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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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).

Author information

Affiliations

  1. Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076 Tübingen, 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, Care Sciences and Society, Division of Family Medicine, 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

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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.).

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.

Corresponding author

Correspondence to Paul Enck.

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DOI

https://doi.org/10.1038/nrdp.2017.81

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