Evidence-based clinical practice guidelines for functional dyspepsia 2021.

Area of Science:

• Gastroenterology
• Clinical Practice Guidelines

Background:

• Functional dyspepsia (FD) is a prevalent condition significantly impacting patient quality of life.
• FD gained national insurance recognition in Japan in 2013, but its recognition is still evolving.
• The Japanese Society of Gastroenterology (JSGE) has revised its first version of FD guidelines.

Purpose of the Study:

• To update the clinical practice guidelines for functional dyspepsia (FD) based on the latest evidence.
• To refine diagnostic approaches and treatment strategies for FD patients.

Main Methods:

• Guidelines were developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
• Clinical questions were categorized into background questions (BQs), future research questions (FRQs), and treatment-associated clinical questions.

Main Results:

• Endoscopy is now recommended only when organic disease is suspected, a shift from previous universal requirements for FD diagnosis.
• Updated first-line treatments include gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide), and rikkunshito.
• Second-line treatments encompass anxiolytics/antidepressants, alternative prokinetics, and other Japanese herbal medicines for refractory FD.

Conclusions:

• The revised guidelines introduce a more targeted approach to FD diagnosis, reducing unnecessary endoscopic procedures.
• Treatment algorithms for FD have been updated to reflect current evidence, offering a broader range of therapeutic options.
• These revisions aim to improve the management of functional dyspepsia and address refractory cases more effectively.