Drug treatment of functional dyspepsia.
Symptomatic improvement of patients with functional dyspepsia after drug therapy is often incomplete and obtained in not more than 60% of patients. This is likely because functional dyspepsia is a heterogeneous disease. Although great advance has been achieved with the consensus definitions of the Rome I and II criteria, there are still some aspects about the definition of functional dyspepsia that require clarification. The Rome criteria explicitly recognise that epigastric pain or discomfort must be the predominant complaint in patients labelled as suffering from functional dyspepsia. However, this strict definition can create problems in the daily primary care clinical practice, where the patient with functional dyspepsia presents with multiple symptoms. Before starting drug therapy it is recommended to provide the patient with an explanation of the disease process and reassurance. A thorough physical examination and judicious use of laboratory data and endoscopy are also indicated. In general, the approach to treat patients with functional dyspepsia based on their main symptom is practical and effective. Generally, patients should be treated with acid suppressive therapy using proton-pump inhibitors if the predominant symptoms are epigastric pain or gastroesophageal reflux symptoms. Although the role of Helicobacter pylori (H pylori) in functional dyspepsia continues to be a matter of debate, recent data indicate that there is modest but clear benefit of eradication of H pylori in patients with functional dyspepsia. In addition, H pylori is a gastric carcinogen and if found it should be eliminated. Although there are no specific diets for patients with FD, it may be helpful to guide the patients on healthy exercise and eating habits.
Mönkemüller
Klaus
K
Divison of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke Medical School, University of Magdeburg, Magdeburg, Leipziger Strabe 44, 39120 Magdeburg, Germany.
Malfertheiner
Peter
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D004415:Dyspepsia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D015444:Exercise; D005247:Feeding Behavior / Q000502:physiology; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives; D028321:Plant Preparations / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors
D000900:Anti-Bacterial Agents; D000928:Antidepressive Agents; D006635:Histamine H2 Antagonists; D006993:Hypnotics and Sedatives; D028321:Plant Preparations; D054328:Proton Pump Inhibitors