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Abstract
Functional dyspepsia (FD) is a condition in which upper abdominal symptoms, such as epigastralgia, postprandial discomfort, and bloating, occur in the absence of any organic or metabolic disease that could explain the symptoms. The prevalence of FD is increasing, presumably because of an increasingly stressful environment, as well as overlap with other motility disorders such as gastroesophageal reflux diseases and irritable bowel syndrome. Numerous studies have attempted to determine the pathophysiological mechanisms of FD and establish effective FD treatment, with little success. Several therapeutic options have been explored, including Helicobacter pylori eradication, proton pump inhibitors, prokinetic agents, anti-depressant and anxiolytic agents, and acotiamide, a recent emerging drug. Through the many trials evaluating the efficacy of drugs for FD treatment, we found that it is necessary to treat according to the symptoms of FD and to use a combination of therapeutic options. Additional well-designed, prospective studies are needed to confirm the management of FD.
References
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Table 1.
Rome III criteria for functional dyspepsia
| Diagnostic criteria∗ for functional dyspepsia must include one or more of the following symptoms: |
| a. Bothersome postprandial fullness |
| b. Early satiation |
| c. Epigastric pain |
| d. Epigastric burning |
| And, there was no evidence of structural disease that is likely to explain symptoms (including at upper endoscopy). |
| 1. Postprandial distress syndrome |
| Diagnostic criteria∗ must include one or both of the following symptoms: |
| a. Bothersome postprandial fullness, occurring after ordinary sized meals, at least several times per week |
| b. Early satiation that prevents finishing a regular meal, at least several times per week |
| – Other supportive criteria: |
| a. Upper abdominal bloating or postprandial nausea or excessive belching can be present |
| b. Epigastic pain syndrome may coexist |
| 2. Epigastric pain syndrome |
| Diagnostic criteria∗ must include all of the following symptoms: |
| a. Pain or burning localized to the epigastrium of at least moderate severity at least once per week |
| b. The pain is intermittent |
| c. Not generalized or localized to other abdominal or chest regions |
| d. Not relieved by defecation or passage of flatus |
| e. Not fulfilling criteria for gallbladder and sphincter of Oddi disorders |
| – Other supportive criteria: |
| a. The pain may be of a burning quality but without a retrosternal component |
| b. The pain is commonly induced or relieved by ingestion of a meal but may occur while fasting |
| c. Postprandial distress syndrome may coexist |
Table 2.
Drug classification used in functional dyspepsia
| Classification |
|---|
| Histamine-type 2 receptor antagonists (H2RAs) |
| Proton pump inhibitors (PPIs) |
| Prokinetics |
| Dopamine receptor antagonists |
| Serotonin (5-HT) receptor agonists and antagonists |
| Motilin receptor agonists |
| Ghrelin receptor agonists |
| Muscarinic receptor antagonists |
| Antidepressants and anxiolytic agents |
| Tricyclic antidepressants (TCAs) |
| Selective serotonin reuptake inhibitors (SSRIs) |
| Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) |
| 5-HT1A agonists∗ |
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