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Therapeutic Approach in Functional (Nonulcer) Dyspepsia

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Dyspepsia in Clinical Practice

Abstract

Functional dyspepsia (FD) is defined as the presence of dyspeptic symptoms thought to generate in the gastroduodenal region, in the absence of organic, systemic, or metabolic disease that is likely to explain the symptoms. The Rome III consensus conference defined two subentities of FD: the postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The variation of symptoms due to different pathophysiological mechanisms complicates the therapeutic response [1, 2]. The selection of the therapeutic approach should be dependent on the predominant symptom (Table 11.1) [3–5].

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References

  1. Hunt RH, Fallone C, Veldhuyzen van Zanten S, et al. Etiology of dyspepsia: implications for empirical therapy. Can J Gastroenterol. 2002;16:635–41.

    PubMed  Google Scholar 

  2. Kleibeuker JH, Thijs JC. Functional dyspepsia. Curr Opin Gastroenterol. 2004;20:546–50.

    Article  PubMed  Google Scholar 

  3. Bytzer P, Hansen JM, Rune S, et al. Identifying responders to acid suppression in dyspepsia using a random starting day trial. Aliment Pharmacol Ther. 2000;14:1485–94.

    Article  PubMed  CAS  Google Scholar 

  4. Madsen LG, Bytzer P. Reproducibility of a symptom response to omeprazole therapy in functional dyspepsia evaluated by a random-starting-day trial design. Aliment Pharmacol Ther. 2004;20:365–72.

    Article  PubMed  CAS  Google Scholar 

  5. Madsen LG, Wallin L, Bytzer P. Identifying response to acid suppressive therapy in functional dyspepsia using a random starting day trial – is gastro-oesophageal reflux important? Aliment Pharmacol Ther. 2004;20: 423–30.

    Article  PubMed  CAS  Google Scholar 

  6. Tytgat G, Hungin AP, Malfertheiner P, et al. Decision-making in ­dyspepsia: controversies in primary and secondary care. Eur J Gastroenterol Hepatol. 1999;11:223–30.

    Article  PubMed  CAS  Google Scholar 

  7. Chiba N, Van Zanten SJ, Sinclair P, Ferguson RA, Escobedo S, Grace E. Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia empiric treatment-Helicobacter pylori positive (CADET-Hp) randomised controlled trial. BMJ. 2002;324:1012–6.

    Article  PubMed  CAS  Google Scholar 

  8. Talley NJ, Vakil N, Delaney B, et al. Management issues in dyspepsia: current consensus and controversies. Scand J Gastroenterol. 2004;39:913–8.

    Article  PubMed  CAS  Google Scholar 

  9. Malfertheiner P, Megraud PF, O’Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–81.

    Article  PubMed  CAS  Google Scholar 

  10. Spiegel BM, Vakil NB, Ofman JJ. Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology. 2002;122:1270–85.

    Article  PubMed  Google Scholar 

  11. Delaney BC, Qume M, Moayyedi P, et al. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial). BMJ. 2008;336:651–4.

    Article  PubMed  CAS  Google Scholar 

  12. Ford AC, Moayyedi P, Jarbol DE, Logan RF, Delaney BC. Meta-analysis: Helicobacter pylori ‘test and treat’ compared with empirical acid suppression for managing dyspepsia. Aliment Pharmacol Ther. 2008;28:534–44.

    Article  PubMed  CAS  Google Scholar 

  13. Moayyedi P, Delaney BC, Vakil N, Forman D, Talley NJ. The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis. Gastroenterology. 2004;127:1329–37.

    Article  PubMed  Google Scholar 

  14. Talley NJ, Vakil N, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology. 2005;129:1756–80.

    Article  PubMed  Google Scholar 

  15. Veldhuyzen Van Zanten SJ, Chiba N, Armstrong D, et al. A randomized trial comparing omeprazole, ranitidine, cisapride, or placebo in helicobacter pylori negative, primary care patients with dyspepsia: the CADET-HN Study. Am J Gastroenterol. 2005;100:1477–88.

    Article  PubMed  CAS  Google Scholar 

  16. Armstrong D, Veldhuyzen Van Zanten SJ, Barkun AN, et al. White, Heartburn-dominant, uninvestigated dyspepsia: a comparison of ‘PPI-start’ and ‘H2-RA-start’ management strategies in primary care – the CADET-HR Study. Aliment Pharmacol Ther. 2005;21:1189–202.

    Article  PubMed  CAS  Google Scholar 

  17. Moayyedi P, Soo S, Deeks J, Delaney B, Innes M, Forman D. Pharmacological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006;CD001960.

    Google Scholar 

  18. Talley NJ, Vakil N, Lauritsen K, et al. Randomized-controlled trial of esomeprazole in functional dyspepsia patients with epigastric pain or burning: does a 1-week trial of acid suppression predict symptom response? Aliment Pharmacol Ther. 2007;26:673–82.

    Article  PubMed  CAS  Google Scholar 

  19. Moayyedi P, Soo S, Deeks J, et al. Systematic review: antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia. Aliment Pharmacol Ther. 2003;17:1215–27.

    Article  PubMed  CAS  Google Scholar 

  20. Holtmann G, Talley NJ, Liebregts T, Adam B, Parow C. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med. 2006;254:832–40.

    Article  Google Scholar 

  21. Talley NJ, Tack J, Ptak T, Gupta R, Giguere M. Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials. Gut. 2008;57:740–6.

    Article  PubMed  CAS  Google Scholar 

  22. Chey WD, Howden CW, Tack J, Ligozio G, Earnest DL. Long-term tegaserod treatment for dysmotility-like functional dyspepsia: results of two identical 1-year cohort studies. Dig Dis Sci. 2010;55:684–97.

    Article  PubMed  Google Scholar 

  23. Vakil N, Laine L, Talley NJ, et al. Tegaserod treatment for dysmotility-like functional dyspepsia: results of two randomized, controlled trials. Am J Gastroenterol. 2008;103:1906–19.

    Article  PubMed  Google Scholar 

  24. Miner PB, Rodriguez-Stanley Jr S, Proskin HM, Kianifard F, Bottoli I. Tegaserod in patients with mechanical sensitivity and overlapping symptoms of functional heartburn and functional dyspepsia. Curr Med Res Opin. 2008;24:2159–72.

    Article  PubMed  CAS  Google Scholar 

  25. Yogo K, Onoma M, Ozaki K, et al. Effects of oral mitemcinal (GM-611), erythromycin, EM-574 and cisapride on gastric emptying in conscious rhesus monkeys. Dig Dis Sci. 2008;53:912–8.

    Article  PubMed  CAS  Google Scholar 

  26. Dinan TG, Mahmud N, Rathore O, et al. A double-blind placebo-controlled study of buspirone-stimulated prolactin release in non-ulcer dyspepsia – are central serotoninergic responses enhanced? Aliment Pharmacol Ther. 2001;15:1613–8.

    Article  PubMed  CAS  Google Scholar 

  27. Seto K, Sasaki T, Katsunuma K, Kobayashi N, Tanaka K, Tack J. Acotiamide hydrochloride (Z-338), a novel prokinetic agent, restores delayed gastric emptying and feeding inhibition induced by restraint stress in rats. Neurogastroenterol Motil. 2008;20:1051–9.

    Article  PubMed  CAS  Google Scholar 

  28. Tack J. Prokinetics and fundic relaxants in upper functional GI disorders. Curr Opin Pharmacol. 2008;8:690–6.

    Article  PubMed  CAS  Google Scholar 

  29. Von AU, Peitz U, Vinson B, Gundermann KJ, Malfertheiner P. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102:1268–75.

    Article  Google Scholar 

  30. Braden B, Caspary W, Borner N, Vinson B, Schneider AR. Clinical effects of STW 5 (Iberogast) are not based on acceleration of gastric emptying in patients with functional dyspepsia and gastroparesis. Neurogastroenterol Motil. 2009;21:632–8. e25.

    Article  PubMed  CAS  Google Scholar 

  31. Melzer J, Rosch W, Reichling J, Brignoli R, Saller R. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20:1279–87.

    Article  PubMed  CAS  Google Scholar 

  32. Holtmann G, Adam B, Haag S, Collet W, Grunewald E, Windeck T. Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 2003;18:1099–105.

    Article  PubMed  CAS  Google Scholar 

  33. Rodriguez-Stanley S, Collings KL, Robinson M, Owen W, Miner Jr PB. The effects of capsaicin on reflux, gastric emptying and dyspepsia. Aliment Pharmacol Ther. 2000;14:129–34.

    Article  PubMed  CAS  Google Scholar 

  34. Bortolotti M, Coccia G, Grossi G. Red pepper and functional dyspepsia. N Engl J Med. 2002;346:947–8.

    Article  PubMed  Google Scholar 

  35. Bortolotti M, Coccia G, Grossi G, Miglioli M. The treatment of functional dyspepsia with red pepper. Aliment Pharmacol Ther. 2002;16:1075–82.

    Article  PubMed  CAS  Google Scholar 

  36. Otaka M, Jin M, Odashima M, et al. New strategy of therapy for functional dyspepsia using famotidine, mosapride and amitriptyline. Aliment Pharmacol Ther. 2005;21 Suppl 2:42–6.

    Article  PubMed  CAS  Google Scholar 

  37. Gorelick AB, Koshy SS, Hooper FG, Bennett TC, Chey WD, Hasler WL. Differential effects of amitriptyline on perception of somatic and visceral stimulation in healthy humans. Am J Physiol. 1998;275:G460–6.

    PubMed  CAS  Google Scholar 

  38. Mertz H, Fass R, Kodner A, Yan-Go F, Fullerton S, Mayer EA. Effect of amitriptyline on symptoms, sleep, and visceral perception in patients with functional dyspepsia. Am J Gastroenterol. 1998;93:160–5.

    Article  PubMed  CAS  Google Scholar 

  39. Tack J, Lee KJ. Pathophysiology and treatment of functional dyspepsia. J Clin Gastroenterol. 2005;39:S211–6.

    Article  PubMed  Google Scholar 

  40. Tack J, Broekaert D, Coulie B, Fischler B, Janssens J. Influence of the selective serotonin re-uptake inhibitor, paroxetine, on gastric sensorimotor function in humans. Aliment Pharmacol Ther. 2003;17:603–8.

    Article  PubMed  CAS  Google Scholar 

  41. Ladabaum U, Glidden D. Effect of the selective serotonin reuptake inhibitor sertraline on gastric sensitivity and compliance in healthy humans. Neurogastroenterol Motil. 2002;14:395–402.

    Article  PubMed  CAS  Google Scholar 

  42. Saad RJ, Chey WD. Review article: current and emerging therapies for functional dyspepsia. Aliment Pharmacol Ther. 2006;24:475–92.

    Article  PubMed  CAS  Google Scholar 

  43. Haug TT, Wilhelmsen I, Svebak S, Berstad A, Ursin H. Psychotherapy in functional dyspepsia. J Psychosom Res. 1994;38:735–44.

    Article  PubMed  CAS  Google Scholar 

  44. Talley NJ, Owen BK, Boyce P, Paterson K. Psychological treatments for irritable bowel syndrome: a critique of controlled treatment trials. Am J Gastroenterol. 1996;91:277–83.

    PubMed  CAS  Google Scholar 

  45. Calvert EL, Houghton LA, Cooper P, Morris J, Whorwell PJ. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology. 2002;123:1778–85.

    Article  PubMed  Google Scholar 

  46. Mine K, Kanazawa F, Hosoi M, Kinukawa N, Kubo C. Treating nonulcer dyspepsia considering both functional disorders of the digestive system and psychiatric conditions. Dig Dis Sci. 1998;43:1241–7.

    Article  PubMed  CAS  Google Scholar 

  47. Soo S, Moayyedi P, Deeks J, Delaney B, Lewis M, Forman D. Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2005;CD002301.

    Google Scholar 

  48. Soo S, Forman D, Delaney BC, Moayyedi P. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol. 2004;99:1817–22.

    Article  PubMed  Google Scholar 

  49. Walker MM, Salehian SS, Murray CE, et al. Implications of eosinophilia in the normal duodenal biopsy – an association with allergy and functional dyspepsia. Aliment Pharmacol Ther. 2010;31:1229–36.

    Article  PubMed  CAS  Google Scholar 

  50. Walker MM, Talley NJ, Prabhakar M, et al. Duodenal mastocytosis, eosinophilia and intraepithelial lymphocytosis as possible disease markers in the irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2009;29:765–73.

    Article  PubMed  CAS  Google Scholar 

  51. Friesen CA, Neilan NA, Schurman JV, Taylor DL, Kearns GL, Abdel-Rahman SM. Montelukast in the treatment of duodenal eosinophilia in children with dyspepsia: effect on eosinophil density and activation in relation to pharmacokinetics. BMC Gastroenterol. 2009;9:32.

    Article  PubMed  Google Scholar 

  52. Talley NJ, Walker MM, Aro P, et al. Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case–control study. Clin Gastroenterol Hepatol. 2007;5:1175–83.

    Article  PubMed  Google Scholar 

  53. Jarbol DE, Kragstrup J, Stovring H, Havelund T, Schaffalitzky de Muckadell OB. Proton pump inhibitor or testing for Helicobacter pylori as the first step for patients presenting with dyspepsia? A cluster-randomized trial. Am J Gastroenterol. 2006;101:1200–8.

    Article  PubMed  Google Scholar 

  54. Malfertheiner P, Sipponen P, Naumann M, et al. Helicobacter pylori eradication has the potential to prevent gastric cancer: a state-of-the-art critique. Am J Gastroenterol. 2005;100:2100–15.

    Article  PubMed  Google Scholar 

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Correspondence to Arne Kandulski .

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Kandulski, A., Venerito, M., Malfertheiner, P. (2011). Therapeutic Approach in Functional (Nonulcer) Dyspepsia. In: Duvnjak, M. (eds) Dyspepsia in Clinical Practice. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1730-0_11

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  • DOI: https://doi.org/10.1007/978-1-4419-1730-0_11

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