Functional Dyspepsia: Advances in Diagnosis and Therapy

Gut Liver. 2017 May 15;11(3):349-357. doi: 10.5009/gnl16055.

Abstract

Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pretest probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD-Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation.

Keywords: Epidemiology; Functional dyspepsia.

Publication types

  • Review

MeSH terms

  • Diagnosis, Differential
  • Duodenal Diseases / complications
  • Duodenal Diseases / diagnosis
  • Dyspepsia / diagnosis*
  • Dyspepsia / etiology
  • Dyspepsia / therapy*
  • Eosinophilia / complications
  • Eosinophilia / diagnosis
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / diagnosis
  • Heartburn / complications
  • Heartburn / diagnosis
  • Helicobacter Infections / complications
  • Helicobacter Infections / drug therapy
  • Helicobacter pylori
  • Humans
  • Postprandial Period*
  • Symptom Assessment*