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.
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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Tack, J. et al. Functional gastroduodenal disorders. Gastroenterology 130, 1466–1479 (2006).
Bisschops, R. et al. Relationship between symptoms and ingestion of a meal in functional dyspepsia. Gut 57, 1495–1503 (2008).
Delgado-Aros, S. et al. Contributions of gastric volumes and gastric emptying to meal size and postmeal symptoms in functional dyspepsia. Gastroenterology 127, 1685–1694 (2004).
Hausken, T., Gilja, O. H., Undeland, K. A. & Berstad, A. Timing of postprandial dyspeptic symptoms and transpyloric passage of gastric contents. Scand. J. Gastroenterol. 33, 822–827 (1998).
Pilichiewicz, A. N., Horowitz, M., Holtmann, G. J., Talley, N. J. & Feinle-Bisset, C. Relationship between symptoms and dietary patterns in patients with functional dyspepsia. Clin. Gastroenterol. Hepatol. 7, 317–322 (2009).
Caldarella, M. P., Azpiroz, F. & Malagelada, J. R. Antro-fundic dysfunctions in functional dyspepsia. Gastroenterology 124, 1220–1229 (2003).
Boyd, K. A. et al. High-fat diet effects on gut motility, hormone, and appetite responses to duodenal lipid in healthy men. Am. J. Physiol. Gastrointest. Liver Physiol. 284, G188–G196 (2003).
Brennan, I. M. et al. Effects of acute dietary restriction on gut motor, hormone and energy intake responses to duodenal fat in obese men. Int. J. Obes. (Lond.) 35, 448–456 (2011).
Cunningham, K. M., Daly, J., Horowitz, M. & Read, N. W. Gastrointestinal adaptation to diets of differing fat composition in human volunteers. Gut 32, 483–486 (1991).
Stewart, J. E. et al. Marked differences in gustatory and gastrointestinal sensitivity to oleic acid between lean and obese men. Am. J. Clin. Nutr. 93, 703–711 (2011).
Feinle-Bisset, C. & Horowitz, M. Dietary factors in functional dyspepsia. Neurogastroenterol. Motil. 18, 608–618 (2006).
Tack, J., Caenepeel, P., Fischler, B., Piessevaux, H. & Janssens, J. Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology 121, 526–535 (2001).
Tack, J., Piessevaux, H., Coulie, B., Caenepeel, P. & Janssens, J. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 115, 1346–1352 (1998).
Carvalho, R. V., Lorena, S. L., Almeida, J. R. & Mesquita, M. A. Food intolerance, diet composition, and eating patterns in functional dyspepsia patients. Dig. Dis. Sci. 55, 60–65 (2010).
Filipovic, B. F. et al. Laboratory parameters and nutritional status in patients with functional dyspepsia. Eur. J. Intern. Med. 22, 300–304 (2011).
Mullan, A. et al. Food and nutrient intakes and eating patterns in functional and organic dyspepsia. Eur. J. Clin. Nutr. 48, 97–105 (1994).
Cuperus, P., Keeling, P. W. & Gibney, M. J. Eating patterns in functional dyspepsia: a case control study. Eur. J. Clin. Nutr. 50, 520–523 (1996).
Hampel, H., Abraham, N. S. & El-Serag, H. B. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann. Intern. Med. 143, 199–211 (2005).
Sinn, D. H. et al. The speed of eating and functional dyspepsia in young women. Gut Liver 4, 173–178 (2010).
Saito, Y. A., Locke, G. R. 3rd, Weaver, A. L., Zinsmeister, A. R. & Talley, N. J. Diet and functional gastrointestinal disorders: a population-based case-control study. Am. J. Gastroenterol. 100, 2743–2748 (2005).
Kearney, J. et al. Dietary intakes and adipose tissue levels of linoleic acid in peptic ulcer disease. Br. J. Nutr. 62, 699–706 (1989).
De la Roca-Chiapas, J. M. et al. Stress profile, coping style, anxiety, depression, and gastric emptying as predictors of functional dyspepsia: a case-control study. J. Psychosom. Res. 68, 73–81 (2010).
Aro, P. et al. Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology 137, 94–100 (2009).
Miwa, H. Life style in persons with functional gastrointestinal disorders—large-scale internet survey of lifestyle in Japan. Neurogastroenterol. Motil. 24, 464–471 (2012).
Gathaiya, N. et al. Novel associations with dyspepsia: a community-based study of familial aggregation, sleep dysfunction and somatization. Neurogastroenterol. Motil. 21, 922-e69 (2009).
Burri, E. et al. Abdomino-phrenic dysynergia in patients with functional dyspepsia [abstract]. Gut 60 (Suppl. 3), A43 (2011).
Villoria, A., Serra, J., Azpiroz, F. & Malagelada, J. R. Physical activity and intestinal gas clearance in patients with bloating. Am. J. Gastroenterol. 101, 2552–2557 (2006).
Caldarella, M. P., Azpiroz, F. & Malagelada, J. R. Selective effects of nutrients on gut sensitivity and reflexes. Gut 56, 37–42 (2007).
Richter, J. E. Stress and psychologic and environmental factors in functional dyspepsia. Scand. J. Gastroenterol. Suppl. 182, 40–46 (1991).
Talley, N. J., Weaver, A. L. & Zinsmeister, A. R. Smoking, alcohol, and nonsteroidal anti-inflammatory drugs in outpatients with functional dyspepsia and among dyspepsia subgroups. Am. J. Gastroenterol. 89, 524–528 (1994).
Eslick, G. D. Gastrointestinal symptoms and obesity: a meta-analysis. Obes. Rev. 13, 469–479 (2012).
Pfeiffer, B. et al. Nutritional intake and gastrointestinal problems during competitive endurance events. Med. Sci. Sports Exerc. 44, 344–351 (2011).
Piche, T. et al. Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease. Gastroenterology 124, 894–902 (2003).
Piche, T. et al. Modulation by colonic fermentation of LES function in humans. Am. J. Physiol. Gastrointest. Liver Physiol. 278, G578–G584 (2000).
Ropert, A. et al. Colonic fermentation and proximal gastric tone in humans. Gastroenterology 111, 289–296 (1996).
Friedlander, P. H. Food and indigestion. An investigation of possible relationships. Br. Med. J. 2, 1454–1458 (1959).
Kaess, H., Kellermann, M. & Castro, A. Food intolerance in duodenal ulcer patients, non ulcer dyspeptic patients and healthy subjects. A prospective study. Klin. Wochenschr. 66, 208–211 (1988).
Elta, G. H., Behler, E. M. & Colturi, T. J. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am. J. Gastroenterol. 85, 1339–1342 (1990).
Feinle-Bisset, C., Vozzo, R., Horowitz, M. & Talley, N. J. Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia. Am. J. Gastroenterol. 99, 170–181 (2004).
Hammer, J., Fuhrer, M., Pipal, L. & Matiasek, J. Hypersensitivity for capsaicin in patients with functional dyspepsia. Neurogastroenterol. Motil. 20, 125–133 (2008).
Pilichiewicz, A. N. et al. Functional dyspepsia is associated with a greater symptomatic response to fat but not carbohydrate, increased fasting and postprandial CCK, and diminished PYY. Am. J. Gastroenterol. 103, 2613–2623 (2008).
Taggart, D. & Billington, B. P. Fatty foods and dyspepsia. Lancet 2, 465–466 (1966).
Manichanh, C. et al. Flatulence: is it what it seems? Clinical, physiological and microbiological features. Gastroenterology 142 (Suppl. 1), S611–S612 (2012).
Seimon, R. V. et al. The droplet size of intraduodenal fat emulsions influences antropyloroduodenal motility, hormone release, and appetite in healthy males. Am. J. Clin. Nutr. 89, 1729–1736 (2009).
Suarez, F. L., Savaiano, D. A. & Levitt, M. D. A comparison of symptoms after the consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N. Engl. J. Med. 333, 1–4 (1995).
Houghton, L. A., Mangall, Y. F., Dwivedi, A. & Read, N. W. Sensitivity to nutrients in patients with non-ulcer dyspepsia. Eur. J. Gastroenterol. Hepatol. 5, 109–114 (1993).
Feinle-Bisset, C., Meier, B., Fried, M. & Beglinger, C. Role of cognitive factors in symptom induction following high and low fat meals in patients with functional dyspepsia. Gut 52, 1414–1418 (2003).
Cecil, J. E., Francis, J. & Read, N. W. Relative contributions of intestinal, gastric, oro-sensory influences and information to changes in appetite induced by the same liquid meal. Appetite 31, 377–390 (1998).
Accarino, A. M., Azpiroz, F. & Malagelada, J. R. Attention and distraction: effects on gut perception. Gastroenterology 113, 415–422 (1997).
Accarino, A. M., Azpiroz, F. & Malagelada, J. R. Modification of small bowel mechanosensitivity by intestinal fat. Gut 48, 690–695 (2001).
Borovicka, J. et al. Role of lipase in the regulation of postprandial gastric acid secretion and emptying of fat in humans: a study with orlistat, a highly specific lipase inhibitor. Gut 46, 774–781 (2000).
Degen, L. et al. Role of free fatty acids in regulating gastric emptying and gallbladder contraction. Digestion 74, 131–139 (2006).
Feinle, C., Grundy, D. & Read, N. W. Effects of duodenal nutrients on sensory and motor responses of the human stomach to distension. Am. J. Physiol. Gastrointest. Liver Physiol. 273, G721–G726 (1997).
Feinle, C., Grundy, D., Otto, B. & Fried, M. Relationship between increasing duodenal lipid doses, gastric perception, and plasma hormone levels in humans. Am. J. Physiol. Regul. Integr. Comp. Physiol. 278, R1217–R1223 (2000).
Feinle, C., Grundy, D. & Fried, M. Modulation of gastric distension-induced sensations by small intestinal receptors. Am. J. Physiol. Gastrointest. Liver Physiol. 280, G51–G57 (2001).
Feinle, C. et al. Effects of fat digestion on appetite, APD motility, and gut hormones in response to duodenal fat infusion in humans. Am. J. Physiol. Gastrointest. Liver Physiol. 284, G798–G807 (2003).
Heddle, R. et al. Motor mechanisms associated with slowing of the gastric emptying of a solid meal by an intraduodenal lipid infusion. J. Gastroenterol. Hepatol. 4, 437–447 (1989).
Pilichiewicz, A. N. et al. Load-dependent effects of duodenal lipid on antropyloroduodenal motility, plasma CCK and PYY, and energy intake in healthy men. Am. J. Physiol. Regul. Integr. Comp. Physiol. 293, R2170–R2178 (2007).
Pilichiewicz, A. N. et al. Load-dependent effects of duodenal glucose on glycemia, gastrointestinal hormones, antropyloroduodenal motility, and energy intake in healthy men. Am. J. Physiol. Endocrinol. Metab. 293, E743–E753 (2007).
Ryan, A. T. et al. Intraduodenal protein modulates antropyloroduodenal motility, hormone release, glycemia, appetite, and energy intake in lean men. Am. J. Clin. Nutr. 96, 474–482 (2012).
Seimon, R. V. et al. Effects of varying combinations of intraduodenal lipid and carbohydrate on antropyloroduodenal motility, hormone release, and appetite in healthy males. Am. J. Physiol. Regul. Integr. Comp. Physiol. 296, R912–R920 (2009).
Seimon, R. V. et al. Pooled-data analysis identifies pyloric pressures and plasma cholecystokinin concentrations as major determinants of acute energy intake in healthy, lean men. Am. J. Clin. Nutr. 92, 61–68 (2010).
Azpiroz, F. & Tack, J. in Pathophysiology of the enteric nervous system: a basis for understanding functional diseases (eds Spiller, R. & Grundy, D.) 126–133 (Wiley-Blackwell, Hoboken, 2004).
Burri, E., Azpiroz, F., Hernandez, C., Accarino, A. & Malagelada, J. R. Biofeedback treatment of abdominal distention: a proof-of-concept [abstract]. Gut 59 (Suppl. 3), A137 (2010).
Boeckxstaens, G. E., Hirsch, D. P., Kuiken, S. D., Heisterkamp, S. H. & Tytgat, G. N. The proximal stomach and postprandial symptoms in functional dyspeptics. Am. J. Gastroenterol. 97, 40–48 (2002).
Bradette, M., Pare, P., Douville, P. & Morin, A. Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig. Dis. Sci. 36, 52–58 (1991).
Mearin, F., Cucala, M., Azpiroz, F. & Malagelada, J. R. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101, 999–1006 (1991).
Coffin, B., Azpiroz, F., Guarner, F. & Malagelada, J. R. Selective gastric hypersensitivity and reflex hyporeactivity in functional dyspepsia. Gastroenterology 107, 1345–1351 (1994).
Greydanus, M. P. et al. Neurohormonal factors in functional dyspepsia: insights on pathophysiological mechanisms. Gastroenterology 100, 1311–1318 (1991).
Holtmann, G., Goebell, H., Jockenhoevel, F. & Talley, N. J. Altered vagal and intestinal mechanosensory function in chronic unexplained dyspepsia. Gut 42, 501–506 (1998).
Barbera, R., Feinle, C. & Read, N. W. Abnormal sensitivity to duodenal lipid infusion in patients with functional dyspepsia. Eur. J. Gastroenterol. Hepatol. 7, 1051–1057 (1995).
Feinle, C., Meier, O., Otto, B., D'Amato, M. & Fried, M. Role of duodenal lipid and cholecystokinin A receptors in the pathophysiology of functional dyspepsia. Gut 48, 347–355 (2001).
Barbera, R., Feinle, C. & Read, N. W. Nutrient-specific modulation of gastric mechanosensitivity in patients with functional dyspepsia. Dig. Dis. Sci. 40, 1636–1641 (1995).
Little, T. J. & Feinle-Bisset, C. Effects of dietary fat on appetite and energy intake in health and obesity—oral and gastrointestinal sensory contributions. Physiol. Behav. 104, 613–620 (2011).
Chua, A. S., Dinan, T. G., Rovati, L. C. & Keeling, P. W. Cholecystokinin hyperresponsiveness in dysmotility-type nonulcer dyspepsia. Ann. NY Acad. Sci. 713, 298–299 (1994).
Lanzini, A. et al. Circulating ghrelin level is increased in coeliac disease as in functional dyspepsia and reverts to normal during gluten-free diet. Aliment. Pharmacol. Ther. 23, 907–913 (2006).
Stewart, J. E., Feinle-Bisset, C. & Keast, R. S. Fatty acid detection during food consumption and digestion: associations with ingestive behavior and obesity. Prog. Lipid Res. 50, 225–233 (2011).
Little, T. J. & Feinle-Bisset, C. Oral and gastrointestinal sensing of dietary fat and appetite regulation in humans: modification by diet and obesity. Front. Neurosci. 4, 178 (2010).
Stewart, J. E. et al. Oral sensitivity to fatty acids, food consumption and BMI in human subjects. Br. J. Nutr. 104, 145–152 (2010).
Samsom, M., Verhagen, M. A., vanBerge Henegouwen, G. P. & Smout, A. J. Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology 116, 515–520 (1999).
Talley, N. J. et al. Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies). Aliment. Pharmacol. Ther. 12, 1055–1065 (1998).
Caterina, M. J. et al. The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 389, 816–824 (1997).
Holzer, P. Capsaicin: cellular targets, mechanisms of action, and selectivity for thin sensory neurons. Pharmacol. Rev. 43, 143–201 (1991).
Bortolotti, M., Coccia, G., Grossi, G. & Miglioli, M. The treatment of functional dyspepsia with red pepper. Aliment. Pharmacol. Ther. 16, 1075–1082 (2002).
Oustamanolakis, P. & Tack, J. Dyspepsia: organic versus functional. J. Clin. Gastroenterol. 46, 175–190 (2012).
Gibson, P. R. & Shepherd, S. J. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J. Gastroenterol. Hepatol. 25, 252–258 (2010).
Villanova, N., Azpiroz, F. & Malagelada, J. R. Gastrogastric reflexes regulating gastric tone and their relationship to perception. Am. J. Physiol. Gastrointest. Liver Physiol. 273, G464–G469 (1997).
Villanova, N., Azpiroz, F. & Malagelada, J. R. Perception and gut reflexes induced by stimulation of gastrointestinal thermoreceptors in humans. J. Physiol. 502 (Pt 1), 215–222 (1997).
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.
The authors declare no competing financial interests.
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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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