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Neuromodulating agents in functional dyspepsia: a comprehensive review.

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Tricyclic antidepressants (TCAs) effectively treat functional dyspepsia. Other neuromodulators may help, but more research is needed for conclusive evidence.

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Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Functional dyspepsia is a prevalent chronic condition causing upper abdominal discomfort without a clear organic cause.
  • Standard treatments like proton pump inhibitors and H. pylori eradication offer insufficient relief for many patients.
  • Tricyclic antidepressants (TCAs) are the only neuromodulating agents currently recommended in major international guidelines for functional dyspepsia.

Purpose of the Study:

  • To comprehensively review the efficacy of various neuromodulating agents in treating functional dyspepsia.
  • To evaluate evidence supporting the use of different classes of neuromodulators beyond TCAs.

Main Methods:

  • A systematic literature review was conducted on PubMed, focusing on randomized controlled trials in adult participants.
  • Studies included patients meeting Rome II, III, or IV criteria or diagnosed with functional dyspepsia via upper endoscopy.
  • The review compared the effects of neuromodulating agents against placebo treatments.

Main Results:

  • Out of 386 identified articles, 14 met the inclusion criteria.
  • Tricyclic antidepressants (TCAs), such as amitriptyline and imipramine, demonstrated effectiveness in managing functional dyspepsia symptoms.
  • Evidence for tetracyclic antidepressants, levosulpiride, and anxiolytics suggests potential benefit, but requires further confirmation.
  • Serotonin and noradrenaline reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) did not show significant benefits.

Conclusions:

  • Certain neuromodulating agents are effective for functional dyspepsia.
  • Tricyclic antidepressants (TCAs) have the strongest evidence base for efficacy.
  • Tetracyclic antidepressants, levosulpiride, and anxiolytics warrant further investigation for their role in functional dyspepsia treatment.