[Pathogenesis and management of functional dyspepsia]

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Context:

• Functional dyspepsia (FD) is prevalent, particularly in Japan, often misdiagnosed as chronic gastritis due to healthcare regulations.
• Distinguishing FD symptoms from histological chronic gastritis is crucial for accurate diagnosis and management.
• Current primary care for FD often involves acid inhibitors and prokinetics, with documented limited therapeutic success.

Purpose:

• To review the multifactorial pathogenesis of functional dyspepsia.
• To evaluate the efficacy of current and potential therapeutic strategies for FD.
• To highlight the need for further research and validation of novel treatments.

Summary:

• FD pathogenesis involves dysmotility, acid secretion, hypersensitivity, psychological factors, H. pylori, genetics, and inflammation.
• Limited efficacy of acid inhibition and prokinetic drugs in placebo-controlled trials for FD.
• Other potential FD treatments like H. pylori eradication, psychotropic drugs, and herbal medicine require more evidence.

Impact:

• Improved diagnostic criteria for FD, differentiating it from chronic gastritis.
• Identification of limitations in current FD pharmacotherapy.
• Guidance for future research directions in functional dyspepsia treatment and validation studies.