Drugs under development for the treatment of functional dyspepsia and related disorders

Abstract

Introduction: Functional dyspepsia (FD), defined as the presence of chronic functional symptoms originating from the gastroduodenum, is one of the most common functional gastrointestinal disorders. FD is subdivided into postprandial distress syndrome (PDS), with meal-related symptoms such as postprandial fullness and early satiation, and epigastric pain syndrome (EPS), with meal-unrelated symptoms such as epigastric pain or burning. In spite of its prevalence, therapeutic options for FD are very limited, probably reflecting the complex pathophysiology which comprises disorders of gastric sensorimotor function as well as low grade duodenal inflammation. Areas covered:This review summarizes recent and ongoing drug development for FD as identified from a literature search was conducted on Pubmed and other sources. Expert opinion:Proton pump inhibitors (PPIs) are the traditional first-line therapy; potassiumcompetitive acid blockers are being studied. Ongoing drug development focuses on gastric motility with prokinetics (dopamine-2 antagonists and 5-HT4 agonists) and fundus relaxant therapies (acotiamide, azapirones), and on sensitivity with peripherally (guanylate cyclase and cannabinoid agonists) and centrally acting neuromodulators.Drugs under development for gastroparesis may also be efficacious in PDS. There are emerging data with pro-and antibiotics and several studies with phytotherapeutic agents. Duodenal low-grade inflammation is a newly emerging target which may respond also to PPIs, histamine and leukotriene receptor blockers.

Rome III, Rome IV, and Potential Asia Symptom Criteria for Functional Dyspepsia Do Not Reliably Distinguish Functional From Organic Disease

“…To the best of our knowledge, this study was not only the first to compare the accuracy of the Rome IV and Rome III criteria in identifying patients with FD but also the first to test the accuracy of the potential Asia criteria in identifying FD. FD is one of the most common clinical diseases due to its high incidence and its chronic recurrence nature ( 7 , 23 , 24 ). The Rome IV criteria were published in 2016; previous studies comparing Rome IV with Rome III standards were mostly conducted in children ( 25 – 27 ) and were mostly about irritable bowel syndrome ( 28 – 30 ).…”

“…Dyspepsia can be subdivided into 2 subgroups: functional dyspepsia (FD) and organic dyspepsia. FD is defined as recurrent or chronic functional symptoms that are believed to originate from the gastroduodenal region without any structural abnormalities ( 6 , 7 ). Because of constant medical visits and continuous medication use, dyspeptic symptoms cause substantial socioeconomic burden ( 8 , 9 ), negatively affect the quality of daily life, and cause significant economic losses ( 10 – 13 ).…”

Management of Dyspepsia and Gastroparesis in Patients with Diabetes. A Clinical Point of View in the Year 2021

“…Acotiamide is a prokinetic, currently approved for use in Japan and India for FD. It inhibits pre-sinaptic acetil-cholinesterase and antagonized presynaptic M1 and M2 receptors and it seems to relieve PDS symptoms, with a good tolerability [ 53 , 54 ].…”

“…In fact, triciclic antidepressant therapy (TCAs), such as amitriptyline, showed to relieve abdominal pain and improve the quality of life in patients with dyspepsia [ 55 , 56 ]. Data on serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are controversial as some studies showed an efficacy similar to TCAs [ 57 ], while other studies did not demonstrate any efficacy in symptom relief [ 53 ]. In the clinical setting the decision between prokinetics and TCAs should be made on a case-by-case basis [ 5 ].…”

Effect of Artemisia rupestris L. Extract on Gastrointestinal Hormones and Brain‐Gut Peptides in Functional Dyspepsia Rats

“…Compared with single-receptor drugs, herbal medicine can exert a wider range of pharmacological effects. In addition, most patients believe that they have lower side effects although this has not been verified [10]. For example, traditional Chinese medicines such as Xiaoerfupi [11], Fructus aurantii [12], and Sini-San [13] have all been shown to be effective in the treatment of FD.…”