Functional dyspepsia: new insights into pathogenesis and therapy

Area of Science:

• Gastroenterology and Internal Medicine
• Clinical Therapeutics and Diagnostics

Background:

• Functional dyspepsia (FD) is a prevalent condition affecting 10% of the population, characterized by chronic upper abdominal symptoms.
• FD encompasses Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS), increasingly recognized as distinct clinical entities.
• Growing evidence suggests a potential overlap between FD and gastroesophageal reflux disease (GERD) in a significant patient subset.

Purpose of the Study:

• To review current understanding of functional dyspepsia (FD) pathophysiology, diagnosis, and management strategies.
• To highlight emerging insights into potential causes of FD, including infections and dietary factors.
• To discuss therapeutic approaches for different FD subtypes, including acid suppression, prokinetics, and pharmacologic interventions.

Main Methods:

• Review of clinical history for diagnosis, with exclusion of peptic ulcer and malignancy via endoscopy.
• Analysis of accumulating data on the pathophysiology and potential triggers of FD.
• Evaluation of treatment outcomes for various therapeutic options in FD management.

Main Results:

• Duodenal eosinophilia and Helicobacter pylori infection are recognized pathologies associated with FD, though H. pylori eradication benefits only a minority.
• Acid suppression therapy is a first-line treatment for EPS, with H2 blockers considered even if proton pump inhibitors fail.
• Prokinetics are preferred for PDS, while low-dose tricyclic antidepressants or mirtazapine are second-line options, excluding SSRIs.

Conclusions:

• FD is a complex syndrome with multifactorial origins, requiring tailored treatment approaches based on symptom presentation.
• Further research is needed to fully elucidate the causes of FD and optimize therapeutic strategies.
• Understanding the spectrum of FD, including its relationship with GERD and potential underlying pathologies, is crucial for effective patient care.