mejorar la calidad de vida, tal como has sido sugerido recientemente (Tack et al, 2001;Tobón, Vinaccia y Sandín, 2003b).…”

“…Algunos autores recomiendan el empleo de ésta sólo cuando el tratamiento farmacológico falla y hay presencia de trastornos psicopatológicos (Tack et al, 2001;Tarilonte, 2002). Sin embargo, es factible que el empleo de la terapia psicológica desde el comienzo mejore de forma significativa el pronóstico y contribuya a una mejor calidad de vida en muchos pacientes.…”

“…El diagnóstico de la DF implica, por lo tanto, descartar otras enfermedades del sistema digestivo que frecuentemente tienen síntomas similares tales como la úlcera péptica, la enfermedad por reflujo gasfro-esofágico, el síndrome de colon irritable, y el cán-cer gástrico, entre otras (Berstad et al 2001;Talley et al 2000;Tack et al 2001).…”