Failed therapy and directions for the future in dyspepsia

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Functional dyspepsia (FD) is a prevalent gastrointestinal disorder with a benign prognosis but significant impact on patient quality of life and societal costs.
• FD presents with diverse pathophysiologies, necessitating varied management strategies as no single cure exists.

Purpose of the Study:

• To review current management strategies for functional dyspepsia.
• To explore evidence-based second- and third-line treatment options for patients refractory to standard therapies.

Main Methods:

• Review of established medical treatments including Helicobacter pylori eradication, acid suppressants, and prokinetics.
• Evaluation of second- and third-line options such as herbal medicines, psychotropic agents, and psychological interventions.

Main Results:

• Standard treatments provide modest benefits over placebo, with 20-40% of patients showing inadequate response.
• Some herbal preparations demonstrate efficacy in controlled trials.
• Psychotropic drugs and psychological interventions like psychotherapy and hypnotherapy are considered for refractory cases, requiring careful risk-benefit assessment.

Conclusions:

• Management of functional dyspepsia requires a stepwise approach, starting with reassurance and lifestyle advice.
• For non-responders to initial therapies, evidence-based second- and third-line treatments, including herbal medicines and psychological interventions, should be considered.