Functional Dyspepsia: Advances in Diagnosis and Therapy

Abstract

Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pre-test probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD–Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation.

Investigation of Gastric Motility in Patients With the Overlap Syndrome of the Gastroesophageal Reflux Disease and Functional Dyspepsia

“…Считается, что общим патофизиологическим механизмом у больных ГЭРБ и ФД является нарушение аккомодации желудка, которое может быть причиной разви-тия синдрома перекреста ГЭРБ и ФД [15]. Как установлено в нашем исследовании, аккомо-дация была нарушена у 40% пациентов с син-дромом перекреста НЭРБ и ФД (аккомодаци-онный рефлекс развивался с задержкой от 5 до 25 минут).…”

Histamine‐enhanced contractile responses of gastric smooth muscle via interstitial cells of Cajal in the Syrian hamster

“…For example, histamine might be an important pharmacological tool for treatment of gastric dysmotility such as functional dyspepsia. 47 One of therapeutic drugs for functional dyspepsia is acotiamide, which inhibits choline esterase and then improves gastric movements by enhancement of acetylcholine release. 48 Considering that the prokinetic effects of histamine are comparable with those of acetylcholine, histamine might be useful to devise a novel therapy for functional dyspepsia.…”

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

“…Furthermore, many patients with the diagnosis of chronic pancreatitis have other causes for their CAP. Patients with functional dyspepsia and irritable bowel syndrome (IBS) experience symptoms that overlap with other chronic gastroduodenal disorders and are often misdiagnosed as chronic pancreatitis [11]. The pooled prevalence of undiagnosed dyspepsia was reported to be 21% [95% confidence interval (CI), 18–24] across 100 population-based studies [12].…”