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Functional (nonulcer) dyspepsia

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Opinion statement

  • Functional (nonulcer) dyspepsia refers to upper abdominal pain or discomfort with or without symptoms of early satiety, nausea, or vomiting with no definable organic cause. The current Rome II criteria help to diagnose functional dyspepsia and avoid misdiagnosis of gastroesophageal reflux disease and irritable bowel syndrome as functional dyspepsia.

  • Assessment of gastric emptying with scintigraphy or breath testing may be useful in identifying delayed gastric emptying in patients with dyspeptic symptoms and may be helpful in patient management. Electrogastrography is a noninvasive test that evaluates for gastric dysrhythmias. Satiety testing is being evaluated as an indirect test for impaired fundic relaxation and visceral hypersensitivity.

  • The symptom response to Helicobacter pylori therapy in patients with functional dyspepsia and a negative endoscopy examination but a positive H. pylori test is marginal.

  • Lifestyle modifications often are suggested for initial treatment of functional dyspepsia. Dietary changes such as frequent small meals, low-fat diet, and avoidance of certain aggravating foods may improve symptoms. Additional measures include cessation of smoking, avoiding excess alcohol intake, and minimizing coffee intake. Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an “on-demand” therapy for intermittent symptoms. They are safe and relatively inexpensive.

  • Different subgroups of functional dyspepsia are based on the predominant symptom and may help in choosing an appropriate drug to initiate therapy. If the predominant symptom is epigastric pain (ulcer-like functional dyspepsia), histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice. If fullness, bloating, early satiety or nausea is the predominant complaint (dysmotility-like functional dyspepsia), a prokinetic agent may help. Metoclopramide is the only available effective prokinetic agent at present. If metoclopramide is used, short-term treatment and discussion of possible side effects with the patient are advised.

  • If there is no response to these initial treatments, switching therapy from proton pump inhibitor to prokinetic or vice versa can be tried.

  • If these treatment options fail, patient re-evaluation for other disorders (including other functional bowel disorders) is advised. A low-dose tricyclic antidepressant at bedtime may be helpful for treatment of visceral hypersensitivity.

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References and Recommended Reading

  1. Russo MW, Gaynes BN, Drossman DA: A National survey of practice patterns of gastroenterologists with comparison to the past two decades. J Clin Gastro 1999, 29:339–343.

    Article  CAS  Google Scholar 

  2. Richter JE: Dyspepsia: organic causes and differential characteristics from functional dyspepsia. Scand J Gastroenterol 1991, 26(suppl 182):11–16.

    Google Scholar 

  3. Talley NJ, Stanghellini V, Heading RC, et al.: Functional gastrointestinal disorders. Gut 1999, 45(suppl II):1137–1142. This article covers the Rome II diagnostic criteria for functional dyspepsia.

    Google Scholar 

  4. Stanghellini V, Tosetti C, Paternico A, et al.: Predominant symptoms identify different subgroups in functional dyspepsia. Am J Gastroenterol 1999, 94:2080–2085.

    Article  PubMed  CAS  Google Scholar 

  5. Fisher RS, Parkman HP: Management of nonulcer dyspepsia. N Engl J Med 1998, 339:1376–1381. A review written by two of the authors of this article.

    Article  PubMed  CAS  Google Scholar 

  6. Tack JF, Caenepeel P, Degreef A, et al.: Proximal gastric sensory and motor function in functional dyspepsia patients with prevalent pain or prevalent discomfort [abstract]. Gastroenterology 2000, 118:A619.

    Article  Google Scholar 

  7. Talley NJ, Silverstein MD, Agreus L, et al.: AGA technical review: evaluation of dyspepsia. Gastroenterology 1998, 114:582–595.

    Article  PubMed  CAS  Google Scholar 

  8. Parkman HP, Miller, Knight LC, et al.: Electrogastrography and gastric emptying scintigraphy are complementary for assessment of dyspepsia. J Clin Gastroenterol 1997, 24:214–219.

    Article  PubMed  CAS  Google Scholar 

  9. Chen JDZ, Ke MY, Lin XM, et al.: Cisapride provides symptomatic relief in functional dyspepsia associated with gastric myoelectrical abnormality. Aliment Pharmacol Ther 2000, 14:1041–1047.

    Article  PubMed  CAS  Google Scholar 

  10. Mearin F, Balboa A, Zarante N, et al.: Placebo in functional dyspepsia: symptomatic gastrointestinal motor and gastric sensational responses. Am J Gastroenterol 1999, 26:312–320.

    Google Scholar 

  11. Nyren O, Hans-Olov, Bates S, et al.: Absence of therapeutic benefits from antacids or cimetidine in nonulcer dyspepsia. N Engl J Med 1986, 314:339–343.

    Article  PubMed  CAS  Google Scholar 

  12. Dobrilla G, Comberlato M, Steele A, et al.: Drug treatment of functional dyspepsia—a meta-analysis of randomized controlled clinical trials. J Clin Gastroenterol 1989, 11:169–177.

    Article  PubMed  CAS  Google Scholar 

  13. Veldhuyzen van Zanten SJO, Cleary C, Talley NJ, et al.: Drug treatment of functional dypspepsia. A systematic analysis of trial methodology with recommendations for design of future trials. Am J Gastroenterol 1996, 91:660–673. This article discusses some of the pitfalls of the published studies on functional dyspepsia.

    PubMed  CAS  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Halter F, Miazza B, Brignoli R: Cisapride or cimetidine in the treatment of functional dyspepsia. Scand J Gastroenterol 1994, 29:618–23.

    PubMed  CAS  Google Scholar 

  16. Finney JS, Kinnersley N, Hughes M, et al.: Meta-analysis of antisecretory and gastrokinetic compounds in functional dyspepsia. J Clin Gastro 1998, 26:312–320.

    Article  CAS  Google Scholar 

  17. Veldhuyzen van Zanen SJOV, Jones MJ, Verlinden M, et al.: Efficacy of cisapride and domperidone in functional dyspepsia: a meta-analysis. Am J Gastroenterol 2001, 96:689–696.

    Article  Google Scholar 

  18. Soo S, Deeks JJ, Delaney BC, et al.: A systematic review of pharmacological therapy in non-ulcer dyspepsia [abstract]. Gastroenterology 2000, 118:A440.

    Article  Google Scholar 

  19. 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 placebo-controlled trial. Aliment Pharmacol Ther 2000, 14:1653–1661.

    Article  PubMed  CAS  Google Scholar 

  20. 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 

  21. Armstrong D: Helicobacter pylori infection and dyspepsia. Scand J Gastroenterol 1996, 31(suppl 215):70–73.

    Google Scholar 

  22. NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. JAMA 1994, 272:65–71.

    Article  Google Scholar 

  23. McColl K, Murray L, El-Omar E, et al.: Symptomatic benefit from eradicating Helicobacter pylori infection in patients with non-ulcer dyspepsia. N Engl J Med 1998, 339:1869–1874.

    Article  PubMed  CAS  Google Scholar 

  24. Blum AL, Talley NJ, O’ Morain C, et al.: Lack of effect of treating Helicobacter pylori infection in patients with non-ulcer dyspepsia. N Engl J Med 1998, 339:1875–1881.

    Article  PubMed  CAS  Google Scholar 

  25. Clouse RE: Antidepressants for functional gastrointestinal syndromes. Dig Dis Sci 1994, 39:2352–2363.

    Article  PubMed  CAS  Google Scholar 

  26. Loldrup D, Langemark M, Hansen HJ, et al.: Clomipramine and mianserin in chronic idiopathic pain syndrome: a placebo controlled study. Psychopharmacology 1989, 99:1–7.

    Article  PubMed  CAS  Google Scholar 

  27. Mertz H, Rass 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 

  28. Enck P, Allescher H-D, Wienbeck M, et al.: Why do patients with functional dyspepsia utilize alternative medicine? Data from a long-term epidemiology study [abstract]. Gastroenterology 2001, 120:A51.

    Article  Google Scholar 

  29. Madisch A, Melderis H, Mayr G, et al.: Commercially available herbal preparation and its modified dispense in patients with functional dyspepsia [abstract]. Gastroenterology 2001, 120:A236.

    Article  Google Scholar 

  30. May B, Kohler S, Schneider B: Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Aliment Pharmacol Ther 2000, 14:1671–1677.

    Article  PubMed  CAS  Google Scholar 

  31. Holtmann G, Gschossmann JM, Buenger, et al.: Effects of fixed peppermint oil caraway oil combination on symptoms and quality of life in functional dyspepsia [abstract]. Gastroenterology 2001, 120:A237.

    Article  Google Scholar 

  32. Calveert EL, Hughton LA, Cooper P, et al.: Hypnotherapy is effective in the long-term treatment of functional dyspepsia [abstract]. Gastroenterology 2001, 120:A115.

    Article  Google Scholar 

  33. 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 

  34. Camilleri M: Tegaserod. Aliment Pharmaco Ther 2001, 15:277–289.

    Article  CAS  Google Scholar 

  35. Thumshirn M, Cho M-G, Zinsmeister AR, et al.: Modulation of gastric sensory and motor functions by nitrergic and alpha-2 adrenergic agents. Gastroenterology 1999, 116:573–585.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  37. Gulliskon GW, Virina MA, Loeffler R, et al.: Alpha-2 adrenergic model of gastroparesis. Am J Physiol 1991, 261:G426-G432.

    Google Scholar 

  38. Freitag B, Homerin M, Hecketsweiler P: Double-blind dose-response multicenter comparison of fedotozine and placebo treatment of non-ulcer dyspepsia. Dig Dis Sci 1994, 39:1072–1080.

    Article  Google Scholar 

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Authors and Affiliations

  1. Gastroenterology Section, Department of Medicine, Temple University, Parkinson Pavilion, 8th Floor, 3401 North Broad Street, 19140-5103, Philadelphia, PA, USA

    Kashyap V. Panganamamula MD, Robert S. Fisher MD & Henry P. Parkman MD

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  1. Kashyap V. Panganamamula MD
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  2. Robert S. Fisher MD
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  3. Henry P. Parkman MD
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Panganamamula, K.V., Fisher, R.S. & Parkman, H.P. Functional (nonulcer) dyspepsia. Curr Treat Options Gastro 5, 153–160 (2002). https://doi.org/10.1007/s11938-002-0063-5

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  • DOI: https://doi.org/10.1007/s11938-002-0063-5

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