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Functional Dyspepsia

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Essential Medical Disorders of the Stomach and Small Intestine

Abstract

Unexplained fullness after eating, inability to finish a normal-sized meal (early satiety), and/or epigastric pain or burning are common symptoms. In clinical practice the likeliest explanation is functional dyspepsia, where by definition esophagogastroduodenoscopy is normal, with no other structural explanation found. Symptoms may be primarily after eating, as in postprandial distress syndrome, or may have no relationship to meals (epigastric pain syndrome). The diagnosis of functional dyspepsia requires exclusion of organic disease. The pathogenesis is incompletely understood and is likely multifactorial. In a minority, Helicobacter pylori (H. pylori) infection plays a role, but some patients have microscopic duodenal inflammation characterised by eosinophils, and sometimes mast cells. Currently, treatment involves a stepwise approach. If H. pylori infection is present, eradication therapy may be beneficial. Acid suppression is otherwise first-line therapy. An antidepressant (a low-dose tricyclic agent) or prokinetic agent is second-line therapy.

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References

  1. Talley NJ, Ford AC. Functional dyspepsia. N Engl J Med. 2015;373(19):1853–63.

    Article  CAS  Google Scholar 

  2. Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, et al. Gastroduodenal disorders. Gastroenterology. 2016;150(6):1380–92.

    Article  Google Scholar 

  3. Tack J, Carbone F. Functional dyspepsia and gastroparesis. Curr Opin Gastroenterol. 2017;33(6):446–54.

    Article  CAS  Google Scholar 

  4. Carbone F, Tack J. Gastroduodenal mechanisms underlying functional gastric disorders. Dig Dis. 2014;32(3):222–9.

    Article  CAS  Google Scholar 

  5. Ueda M, Iwasaki E, Suzuki H. Profile of acotiamide in the treatment of functional dyspepsia. Clin Exp Gastroenterol. 2016;9:83–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Walker MM, Aggarwal KR, Shim LSE, Bassan M, Kalantar JS, Weltman MD, et al. Duodenal eosinophilia and early satiety in functional dyspepsia: confirmation of a positive association in an Australian cohort. J Gastroenterol Hepatol. 2014;29(3):474–9.

    Article  Google Scholar 

  7. Cirillo C, Bessissow T, Desmet A-S, Vanheel H, Tack J, Vanden Berghe P. Evidence for neuronal and structural changes in submucous ganglia of patients with functional dyspepsia. Am J Gastroenterol. 2015;110:1205.

    Article  CAS  Google Scholar 

  8. Walker MM, Talley NJ, Prabhakar M, Pennaneac’H CJ, Aro P, Ronkainen J, 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(7):765–73.

    Article  CAS  Google Scholar 

  9. Pinto-Sanchez MI, Yuan Y, Hassan A, Bercik P, Moayyedi P. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev. 2017;11:CD011194.

    Google Scholar 

  10. Mearin F, Pérez-Oliveras M, Perelló A, Vinyet J, Ibañez A, Coderch J, Perona M. Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: one-year follow-up cohort study. Gastroenterology. 2005;129(1):98–104.

    Article  Google Scholar 

  11. Potter M, Walker MM, Talley NJ. Non-coeliac gluten or wheat sensitivity: emerging disease or misdiagnosis? Med J Aust. 2017;207(5):211–5.

    Article  Google Scholar 

  12. Du L, Shen J, Kim JJ, He H, Chen B, Dai N. Impact of gluten consumption in patients with functional dyspepsia: a case–control study. J Gastroenterol Hepatol. 2018;33(1):128–33.

    Article  CAS  Google Scholar 

  13. Igarashi M, Nakae H, Matsuoka T, Takahashi S, Hisada T, Tomita J, et al. Alteration in the gastric microbiota and its restoration by probiotics in patients with functional dyspepsia. BMJ Open Gastroenterol. 2017;4(1):e000144.

    Article  Google Scholar 

  14. Fikree A, Chelimsky G, Collins H, Kovacic K, Aziz Q. Gastrointestinal involvement in the Ehlers–Danlos syndromes. Am J Med Genet C: Semin Med Genet. 2017;175(1):181–7.

    Article  Google Scholar 

  15. Vakil NB, Howden CW, Moayyedi P, Tack J. White paper AGA: functional dyspepsia. Clinical Gastroenterol Hepatol. 2017;15(8):1191–4.

    Article  Google Scholar 

  16. Enck P, Azpiroz F, Boeckxstaens G, Elsenbruch S, Feinle-Bisset C, Holtmann G, et al. Functional dyspepsia. Nat Rev Dis Primers. 2017;3:17081.

    Article  Google Scholar 

  17. Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112:988.

    Article  CAS  Google Scholar 

  18. D’Alessandro A, Zito F, Pesce M, Andreozzi P, Efficie E, Cargiolli M, et al. Specific dyspeptic symptoms are associated with poor response to therapy in patients with gastroesophageal reflux disease. United European Gastroenterol J. 2017;5(1):54–9.

    Article  Google Scholar 

  19. Koloski NA, Jones M, Talley NJ. Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study. Aliment Pharmacol Ther. 2016;44(6):592–600.

    Article  CAS  Google Scholar 

  20. Ford AC, Forman D, Bailey AG, Axon ATR, Moayyedi P. Effect of dyspepsia on survival: a longitudinal 10-year follow-up study. Am J Gastroenterol. 2012;107:912.

    Article  Google Scholar 

  21. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of helicobacter pylori infection. Am J Gastroenterol. 2017;112:212.

    Article  Google Scholar 

  22. Jackson MA, Goodrich JK, Maxan M-E, Freedberg DE, Abrams JA, Poole AC, et al. Proton pump inhibitors alter the composition of the gut microbiota. Gut. 2016;65(5):749–56.

    Article  Google Scholar 

  23. 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):411–20.

    Article  CAS  Google Scholar 

  24. Kusunoki H, Haruma K, Manabe N, Imamura H, Kamada T, Shiotani A, et al. Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography. Neurogastroenterol Motil. 2012;24(6):540–e251.

    Article  CAS  Google Scholar 

  25. Tan VPY, Liu KSH, Lam FYF, Hung IFN, Yuen MF, Leung WK. Randomised clinical trial: rifaximin versus placebo for the treatment of functional dyspepsia. Aliment Pharmacol Ther. 2017;45(6):767–76.

    Article  CAS  Google Scholar 

Essential Reading

  • Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112:988. Evidence-based guidelines for the diagnosis and management of patients with dyspepsia.

    Article  CAS  Google Scholar 

  • Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, et al. Gastroduodenal disorders. Gastroenterol. 2016;150(6):1380–92. Provides a detailed overview of FD and other functional disorders, with reference to the Rome IV Criteria.

    Article  Google Scholar 

  • Talley NJ, Ford AC. Functional dyspepsia. N Engl J Med. 2015;373(19):1853–63. Expert overview of FD with explanation of disease mechanisms and discussion of relevant clinical trials.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Global Research, The University of Newcastle, New Lambton, NSW, Australia

    Nicholas J. Talley & Dane R. Cook

Authors
  1. Nicholas J. Talley
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  2. Dane R. Cook
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Corresponding author

Correspondence to Nicholas J. Talley .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Alexander C. Ford

Self-Test

Self-Test

  • Question 1. A 45-year-old man consults regarding a 5-year history of epigastric discomfort, described as burning in nature. Early in its course, the pain was intermittent and tended to occur after meals, although he feels that it is occurring more frequently in recent times. He had a poor response to a PPI. In addition, he has noticed his stools have become increasingly loose and offensive and at times are difficult to flush. EGD with gastric and duodenal biopsies 2 years ago on a normal diet were unremarkable.

    Which of the following investigations is most likely to help establish a diagnosis?

    1. A.

      Repeat EGD and duodenal biopsies.

    2. B.

      Urease breath test for H. pylori

    3. C.

      Abdominal CT scan

    4. D.

      Glucose hydrogen breath test

    5. E.

      Celiac serology

  • Question 2. You are reviewing a 35-year-old female who has returned for follow-up after a normal EGD for symptoms of moderately severe persistent dyspepsia, with normal bowel habits. Gastric biopsies were normal, without evidence of H. pylori. Duodenal biopsies demonstrated an eosinophil count of 30/hpf, on at least 5 high-power fields. There were no typical changes of coeliac disease.

    You make a diagnosis of FD, likely PDS, and discuss management options. Which of the following would you recommend as first-line based on randomised controlled trials?

    1. A.

      Trial of PPI

    2. B.

      Low FODMAP diet and psychotherapy

    3. C.

      Trial of a TCA

    4. D.

      No treatment indicated – reassurance and discharge to primary care physician

    5. E.

      H2RA

  • Question 3. The Rome IV criteria provide a symptom-based framework for the diagnosis of functional dyspepsia (FD) and its subtypes. Which of the following symptoms is least likely to occur in functional dyspepsia, and should alert clinicians to an alternative diagnosis?

    1. A.

      Excessive belching

    2. B.

      Heartburn less than once a week

    3. C.

      Frequent postprandial vomiting

    4. D.

      Nausea

    5. E.

      Early satiety

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Talley, N.J., Cook, D.R. (2019). Functional Dyspepsia. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_8

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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