Functional dyspepsia. Current treatment recommendations.
Symptoms of functional dyspepsia are frequent; the prevalence of dyspepsia (defined as pain or discomfort centred in the upper abdomen) in the general population approaches 25%. By definition, patients with functional dyspepsia do not have a structural or biochemical explanation for their symptoms. Disorders of function (e.g. delayed gastric emptying) are detectable in a proportion of patients but remain poorly understood. Nevertheless, the current rationale for drug treatment is based on altering pathophysiological mechanisms which are believed to be associated with the development of symptoms. Although the placebo response rates approach 60%, prokinetics, acid-suppressing agents and bismuth-containing compounds have been shown to be significantly better than placebo in reducing symptoms. Antacids are widely used, but no controlled study has been able to demonstrate a significant benefit over placebo. The efficacy of sucralfate is uncertain. Rational guidelines on which drug should be used for a given patient are lacking, although approaches based on symptom profiles have been proposed; the duration of treatment needed to achieve long-lasting relief of symptoms is also poorly defined. Identifying optimal treatment for the individual patient, therefore, continues to be largely a trial and error process. Further research efforts are needed to elucidate the pathophysiological basis of functional dyspepsia so that specific therapy can be tailored to underlying pathophysiological disturbances.
Holtmann
Gerald
G
Division of Gastroenterology, University of Essen, Essen, Germany.
Talley
Nicholas J
NJ
Division of Gastroenterology and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, 55905, USA.
D020117:Cisapride; D018492:Dopamine Antagonists; D004415:Dyspepsia / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D005744:Gastric Acid / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005769:Gastrointestinal Motility / Q000187:drug effects; D016481:Helicobacter Infections / Q000188:drug therapy; D016480:Helicobacter pylori / Q000187:drug effects; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010880:Piperidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012702:Serotonin Antagonists / Q000627:therapeutic use
D018492:Dopamine Antagonists; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D010880:Piperidines; D012702:Serotonin Antagonists; D020117:Cisapride