Skip to main content

Advertisement

Log in

Causes and treatment of functional dyspepsia

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Functional dyspepsia is a clinical syndrome defined by upper abdominal symptoms without identifiable cause by conventional diagnostic means. Recent studies have established that functional dyspepsia is a heterogeneous disorder in which different pathophysiologic disturbances underlie different symptom profiles. Delayed gastric emptying is associated with postprandial fullness, nausea, and vomiting; impaired accommodation is associated with early satiety and weight loss; and hypersensitivity to gastric distention is associated with epigastric pain, belching, and weight loss. The pathogenesis of functional dyspepsia is unknown but may be postinfectious in a subgroup of patients. The role of psychological disturbances and of duodenal hypersensitivity requires further study. Treatment of the underlying pathophysiologic abnormality seems logical, but options for pharmacotherapy are limited to acid suppression, prokinetic drugs, and antidepressants. Psychotherapy can be considered for refractory patients. Several novel drug therapies are under evaluation.

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.

Similar content being viewed by others

References and Recommended Reading

  1. Talley NJ, Stanghellini V, Heading RC, et al.: Functional gastroduodenal disorders. Gut 1999, 45(suppl2):37–42. This paper describes the Rome II criteria for functional dyspepsia, the dyspepsia subtypes, and the rationale behind them.

    Google Scholar 

  2. Stanghellini V, Tosetti C, Paternico A, et al.: Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996, 110:1036–1042.

    Article  PubMed  CAS  Google Scholar 

  3. Maes BD, Ghoos YF, Hiele MI, Rutgeerts PJ: Gastric emptying rate of solids in patients with nonulcer dyspepsia. Dig Dis Sci 1997, 42:1158–1162.

    Article  PubMed  CAS  Google Scholar 

  4. Troncon LEA, Bennett RJM, Ahluwalia NK, Thompson DG: Abnormal distribution of food during gastric emptying in functional dyspepsia patients. Gut 1994, 35:327–332.

    PubMed  CAS  Google Scholar 

  5. Gilja OH, Hausken T, Wilhelmsen I, Berstad A: Impaired accommodation of proximal stomach to a meal in functional dyspepsia. Dig Dis Sci 1996, 41:689–696.

    Article  PubMed  CAS  Google Scholar 

  6. Salet GAM, Samsom M, Roelofs JMM, et al.: Responses to gastric distention in functional dyspepsia. Gut 1998, 42:823–829.

    Article  PubMed  CAS  Google Scholar 

  7. Tack J, Piessevaux H, Coulie B, et al.: Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 1998, 115:1346–1352. This paper investigates the link between symptoms and impaired accommodation in a large group of functional dyspepsia patients. Impaired accommodation was associated with a higher prevalence of early satiety and weight loss.

    Article  PubMed  CAS  Google Scholar 

  8. Camilleri M, Coulie B, Tack J: Visceral hypersensitivity: Facts, speculations and challenges. Gut 2001, 48:125–131.

    Article  PubMed  CAS  Google Scholar 

  9. Mearin F, Cucala M, Azpiroz F, Malagelada JR: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 1991, 101:999–1006.

    PubMed  CAS  Google Scholar 

  10. MertzH, Fullerton S, Naliboff B, Mayer EA: Symptoms and visceral perception in severe functional and organic dyspepsia. Gut 1998, 42:814–822. This study shows that hypersenstivity to gastric distention is a feature of functional dyspepsia, not of organic dyspepsia.

    Article  PubMed  CAS  Google Scholar 

  11. Tack J, Caenepeel P, Fischler B, et al.: Symptoms associated with hypersensitivity to gastric distension in functional dyspepsia. Gastroenterology 2001, 121:526–535. This paper investigates the link between symptoms and hypersensitvity to gastric distention in a large group of patients with functional dyspepsia. Visceral hypersensitivity was associated with a higher prevalence of epigastric pain, belching, and weight loss.

    Article  PubMed  CAS  Google Scholar 

  12. Danesh J, Lawrence M, Murphy M, et al.: Systematic review of the epidemiological evidence on Helicobacter pylori infection and nonulcer or uninvestigated dyspepsia. Arch Intern Med 2000, 160:1192–1198.

    Article  PubMed  CAS  Google Scholar 

  13. Wilmer A, Van Cutsem E, Andrioli A, et al.: Prolonged ambulatory gastrojejunal manometry in severe motility-like dyspepsia: lack of correlation between dysmotility, symptoms and gastric emptying. Gut 1998, 42:36–41.

    Article  PubMed  Google Scholar 

  14. Samsom M, Verhagen MA, vanBerge Henegouwen GP, Smout AJ: Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology 1999, 116:515–520. The authors demonstrate induction of nausea by duodenal acid perfusion, as well as delayed duodenal acid clearance, in a small group of patients with dyspepsia.

    Article  PubMed  CAS  Google Scholar 

  15. Feinle C, Meier O, Otto B, et al.: Role of duodenal lipid and cholecystokinin A receptors in the pathophysiology of functional dyspepsia. Gut 2001, 48:347–355. This report demonstrates enhancement of gastric mechanosensitivity by duodenal lipids, mediated by CCK acting on CCK A receptors.

    Article  PubMed  CAS  Google Scholar 

  16. Camilleri M, Hasler WL, Parkman HP, et al.: Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998, 115:747–762.

    Article  PubMed  CAS  Google Scholar 

  17. Chaudhary NA, Truelove SC: The irritable colon syndrome. Q J Med 1962, 123:307–322.

    Google Scholar 

  18. Gwee KA, Graham JC, McKendrick MW, et al.: Psychometric scores and persistence of irritable bowel after infectious diarrhea. Lancet 1996, 347:150–153.

    Article  PubMed  CAS  Google Scholar 

  19. Bityutskiy LP, Soykan I, McCallum RW: Viral gastroparesis: a subgroup of idiopathic gastroparesis: clinical characteristics and long-term outcomes. Am J Gastroenterol 1997, 92:1501–1504.

    PubMed  CAS  Google Scholar 

  20. Tack J, Dehondt G, Caenepeel G, et al.: Clinical and pathophysiological characteristics of severe post-infectious dyspepsia. Gastroenterology, in press.

  21. Wilhelmsen I, Haug TT, Ursin H, Berstad A: Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer: significance of somatization. Dig Dis Sci 1995, 40:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  22. Nyrèn O, Adami HO, Gustavsson S, Loof L: Excess sick-listing in nonulcer dyspepsia. J Clin Gastroenterol 1986, 8:339–345.

    Article  PubMed  Google Scholar 

  23. Langeluddecke P, Goulston K, Tennant C: Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease. J Psychosom Res 1990, 34:215–222.

    Article  PubMed  CAS  Google Scholar 

  24. Tack J, Caenepeel P, Degreef A, Janssens J: Symptom severity and subtypes in functional dyspepsia: Rome II criteria or a pathophysiological approach [abstract]? Gastroenterology 2000, 118:A619.

    Article  Google Scholar 

  25. Tack J, Bisschops R, Degreef T, et al.: Can symptoms predict underlying pathophysiological mechanisms in functional dyspepsia [abstract]? Gastroenterology 2001, 120:A80.

    Article  Google Scholar 

  26. Feinle C, Grundy D, Read NW: Effects of duodenal nutrients on sensory and motor responses of the human stomach to distension. Am J Physiol 1997, 273:G721-G726.

    PubMed  CAS  Google Scholar 

  27. Soo S, Moayyedi P, Deeks J, et al.: Pharmacological interventions for non-ulcer dyspepsia (Cochrane Review). Cochrane Database Syst Rev 2001, 1.

  28. Talley NJ, Meineche-Schmidt V, Pare P, et al.: Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the BOND and OPERA studies). Aliment Pharmacol Ther 1998, 12:1055–1065. This study established the therapeutic potential of proton pump inhibition in dyspeptics who also have reflux symptoms.

    Article  PubMed  CAS  Google Scholar 

  29. Janssens J, Peeters TL, Vantrappen G, et al.: Improvement of gastric emptying in diabetic gastroparesis by erythromycin: preliminary studies. N Engl J Med 1987, 322:1028–1031.

    Article  Google Scholar 

  30. Talley NJ, Verlinden M, Snape W, et al.: Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebocontrolled trial. Aliment Pharmacol Ther 2000, 14:1653–1661.

    Article  PubMed  CAS  Google Scholar 

  31. Tack J, Peeters T: What comes after macrolides and other motilin stimulants? Gut 2001, 49:317–318.

    PubMed  CAS  Google Scholar 

  32. Bruley des Varannes S, Parys V, Ropert A, et al.: Erythromycin enhances fasting and postprandial proximal gastric tone in humans. Gastroenterology 1995, 109:32–39.

    Article  PubMed  CAS  Google Scholar 

  33. Piessevaux H, Tack J, Wilmer A, et al.: Perception of changes in wall tension of the proximal stomach in man. Gut 2001, 49:203–208.

    Article  PubMed  CAS  Google Scholar 

  34. Tack J: The physiology and the pathophysiology of the gastric accommodation reflex in man. Verhand Kon Acad Geneesk 2000, 62:183–210.

    CAS  Google Scholar 

  35. Meulemans AL, Helsen LF, Schuurkes JAJ: The role of nitric oxide (NO) in 5-HT induced relaxations of the guinea-pig stomach. Naunyn-Schmiedeberg’s Arch Pharmacol 1993, 384:424–430.

    Google Scholar 

  36. Thumshirn M, Camilleri M, Choi MG, Zinsmeister AR: Modulation of gastric sensory and motor functions by nitrergic and alpha2-adrenergic agents in humans. Gastroenterology 1999, 116:573–585.

    Article  PubMed  CAS  Google Scholar 

  37. Tack J, Broeckaert D, Coulie B, Janssens J: Influence of cisapride on gastric tone and on the perception of gastric distension. Aliment Pharmacol Ther 1998, 12:761–766.

    Article  PubMed  CAS  Google Scholar 

  38. Tack J, Coulie B, Wilmer A, et al.: Effect of sumatriptan on gastric fundus tone and on the perception of gastric distension in man. Gut 2000, 46:468–473.

    Article  PubMed  CAS  Google Scholar 

  39. Coffin B, Bouhassira D, Chollet R, et al.: Effect of the kappa agonist fedotozine on perception of gastric distension in healthy humans. Aliment Pharmacol Ther 1996, 10:919–925.

    Article  PubMed  CAS  Google Scholar 

  40. Tanum L, Malt UF: A new pharmacologic treatment of functional gastrointestinal disorder: a double-blind placebocontrolled study with mianserin. Scand J Gastroenterol 1996, 31:318–325.

    PubMed  CAS  Google Scholar 

  41. Mertz H, Fass R, Kodner A, et al.: Effect of amitriptyline on symptoms, sleep, and visceral perception in patients with functional dyspepsia. Am J Gastroenterol 1998, 93:160–165.

    Article  PubMed  CAS  Google Scholar 

  42. Jaakkimainen RL, Boyle E, Tudiver F: Is Helicobacter pylori associated with non-ulcer dyspepsia and will eradication improve symptoms? A meta-analysis. BMJ 2000, 319:1040–1044.

    Google Scholar 

  43. Laine L, Schoenfeld P, Fennerty MB: Therapy for Helicobacter pylori in patients with nonulcer dyspepsia: a meta-analysis of randomized, controlled trials. Ann Intern Med 2000, 134:361–369.

    Google Scholar 

  44. Moayyedi P, Soo S, Deeks J, et al.: Eradication of Helicobacter pylori for non-ulcer dyspepsia (Cochrane Review). Cochrane Database Syst Rev 2001, 1.

  45. Talley NJ, Van Zanten SV, Saez LR, et al.: A dose-ranging, placebo-controlled, randomized trial of alosetron in patients with functional dyspepsia. Aliment Pharmacol Ther 2001, 15:525–537. This study establishes the therapeutic potential of 5HT3 antagonists in functional dyspepsia.

    Article  PubMed  CAS  Google Scholar 

  46. Zerbib F, Bruley des Varannes S, Oriola RC, et al.: Alosetron does not affect the visceral perception of gastric distension in healthy subjects. Aliment Pharmacol Ther 1994, 8:403–407.

    Article  PubMed  CAS  Google Scholar 

  47. Feinle C, Read NW: Ondansetron reduces nausea induced by gastroduodenal stimulation without changing gastric motility. Am J Physiol 1996, 271:G591-G597.

    PubMed  CAS  Google Scholar 

  48. Hamilton J, Guthrie E, Creed F, et al.: A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Gastroenterology 2000, 119:661–669.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tack, J., Bisschops, R. & DeMarchi, B. Causes and treatment of functional dyspepsia. Curr Gastroenterol Rep 3, 503–508 (2001). https://doi.org/10.1007/s11894-001-0071-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-001-0071-y

Keywords

Navigation