Evidence-based clinical practice guidelines for functional dyspepsia 2021

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.

Overlap of Gastroesophageal Reflux Disease and Functional Dyspepsia and Yield of Esophagogastroduodenoscopy in Patients Clinically Fulfilling the Rome IV Criteria for Functional Dyspepsia

“…Our study showed a very low rate of gastroduodenal ulcers and no upper gastrointestinal malignancies in such patients. The findings support the recommendation of recent Japanese guidelines on the management of FD, which states that esophagogastroduodenoscopy should be considered individually based on the clinical ground rather than being performed indiscriminately ( 20 ). However, these findings should be cautiously interpreted when extrapolated to other populations.…”

The Diagnostic Yield of Abdominal Ultrasounds Requested by Family Physicians at an Academic Hospital in Riyadh, Saudi Arabia

“…Utility of abdominal ultrasound for check-up or screening is only recommended for patients at higher risk of abdominal aortic aneurysm [ 17 ]. Lastly, abdominal ultrasonography is not typically recommended for patients presenting with dyspepsia unless there is a presence of red flags [ 18 ].…”

Smaller CO2 injection volume and lower gastric pressure induce bothersome symptoms in drug-resistant functional dyspepsia patients with less frequent belching

“…Acid suppression, acotiamide (prokinetic agent) and rikkunshito (Japanese herbal medicine) are recommended for the initial treatment of FD [ 10 ]. The second line treatment includes prokinetic agents except for acotimide and other Japanese herbal medicines except for rikkunshito [ 10 ]. However, patients in our study had persistent symptoms despite the use of these therapeutic agents.…”

“…The symptoms of patients in this group were not attenuated by the administration of proton pump inhibitors (PPIs) or prokinetic agents. In the present study, FD was diagnosed according to the criteria of evidence-based clinical guidelines for FD by the Japanese Society of Gastroenterology [ 10 ].…”