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  • Review Article
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Current management strategies and emerging treatments for functional dyspepsia

Nature Reviews Gastroenterology & Hepatology volume 10, pages 187–194 (2013)Cite this article

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A Correction to this article was published on 23 April 2013

This article has been updated

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.

Key Points

  • Functional dyspepsia encompasses a myriad of painful and nonpainful symptoms perceived to arise in the upper digestive tract that are not secondary to organic diseases; its management is not simple

  • If Helicobacter pylori infection is diagnosed, it should be treated; a test and treat strategy is recommended in populations with a high prevalence of H. pylori infection

  • Lifestyle modifications can provide relief from symptoms in patients with mild or intermittent symptoms; drug therapy is the preferred option to treat severe symptoms or nonresponders

  • PPIs or prokinetics can be initial empirical pharmacotherapy: PPIs in the presence of retrosternal or epigastric burning or epigastric pain; prokinetics in dyspepsia with early satiation or postprandial fullness

  • Treatment of functional dyspepsia remains unsatisfactory; advances in our understanding of the pathophysiology of this disorder could enable targeted therapy in the future

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Figure 1: Current management of uninvestigated dyspepsia.
Figure 2: Management of functional dyspepsia in referral gastroenterology practice.

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Change history

  • 18 April 2013

    In the version of this article initially published online, the drug names in Figure 1 were displayed incorrectly. The error has been corrected for the HTML and PDF versions of the article.

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Acknowledgements

The authors wish to thank Cindy Stanislav for secretarial assistance.

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Authors and Affiliations

  1. Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, 200 First Street S.W., Rochester, 55905, MN, USA

    Michael Camilleri

  2. Department of Gastrointestinal Diseases and Internal Medicine, Policlinico S. Orsola-Malpighi, University of Bologna, Via Massarenti 9, Bologna, 40138, Italy

    Vincenzo Stanghellini

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Correspondence to Vincenzo Stanghellini.

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M. Camilleri declares no competing interests. V. Stanghellini has acted as a speaker for Alfa Wassermann, Almirall, Angelini, Janssen, Shire, and Takeda. He has acted as a consultant for Alfa Wassermann, Almirall, Angelini, Aptalis, Ironwood Pharmaceuticals, Norgine, Shire and Takeda. He has received research support from Alfa Wassermann, Almirall, Aptalis, Italchimici, Norgine, Shire and Sofar.

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Rome III Criteria for Functional Dyspepsia (DOC 33 kb)

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Camilleri, M., Stanghellini, V. Current management strategies and emerging treatments for functional dyspepsia. Nat Rev Gastroenterol Hepatol 10, 187–194 (2013). https://doi.org/10.1038/nrgastro.2013.11

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