Functional dyspepsia: A critical appraisal of the European consensus from a global perspective

Abstract

The European Society for Neurogastroenterology and Motility's (ESNM) consensus document on functional dyspepsia (FD) has provided a critical review of the evidence for 36 statements highly relevant to the diagnosis and treatment of FD. We provide here our expert opinion on the North American, Australian and Asian assessments of the same topics discussed, and provide evidence where the ESNM consensus may deviate from those in the other continents. New and exciting data about the pathogenesis of FD are emerging including the possible central role of duodenal micro‐inflammation (most notably eosinophilic duodenitis and intestinal mast cell disease), but this is a very dynamic field with several gaps remaining in our understanding that are summarized in this review. Identification of non‐invasive biomarkers and testing of targeted therapies, including assessing the benefits of multidisciplinary teams in the management of FD, should be future priorities.

Eosinophil and Mast Cell Counts in the Stomach and Duodenum of Patients with Functional Dyspepsia without a Helicobacter pylori infection

“…20 Recently, duodenal pathology, such as eosinophilic infiltration, has been suggested as an important mechanism for FD. 14,21 Accordingly, it is essential to determine if the conventional symptom-based subtypes could also reflect the status of the duodenal pathology. The eosinophils and mast cell counts in the duodenum and stomach were examined according to symptom-based subtypes of FD, and no differences were found among the subtypes.…”

Editorial: Functional dyspepsia in pregnancy—Distinct approaches to a special population

“…Most consensus statements agree that in cases of diagnostic uncertainty, upper endoscopy becomes a mandatory step in FD diagnosis. 6 However, the recognised low diagnostic yield 7 and procedural risks to mother and foetus shift the balance against endoscopic evaluation of dyspepsia in pregnancy. Initial non-invasive Helicobacter pylori testing and eradication ('test-and-treat') is also recommended early in the FD diagnostic and therapeutic approach.…”

“…As a disorder defined by symptom‐based criteria, the diagnosis of FD can be challenging, and is further complicated by the physiologic changes of pregnancy imposed on the upper gastrointestinal tract. Most consensus statements agree that in cases of diagnostic uncertainty, upper endoscopy becomes a mandatory step in FD diagnosis 6 . However, the recognised low diagnostic yield 7 and procedural risks to mother and foetus shift the balance against endoscopic evaluation of dyspepsia in pregnancy.…”