Dietary and lifestyle factors in functional dyspepsia

Abstract

Dietary factors are increasingly recognized to have an important role in triggering symptoms in a large proportion of patients with functional dyspepsia. Fatty foods seem to be the main culprits, but other foods (including carbohydrate-containing foods, milk and dairy products, citrus fruits, spicy foods, coffee and alcohol) have also been implicated. However, blind challenge tests do not provide consistent results. Moreover, although patients identify specific foods as triggers of their symptoms, these patients often do not seem to make behavioural adjustments in an attempt to improve symptoms; that is, any differences in dietary intake and lifestyle between patients and healthy individuals are small. Patients with functional dyspepsia exhibit mixed sensory–motor abnormalities, such as gastric hypersensitivity and impaired gastric accommodation of a meal. Nutrients, particularly fat, exacerbate these abnormalities and might thereby trigger postprandial symptoms. Cognitive factors, including anticipation related to previous negative experience with certain foods, might also have a role in triggering symptoms. Studies evaluating the potential beneficial effect of dietary interventions and changes in lifestyle are lacking, and this Review outlines a number of options that could be used as starting points for meaningful large-scale studies in the future.

Key Points

  • A large proportion of patients with functional dyspepsia report that their symptoms are triggered by meal ingestion

  • Dietary intake between patients with functional dyspepsia and healthy individuals is similar; patients with functional dyspepsia have a slightly reduced dietary fat intake and a tendency to consume smaller meals more frequently

  • Patients with functional dyspepsia exhibit abnormal sensory and reflex activity in the upper gastrointestinal tract, and these dysfunctions can be exacerbated by dietary and lifestyle factors

  • The reported relationship between food ingestion and symptom induction suggests a role for diet in the treatment of functional dyspepsia; however, the relationship is complex and difficult to define

  • Large, well-designed and adequately powered studies are required to address clearly defined questions focusing on specific subgroups in this heterogenous condition to evaluate the role of dietary interventions

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Figure 1: Dietary and lifestyle factors in functional dyspepsia.

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Acknowledgements

C. Feinle-Bisset is supported by a Senior Research Fellowship (grant no 627002, 2010–2014) from the National Health and Medical Research Council of Australia. F. Azpiroz acknowledges support from the Dirección General de Investigación (SAF 2009-07416) and Centro para el Desarrollo Tecnólogico Industrial (CEN-20101016), Spain. CIBREREHD is funded by the Instituto de Salud Carlos III.

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Both authors contributed equally to all aspects of the manuscript.

Correspondence to Christine Feinle-Bisset.

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The authors declare no competing financial interests.

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Supplementary Table 1

Studies evaluating food intolerances and dietary habits in functional dyspepsia (DOC 44 kb)

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Feinle-Bisset, C., Azpiroz, F. Dietary and lifestyle factors in functional dyspepsia. Nat Rev Gastroenterol Hepatol 10, 150–157 (2013). https://doi.org/10.1038/nrgastro.2012.246

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