title: Review article: current treatment options and management of functional dyspepsia.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. brian.lacy@hitchcock.org
authors.forename: B E
authors.initials: BE
authors.lastname: Lacy
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
authors.forename: G R
authors.initials: GR
authors.lastname: Locke
authors.forename: E P
authors.initials: EP
authors.lastname: Bouras
authors.forename: J K
authors.initials: JK
authors.lastname: DiBaise
authors.forename: H B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: B P
authors.initials: BP
authors.lastname: Abraham
authors.forename: C W
authors.initials: CW
authors.lastname: Howden
authors.forename: P
authors.initials: P
authors.lastname: Moayyedi
authors.forename: C
authors.initials: C
authors.lastname: Prather
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D000529:Complementary Therapies; D019587:Dietary Supplements; D004415:Dyspepsia / Q000188:drug therapy* / Q000382:microbiology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D011613:Psychotherapy; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000929:Antidepressive Agents, Tricyclic; D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors