title: Current management strategies and emerging treatments for functional dyspepsia.
abstract: Functional dyspepsia refers to painful and nonpainful symptoms that are perceived to arise in the upper digestive tract but are not secondary to organic, systemic or metabolic diseases. The symptoms of this syndrome often overlap with those of GERD and IBS, making its management far from simple. If Helicobacter pylori infection is diagnosed in patients with functional dyspepsia, it should be treated. In patients with mild or intermittent symptoms, reassurance and lifestyle advice might be sufficient; in patients not responding to these measures, or in those with more severe symptoms, drug therapy should be considered. Both PPIs and prokinetics can be used in initial empirical pharmacotherapy based on symptom patterns--a PPI is more likely to be effective in the presence of retrosternal or epigastric burning or epigastric pain, whereas a prokinetic is more effective in dyspepsia with early satiation or postprandial fullness. Although combinations of PPIs and prokinetics might have additive symptomatic effects, single-drug therapy is initially preferable. Antidepressants or referral to a psychiatrist or psychotherapist can be considered in nonresponders and in those whose symptoms have a marked effect on daily functioning. Despite extensive research, functional dyspepsia treatment often remains unsatisfactory. Better characterization of dyspeptic subgroups and understanding of underlying mechanisms will enable treatment advances to be made in the future.
authors: Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
authors: Michael
authors: M
authors: Camilleri
authors: Vincenzo
authors: V
authors: Stanghellini
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D019468:Disease Management; D004415:Dyspepsia / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008019:Life Style; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D054328:Proton Pump Inhibitors
references: Gut. 2008 Jun;57(6):740-6
references: 17965059
references: Aliment Pharmacol Ther. 1998 Nov;12(11):1055-65
references: 9845395
references: Am J Gastroenterol. 2010 Dec;105(12):2626-31
references: 20823838
references: Gastroenterology. 2004 Nov;127(5):1329-37
references: 15521002
references: J Gastroenterol. 2006 Jul;41(7):647-53
references: 16933001
references: Gut. 1997 Nov;41(5):664-8
references: 9414975
references: Gut. 2008 Sep;57(9):1214-20
references: 18441005
references: Am J Gastroenterol. 2008 Mar;103(3):753-63
references: 18028513
references: Gastroenterology. 2006 Apr;130(5):1466-79
references: 16678560
references: Gastroenterology. 2009 Jul;137(1):94-100
references: 19328797
references: Aliment Pharmacol Ther. 2002 May;16(5):959-67
references: 11966505
references: Pharmacoeconomics. 1992 May;1(5):312-24
references: 10146996
references: Lancet. 2000 Aug 5;356(9228):455-60
references: 10981888
references: Am J Gastroenterol. 2009 Nov;104(11):2779-87
references: 19638966
references: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD001961
references: 19821286
references: Aliment Pharmacol Ther. 2008 Jun 1;27(11):1122-31
references: 18331462
references: Aliment Pharmacol Ther. 2003 Feb 15;17(4):603-8
references: 12622770
references: Aliment Pharmacol Ther. 2005 Jun;21 Suppl 2:42-6
references: 15943846
references: Aliment Pharmacol Ther. 2008 Dec 1;28(11-12):1326-33
references: 18793342
references: Gastroenterology. 2005 Nov;129(5):1753-5
references: 16285970
references: Aliment Pharmacol Ther. 2002 Aug;16(8):1491-501
references: 12182749
references: Neurogastroenterol Motil. 2012 Jun;24(6):540-5, e250-1
references: 22385472
references: PLoS One. 2012;7(6):e39173
references: 22720064
references: Neurogastroenterol Motil. 2010 Jun;22(6):618-e173
references: 20059698
references: Aliment Pharmacol Ther. 2000 Dec;14(12):1653-61
references: 11121915
references: Can J Gastroenterol. 2005 May;19(5):285-303
references: 15915244
references: World J Gastroenterol. 2012 Apr 7;18(13):1517-24
references: 22509084
references: Gastroenterology. 1996 Apr;110(4):1036-42
references: 8612991
references: Am J Gastroenterol. 2010 Apr;105(4):757-63
references: 20372127
references: N Engl J Med. 2006 Feb 23;354(8):832-40
references: 16495395
references: Dan Med Bull. 2011 May;58(5):A4363
references: 21535988
references: Gastroenterol Clin North Am. 2007 Sep;36(3):649-64, xi-x
references: 17950442
references: Clin Gastroenterol Hepatol. 2009 Apr;7(4):432-7
references: 19264574
references: Clin Gastroenterol Hepatol. 2008 Jul;6(7):746-52; quiz 718
references: 18424191
references: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001960
references: 17054151
references: Am J Gastroenterol. 2005 Oct;100(10):2324-37
references: 16181387
references: Gastroenterol Clin North Am. 2010 Sep;39(3):481-93
references: 20951913
references: Nat Rev Gastroenterol Hepatol. 2013 Mar;10(3):134-41
references: 23399526
references: Neurogastroenterol Motil. 2009 Jul;21(7):706-e38
references: 19309440
references: Int J Technol Assess Health Care. 2006 Summer;22(3):362-71
references: 16984065
references: Neurogastroenterol Motil. 2012 Dec;24(12):1076-e562
references: 22747676
references: Am J Physiol Gastrointest Liver Physiol. 2003 Jan;284(1):G130-7
references: 12488239
references: Gut. 2004 Dec;53(12):1758-63
references: 15542510
references: Clin Gastroenterol Hepatol. 2008 Jun;6(6):635-643.e1
references: 18406670
references: Clin Gastroenterol Hepatol. 2003 Jul;1(4):264-72
references: 15017667
references: Gut. 2000 Jan;46(1):93-7
references: 10601062
references: Gastroenterology. 2002 May;122(5):1270-85
references: 11984514
references: J Gastroenterol. 2005 Nov;40(11):1036-42
references: 16322947
references: Gastroenterology. 2004 Dec;127(6):1685-94
references: 15578506
references: Aliment Pharmacol Ther. 2003 Aug 15;18(4):387-93
references: 12940923
references: Gut. 2012 Sep;61(9):1284-90
references: 22234979
references: Neurogastroenterol Motil. 2009 Mar;21(3):272-80
references: 19254354
references: Am J Gastroenterol. 2002 Dec;97(12):3045-51
references: 12492188
references: Am J Gastroenterol. 2010 Dec;105(12):2632-4
references: 21131930
references: Clin Gastroenterol Hepatol. 2004 Apr;2(4):301-8
references: 15067624
references: Am J Gastroenterol. 2008 Aug;103(8):1906-19
references: 18616658
references: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD002301
references: 21328255
references: Clin Gastroenterol Hepatol. 2007 Feb;5(2):178-85; quiz 140
references: 17174612
references: Clin Gastroenterol Hepatol. 2012 Nov;10(11):1239-45
references: 22813445
references: Digestion. 2012;86(2):114-21
references: 22846371
references: Gut. 2012 Jun;61(6):821-8
references: 22157329
references: Am J Gastroenterol. 2007 Sep;102(9):1983-9
references: 17581264
references: Am J Physiol. 1999 Feb;276(2):G373-7
references: 9950810
references: Gastroenterology. 2002 Dec;123(6):1778-85
references: 12454833
references: Gastroenterology. 2005 Jun;128(7):1838-44
references: 15940619
references: Aliment Pharmacol Ther. 2001 Oct;15(10):1613-8
references: 11564001
references: Gut. 2003 Nov;52(11):1555-61
references: 14570722
references: Gut. 2002 Dec;51(6):781-6
references: 12427776
references: Neurogastroenterol Motil. 2009 Nov;21(11):1183-e105
references: 19663903
references: Gastroenterology. 2000 Sep;119(3):661-9
references: 10982759
references: Cochrane Database Syst Rev. 2011 Feb 16;(2):CD002096
references: 21328254
references: J Psychosom Res. 1994 Oct;38(7):735-44
references: 7877128
references: Expert Opin Investig Drugs. 2011 May;20(5):701-12
references: 21417958
references: World J Gastroenterol. 2006 Aug 21;12(31):5010-6
references: 16937497
references: Gut. 2008 Nov;57(11):1495-503
references: 18519430
references: Gut. 2005 Apr;54(4):455-60
references: 15753526
references: Gastroenterology. 2004 Oct;127(4):1239-55
references: 15481001
references: Gut. 2012 May;61(5):646-64
references: 22491499
references: Aliment Pharmacol Ther. 2012 Jul;36(1):3-15
references: 22591037
references: Clin Gastroenterol Hepatol. 2004 Nov;2(11):985-96
references: 15551251
references: Dig Dis Sci. 1993 Sep;38(9):1569-80
references: 8359066
references: Am J Gastroenterol. 1998 Feb;93(2):160-5
references: 9468233
references: Neurogastroenterol Motil. 2002 Jun;14(3):249-53
references: 12061909
references: Gut. 2008 Dec;57(12):1666-73
references: 18625692