Gut Liver.  2017 May;11(3):349-357. 10.5009/gnl16055.

Functional Dyspepsia: Advances in Diagnosis and Therapy

• Talley NJ

• KMID: 2412207
• DOI: http://doi.org/10.5009/gnl16055

Abstract

Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pre-test probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD-Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation.

Keyword

Functional dyspepsia; Epidemiology

MeSH Terms

Diagnosis, Differential
Duodenal Diseases/complications/diagnosis
Dyspepsia/*diagnosis/etiology/*therapy
Eosinophilia/complications/diagnosis
Gastroesophageal Reflux/complications/diagnosis
Heartburn/complications/diagnosis
Helicobacter Infections/complications/drug therapy
Helicobacter pylori
Humans
*Postprandial Period
*Symptom Assessment