Skip to main content
Log in

New Approaches to Diagnosis and Treatment of Functional Dyspepsia

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to review the recent literature and discuss the new approaches to the diagnosis and treatment of functional dyspepsia (FD).

Recent Findings

According to the recent American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guideline for dyspepsia, Helicobacter pylori (H. pylori) eradication is recommended as a first treatment option, and proton pump inhibitors (PPIs), tricyclic antidepressants, and prokinetics are listed as second-line therapy. On the other hand, in the Japanese guideline for FD, PPIs and prokinetics are recommended as the first-line treatment. In Japan, acotiamide, a recently launched prokinetic, showed significant efficacy in several clinical trials performed either in Japan or Europe. Regarding non-pharmacological treatment, recent topics include acupuncture, electrical stimulation, gastric peroral endoscopic myotomy, and meal and lifestyle modification. These treatments have provided significant efficacy, which provides some insights into the main pathophysiology of this disease.

Summary

Although FD is common among functional gastrointestinal disorders, it is not easy to relieve the dyspeptic symptoms of FD patients. Combinations of pharmacological and non-pharmacological treatment options are expected.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, et al. Gastroduodenal disorders. Gastroenterology. 2016;150(6):1380–92 This paper is an updated Rome classification of FD.

    Article  Google Scholar 

  2. Miwa H, Kusano M, Arisawa T, Oshima T, Kato M, Joh T, et al. Evidence-based clinical practice guidelines for functional dyspepsia. J Gastroenterol. 2015;50(2):125–39.

    Article  CAS  Google Scholar 

  3. Oshima T, Miwa H. Epidemiology of functional gastrointestinal disorders in Japan and in the world. J Neurogastroenterol Motil. 2015;21(3):320–9.

    Article  Google Scholar 

  4. •• Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988–1013 This paper is an updated ACG and CAG guidelines of FD.

    Article  CAS  Google Scholar 

  5. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466–79 Review.

    Article  Google Scholar 

  6. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004. 1490;328(7454):19.

    Google Scholar 

  7. Vanheel H, Carbone F, Valvekens L, et al. Pathophysiological abnormalities in functional dyspepsia subgroups according to the Rome III criteria. Am J Gastroenterol. 2017;112:132140.

    Article  Google Scholar 

  8. Asano H, Tomita T, Nakamura K, Yamasaki T, Okugawa T, Kondo T, et al. Prevalence of gastric motility disorders in patients with functional dyspepsia. J Neurogastroenterol Motil. 2017;23(3):392–9.

    Article  Google Scholar 

  9. DiBaise JK, Patel N, Noelting J, Dueck AC, Roarke M, Crowell MD. The relationship among gastroparetic symptoms, quality of life, and gastric emptying in patients referred for gastric emptying testing. Neurogastroenterol Motil. 2016;28:234–42.

    Article  CAS  Google Scholar 

  10. Simrén M, Törnblom H, Palsson OS, van Tilburg MAL, Van Oudenhove L, Tack J, et al. Visceral hypersensitivity is associated with GI symptom severity in functional GI disorders: consistent findings from five different patient cohorts. Gut. 2018;67(2):255–62.

    Article  Google Scholar 

  11. • Carbone F, Tack J, Hoffman I. The intragastric pressure measurement: a novel method to assess gastric accommodation in functional dyspepsia children. J Pediatr Gastroenterol Nutr. 2017;64(6):918–24 This paper showed new measurement methods of adaptive relaxation response of the stomach using high-resolution manometry.

    Article  Google Scholar 

  12. Carbone F, Vanuytsel T, Tack J. The effect of mirtazapine on gastric accommodation, gastric sensitivity to distention, and nutrient tolerance in healthy subjects. Neurogastroenterol Motil 2017;29(12).

  13. Wu Q, Zou M, Yang M, Zhou S, Yan X, Sun B, et al. Revealing potential biomarkers of functional dyspepsia by combining 1H NMR metabonomics techniques and an integrative multi-objective optimization method. Sci Rep. 2016;6:18852.

    Article  CAS  Google Scholar 

  14. Moayyedi P. Helicobacter pylori eradication for functional dyspepsia: what are we treating?: comment on “Helicobacter pylori eradication in functional dyspepsia”. Arch Intern Med. 2011;171(21):1936–7.

    Article  Google Scholar 

  15. Mazzoleni LE, Sander GB, Francesconi CF, Mazzoleni F, Uchoa DM, De Bona LR, et al. Helicobacter pylori eradication in functional dyspepsia: HEROES trial. Arch Intern Med 2011;28;171(21):1929–1936.

  16. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353–67.

    Article  Google Scholar 

  17. • Pinto-Sanchez MI, Yuan Y, Hassan A, Bercik P, Moayyedi P. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev. 2017; This paper is a systematic review to evaluate whether PPI therapy provides symptomatic relief in FD.

  18. Wang WH, Huang JQ, Zheng GF, Xia HH, Wong WM, Liu XG, et al. Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials. Clin Gastroenterol Hepatol. 2007;5(2):178–85.

    Article  CAS  Google Scholar 

  19. Lee KJ, Demarchi B, Demedts I, Sifrim D, Raeymaekers P, Tack J. A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea. Am J Gastroenterol. 2004;99(9):1765–73.

    Article  Google Scholar 

  20. Oshima T, Okugawa T, Tomita T, Sakurai J, Toyoshima F, Watari J, et al. Generation of dyspeptic symptoms by direct acid and water infusion into the stomachs of functional dyspepsia patients and healthy subjects. Aliment Pharmacol Ther. 2012;35(1):175–82.

    Article  CAS  Google Scholar 

  21. Ishii M, Kusunoki H, Manabe N, Kamada T, Sato M, Imamura H, et al. Evaluation of duodenal hypersensitivity induced by duodenal acidification using transnasal endoscopy. J Gastroenterol Hepatol. 2010;25(5):913–8.

    Article  Google Scholar 

  22. NJ WMM, Aro P, Ronkainen J, Storskrubb T, Hindley LA, Harmsen WS, et al. Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study. Clin Gastroenterol Hepatol. 2007;5:11751183.

    Google Scholar 

  23. Wang X, Li X, Ge W, Huang J, Li G, Cong Y, et al. Quantitative evaluation of duodenal eosinophils and mast cells in adult patients with functional dyspepsia. Ann Diagn Pathol. 2015;19(2):50–6.

    Article  Google Scholar 

  24. Du L, Shen J, Kim JJ, Yu Y, Ma L, Dai N. Increased duodenal eosinophil degranulation in patients with functional dyspepsia: a prospective study. Sci Rep. 2016;6:34305.

    Article  CAS  Google Scholar 

  25. Potter MDE, Wood NK, Walker MM, Jones MP, Talley NJ. Proton pump inhibitors and suppression of duodenal eosinophilia in functional dyspepsia. Gut. 2018.

  26. Matsueda K, Hongo M, Tack J, Saito Y, Kato H. A placebo-controlled trial of acotiamide for meal-related symptoms of functional dyspepsia. Gut. 2012;61(6):821–8.

    Article  CAS  Google Scholar 

  27. Altan E, Masaoka T, Farré R, Tack J. Acotiamide, a novel gastroprokinetic for the treatment of patients with functional dyspepsia: postprandial distress syndrome. Expert Rev Gastroenterol Hepatol. 2012;6(5):533–44.

    Article  CAS  Google Scholar 

  28. Nakamura K, Tomita T, Oshima T, Asano H, Yamasaki T, Okugawa T, et al. A double-blind placebo controlled study of acotiamide hydrochloride for efficacy on gastrointestinal motility of patients with functional dyspepsia. J Gastroenterol. 2017;52(5):602–10.

    Article  CAS  Google Scholar 

  29. •• Tack J, Pokrotnieks J, Urbonas G, Banciu C, Yakusevich V, Bunganic I, et al. Long-term safety and efficacy of acotiamide in functional dyspepsia (postprandial distress syndrome)-results from the European phase 3 open-label safety trial. Neurogastroenterol Motil. 2018;30(6):e13284 This paper indicated the long-term safety and efficacy of acotiamide in FD.

    Article  CAS  Google Scholar 

  30. Yamawaki H, Futagami S, Kawagoe T, Maruki Y, Hashimoto S, Nagoya H, et al. Improvement of meal-related symptoms and epigastric pain in patients with functional dyspepsia treated with acotiamide was associated with acylated ghrelin levels in Japan. Neurogastroenterol Motil. 2016;28(7):1037–47.

    Article  CAS  Google Scholar 

  31. • Ford AC, Luthra P, Tack J, Boeckxstaens GE, Moayyedi P, Talley NJ. Efficacy of psychotropic drugs in functional dyspepsia: systematic review and meta-analysis. Gut. 2017;66(3):411–420. Review This paper is a systematic review of psychotropic drug in FD.

    Article  CAS  Google Scholar 

  32. Braak B, Klooker TK, Wouters MM, Lei A, van den Wijngaard RM, Boeckxstaens GE. Randomised clinical trial: the effects of amitriptyline on drinking capacity and symptoms in patients with functional dyspepsia, a double-blind placebo-controlledstudy. Aliment Pharmacol Ther. 2011 Sep;34(6):638–48.

    Article  CAS  Google Scholar 

  33. Talley NJ, Locke GR, Saito YA, Almazar AE, Bouras EP, Howden CW, et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study. Gastroenterology. 2015 Aug;149(2):340–9.e2.

    Article  CAS  Google Scholar 

  34. Tan VP, Cheung TK, Wong WM, Pang R, Wong BC. Treatment of functional dyspepsia with sertraline: a double-blind randomized placebo-controlled pilot study. World J Gastroenterol. 2012;18(42):6127–33.

    Article  CAS  Google Scholar 

  35. • Tominaga K, Sakata Y, Kusunoki H, Odaka T, Sakurai K, Kawamura O, et al. Rikkunshito simultaneously improves dyspepsia correlated with anxiety in patients with functional dyspepsia: a randomized clinical trial (the DREAM study). Neurogastroenterol Motil. 2018;30(7):e13319 This paper is a randomized, placebo-controlled, double-blind clinical trial to determine the efficacy of rikkunshito in FD patients.

    Article  CAS  Google Scholar 

  36. Suzuki H, Matsuzaki J, Fukushima Y, Suzaki F, Kasugai K, Nishizawa T, et al. Randomized clinical trial: rikkunshito in the treatment of functional dyspepsia--a multicenter, double-blind, randomized, placebo-controlled study. Neurogastroenterol Motil. 2014;26(7):950–61.

    Article  CAS  Google Scholar 

  37. Kim KN, Chung SY, Cho SH. Efficacy of acupuncture treatment for functional dyspepsia: a systematic review and meta-analysis. Complement Ther Med. 2015;23(6):759–66.

    Article  Google Scholar 

  38. Lan L, Zeng F, Liu GJ, Ying L, Wu X, Liu M, et al. Acupuncture for functional dyspepsia. Cochrane Database Syst Rev. 2014;10:CD008487.

    Google Scholar 

  39. Zheng H, Xu J, Sun X, Zeng F, Li Y, Wu X, et al. Electroacupuncture for patients with refractory functional dyspepsia: a randomized controlled trial. Neurogastroenterol Motil. 2018;30(7):e13316.

    Article  CAS  Google Scholar 

  40. Laine M, Sirén J, Koskenpato J, Punkkinen J, Rantanen T, Typpö I, et al. Outcomes of high-frequency gastric electric stimulation for the treatment of severe, medically refractory gastroparesis in Finland. Scand J Surg. 2018;107(2):124–9.

    Article  CAS  Google Scholar 

  41. Davis BR, Sarosiek I, Bashashati M, Alvarado B, McCallum RW. The long-term efficacy and safety of pyloroplasty combined with gastric electrical stimulation therapy in gastroparesis. J Gastrointest Surg. 2017;21(2):222–7.

    Article  Google Scholar 

  42. Mekaroonkamol P, Dacha S, Wang L, Li X, Jiang Y, Li L, et al. Gastric peroral endoscopic pyloromyotomy reduces symptoms, increases quality of life, and reduces health care use for patients with gastroparesis. Clin Gastroenterol Hepatol 2018

  43. Xue HB, Fan HZ, Meng XM, Cristofaro S, Mekaroonkamol P, Dacha S, et al. Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis. Surg Endosc. 2017;31(11):4617–24.

    Article  CAS  Google Scholar 

  44. Malik Z, Kataria R, Modayil R, Ehrlich AC, Schey R, Parkman HP, et al. Gastric per oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: early experience. Dig Dis Sci 2018 22.

  45. Duncanson KR, Talley NJ, Walker MM, Burrows TL. Food and functional dyspepsia: a systematic review. J Hum Nutr Diet. 2018;31(3):390–407.

    Article  CAS  Google Scholar 

  46. Acker BW, Cash BD. Medicinal foods for functional GI disorders. Curr Gastroenterol Rep. 2017;19(12):62.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroto Miwa.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the author.

Additional information

This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tomita, T., Oshima, T. & Miwa, H. New Approaches to Diagnosis and Treatment of Functional Dyspepsia. Curr Gastroenterol Rep 20, 55 (2018). https://doi.org/10.1007/s11894-018-0663-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-018-0663-4

Keywords

Navigation