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Functional dyspepsia

Nature Reviews Disease Primers volume 3, Article number: 17081 (2017) Cite this article

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Abstract

Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation.

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Figure 1: Putative mechanisms of functional dyspepsia symptoms at the macroscopic and microscopic level.
Figure 2: Proposed model for the interaction of factors involved in the generation of functional dyspepsia symptoms.
Figure 3: Diagnostic algorithm in functional dyspepsia.
Figure 4: Treatment algorithm in functional dyspepsia.
Figure 5: Foods and food groups frequently associated with symptom induction or exacerbation in functional dyspepsia.

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Acknowledgements

The research leading to these results has received funding from the People Programme of the European Union's Seventh Framework Programme under REA grant agreement no. 607652 (NeuroGUT), involving some of the authors (P.E., F.A., G.B. and M.S.). F.A. is supported by the Spanish Ministry of Economy (SAF 2016-76648-R). C.F.-B. is supported by a Senior Research Fellowship from the National Health and Medical Research Council of Australia (grant 1103020, 2016 - 21).

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Authors and Affiliations

  1. Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, Tübingen, 72076, Germany

    Paul Enck, Andreas Stengel & Stephan Zipfel

  2. Digestive Department, University Hospital Vall d’Hebron, Barcelona, Spain

    Fernando Azpiroz

  3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

    Fernando Azpiroz

  4. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

    Fernando Azpiroz

  5. Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium

    Guy Boeckxstaens & Jan Tack

  6. Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany

    Sigrid Elsenbruch

  7. Adelaide Medical School, University of Adelaide, Adelaide, Australia

    Christine Feinle-Bisset

  8. National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia

    Christine Feinle-Bisset

  9. Princess Alexandra Hospital, Brisbane, Australia

    Gerald Holtmann

  10. Translational Research Institute, University of Queensland, Brisbane, Australia

    Gerald Holtmann

  11. Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA

    Jeffrey M. Lackner

  12. Center for Life Course Health Research, University of Oulu and Primary Health Care Center, Tornio, Finland

    Jukka Ronkainen

  13. Department of Neurobiology, Division of Family Medicine, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

    Jukka Ronkainen

  14. Chair Human Biology, Technical University Munich, Freising, Germany

    Michael Schemann

  15. Medical Department, Division of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany

    Andreas Stengel

  16. Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia

    Nicholas J. Talley

Authors
  1. Paul Enck
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  2. Fernando Azpiroz
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  3. Guy Boeckxstaens
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  4. Sigrid Elsenbruch
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  5. Christine Feinle-Bisset
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  6. Gerald Holtmann
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  7. Jeffrey M. Lackner
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  8. Jukka Ronkainen
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  9. Michael Schemann
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  10. Andreas Stengel
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  11. Jan Tack
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  12. Stephan Zipfel
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  13. Nicholas J. Talley
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Contributions

Introduction (P.E. and J.R.); Epidemiology (P.E.); Mechanisms/pathophysiology (M.S., J.R., S.E., G.H., N.J.T. and J.T.); Diagnosis, screening and prevention (G.B.); Management (J.T., C.F.-B., A.S. and S.Z.); Quality of life (J.M.L.); Outlook (N.J.T., M.S. and P.E.); Overview of Primer (P.E.).

Corresponding author

Correspondence to Paul Enck.

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Competing interests

P.E. has received an unrestricted grant from SymbioPharm; has served as an adviser for Allergan, Almirall, AstraZeneca, Boehringer, Biocodex, Ferring, GA, Heel, SymbioPharm, TEVA and UCB; and has served as a speaker for Almirall, Bayer/Steigerwald, Boehringer, Chiesi, Heel and Sanofi. F.A. has received grant support from Danone, Clasado and Noventure; has served as an adviser for Danone, Clasado and Allergan; and has served as a speaker for Allergan. G.B. has served as an adviser for Reckitt-Benckiser and as speaker for Menarini. G.H. has received unrestricted grants from Bayer, Commonwealth Laboratories, the Falk Foundation and Takeda and has served as a speaker for Schwabe. M.S. has received unrestricted grants from Bayer/Steigerwald, Boehringer and Schwabe; has served as an adviser for Bionorica, Takeda and Almirall; and has served as a speaker for Almirall and Bayer/Steigerwald. J.T. has received research grants from Abide Therapeutics, Shire, Tsumura and Zeria; has given scientific advice to Abide Therapeutics, Alfa Wassermann, Allergan, Christian Hansen, Danone, Genfit, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Novartis, Nutricia, Ono Pharma, Rhythm, Shionogi, Shire, SK Life Sciences, Takeda, Theravance, Tsumura, Yuhan, Zealand and Zeria Pharmaceuticals; and has served as a speaker for Abbott, Allergan, AstraZeneca, Janssen, Kiowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda and Zeria. N.J.T. has received grant support from Abbott, Commonwealth Diagnostic Laboratories, GI Therapies, Janssen, Pfizer, Prometheus and Salix and has served as a consultant for Adelphi Values, Allergan, Ardelyx, CJ Healthcare, Commonwealth Diagnostic Laboratories, Danone, Forest Laboratories, Furiex, GI Care, GI Therapies, Napo Pharmaceuticals, Outpost Medicine, Samsung, Synergy, Takeda and Yuhan. All other authors declare no competing interests.

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Enck, P., Azpiroz, F., Boeckxstaens, G. et al. Functional dyspepsia. Nat Rev Dis Primers 3, 17081 (2017). https://doi.org/10.1038/nrdp.2017.81

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