This uncommissioned review article was subject to full peer-review.
Review article: current treatment options and management of functional dyspepsia
Article first published online: 16 MAY 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 1, pages 3–15, July 2012
How to Cite
Lacy, B. E., Talley, N. J., Locke, G. R., Bouras, E. P., DiBaise, J. K., El-Serag, H. B., Abraham, B. P., Howden, C. W., Moayyedi, P. and Prather, C. (2012), Review article: current treatment options and management of functional dyspepsia. Alimentary Pharmacology & Therapeutics, 36: 3–15. doi: 10.1111/j.1365-2036.2012.05128.x
- Issue published online: 1 JUN 2012
- Article first published online: 16 MAY 2012
- Accepted manuscript online: 16 MAY 2012 12:00AM EST
- Manuscript Accepted: 21 APR 2012
- Manuscript Revised: 18 APR 2012
- Manuscript Revised: 26 FEB 2012
- Manuscript Received: 7 FEB 2012
- National Institute for Diabetes and Digestive and Kidney Disease. Grant Number: U01DK065713
- Houston VA HSR&D Center of Excellence. Grant Number: HFP90-020
- P30 Center Grant. Grant Number: DK56338
Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89–90%), postprandial fullness (75–88%), and early satiety (50–82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive.
To present current management options for the treatment of FD (therapeutic gain/response rate noted when available).
The utility of Helicobacter pylori eradication for the treatment of FD is modest (6–14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7–10% therapeutic gain), histamine-type-2-receptor antagonists (8–35% therapeutic gain), prokinetic agents (18–45%), tricyclic antidepressants (TCA) (response rates of 64–70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies.
A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an anti-nociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.