Neuromodulating agents in functional dyspepsia: a comprehensive review.

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.