title: Evidence-based clinical practice guidelines for functional dyspepsia.
abstract: General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world's first country to list "functional dyspepsia" as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor-patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.
authors.affiliation: Guidelines Committee for creating and evaluating the "Evidence-based clinical practice guidelines for functional dyspepsia", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13 Ginza, Chuo, Tokyo, 104-0061, Japan, miwahgi@hyo-med.ac.jp.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kusano
authors.forename: Tomiyasu
authors.initials: T
authors.lastname: Arisawa
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Oshima
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Kato
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tominaga
authors.forename: Koji
authors.initials: K
authors.lastname: Nakada
authors.forename: Akihito
authors.initials: A
authors.lastname: Nagahara
authors.forename: Seiji
authors.initials: S
authors.lastname: Futagami
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.forename: Akio
authors.initials: A
authors.lastname: Inui
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Koji
authors.initials: K
authors.lastname: Yakabi
authors.forename: Michio
authors.initials: M
authors.lastname: Hongo
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000465:Algorithms; D000529:Complementary Therapies / Q000379:methods; D003938:Diagnostic Techniques, Digestive System; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D019317:Evidence-Based Medicine / Q000379:methods; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D009626:Terminology as Topic
chemical_list: D005765:Gastrointestinal Agents