Abstract

BACKGROUND
Functional dyspepsia (FD), a common functional gastrointestinal disorder, is defined by the Rome III criteria as symptoms of epigastric pain or discomfort (prevalence in FD of 89-90%), postprandial fullness (75-88%), and early satiety (50-82%) within the last 3 months with symptom onset at least 6 months earlier. Patients cannot have any evidence of structural disease to explain symptoms and predominant symptoms of gastroesophageal reflux are exclusionary. Symptoms of FD are non-specific and the pathophysiology is diverse, which explains in part why a universally effective treatment for FD remains elusive.
AIM
To present current management options for the treatment of FD (therapeutic gain/response rate noted when available).
RESULTS
The utility of Helicobacter pylori eradication for the treatment of FD is modest (6-14% therapeutic gain), while the therapeutic efficacy of proton pump inhibitors (PPI) (7-10% therapeutic gain), histamine-type-2-receptor antagonists (8-35% therapeutic gain), prokinetic agents (18-45%), tricyclic antidepressants (TCA) (response rates of 64-70%), serotonin reuptake inhibitors (no better than placebo) is limited and hampered by inadequate data. This review discusses dietary interventions and analyses studies involving complementary and alternative medications, and psychological therapies.
CONCLUSIONS
A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylori-negative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an anti-nociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.

Links

Publisher Full Text

Authors

Lacy BE, Talley NJ, Locke GR, Bouras EP, DiBaise JK, El-Serag HB, Abraham BP, Howden CW, Moayyedi P, Prather C

Institution

Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. brian.lacy@hitchcock.org

Source

Alimentary pharmacology & therapeutics 36:1 2012 Jul pg 3-15

MeSH

Analgesics
Antidepressive Agents, Tricyclic
Complementary Therapies
Dietary Supplements
Dyspepsia
Gastrointestinal Agents
Helicobacter Infections
Helicobacter pylori
Histamine H2 Antagonists
Humans
Proton Pump Inhibitors
Psychotherapy
Treatment Outcome

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Review

Language

eng

PubMed ID

22591037