Functional Dyspepsia: Advances in Diagnosis and Therapy

• Published in: Gut and liver Vol. 11; no. 3; pp. 349 - 357
• Main Author: Talley, Nicholas J
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 01.05.2017; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Diagnosis, Differential; Duodenal Diseases - complications; Duodenal Diseases - diagnosis; Dyspepsia - diagnosis; Dyspepsia - etiology; Dyspepsia - therapy; Eosinophilia - complications; Eosinophilia - diagnosis; epidemiology; functional dyspepsia; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Heartburn - complications; Heartburn - diagnosis; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Postprandial Period; Review; Symptom Assessment; 내과학; Epidemiology; Functional dyspepsia
• DOI: 10.5009/gnl16055
• ISSN: 1976-2283

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 pretest 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- eradication. Treatment of duodenal eosinophilia is under investigation.