Review article: current treatment options and management of functional dyspepsia

Abstract

SUMMARY Background Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89–90%), postprandial fullness (75–88%), and early satiety (50–82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive. Aim To present current management options for the treatment of FD (therapeutic gain/response rate noted when available). Results The utility of Helicobacter pylori eradication for the treatment of FD is modest (6–14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7–10% therapeutic gain), histamine-type-2-receptor antagonists (8–35% therapeutic gain), prokinetic agents (18–45%), tricyclic antidepressants (TCA) (response rates of 64–70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies. Conclusions A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an antinociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…While H pylori eradication promotes an 8%-14% therapeutic gain, rates achieved using proton pump inhibitors vary between 7% and 10%. Less consistent data having similar results are also obtained using prokinetic agents, H 2 blocker antagonists, tricyclic antidepressants and serotonin reuptake inhibitors (112) . Recent evidence has demonstrated the long-term effects of H pylori eradication in reducing consultations for dyspeptic complaints (89,129) .…”

ACG and CAG Clinical Guideline: Management of Dyspepsia

“…Patients with FD oft en have disorders of gastric motility ( 130 ) and many pharmacological agents have been developed to improve gastric emptying ( 131 ). Prokinetics have been studied exten-Th e quality of the data is very low despite a reasonably dramatic eff ect on reducing dyspepsia symptoms.…”

“…Th e proportion of secondary and tertiary care patients with FD taking CAM may be even higher. Th ese interventions have been reviewed ( 131 ) and there are numerous proposed herbal remedies as well as other approaches. Many of these have been subject to randomized trials but the approaches are too diverse to draw any defi nitive conclusions.…”

Efficacy of Acotiamide in Combination with Esomeprazole for Functional Dyspepsia Refractory to Proton-Pump Inhibitor Monotherapy

“…Prolonged dyspepsia symptoms cause a noticeable deterioration of quality of life (QOL). Various therapies such as administration of proton pump inhibitors (PPIs), histamine-type 2 receptor antagonists, or prokinetic agents or eradication of Helicobacter pylori have been used as treatment for FD (Lacy et al 2012). PPIs are often the first choice of treatment for FD.…”