- Basic concepts
- Functional esophageal disorders
- Functional gastroduodenal disorders
- General approach to gastroduodenal disorders
- Functional dyspepsia
- Belching disorders
- Nausea and vomiting disorders
- Functional bowel disorders
- Scientific update
- Resources
- Bibliography
Search
Functional gastroduodenal disorders / Functional dyspepsia
Functional dyspepsia
Cisapride is no longer available for treatment due to its rare, but potentially severe, cardiotoxicity; the macrolide antibiotic erythromycin acts on the motilin receptor to increase gastric emptying rate in patients with diabetic and idiopathic gastroparesis, but its side effects and tachyphylaxis limit its clinical utility(1) ; ABT-229, a synthetic motilin-like prokinetic drug without antibacterial activity, was of no significant benefit in functional dyspepsia over placebo, possibly because the drug impairs fundic relaxation(19).
Antidepressant therapy in FD may have a role in management of difficult cases, but adequate randomized controlled trials are unavailable(16). Administered in low doses, antidepressant drugs, especially those in the tricyclic antidepressant class, appear to moderate visceral hypersensitivity and mediate nociception. Limited promising data are available on psychotherapy or hypnotherapy, and there is a need of further studies to be performed(20).
It is widely recognized that psychologic factors can be identified in patients with functional gastrointestinal disorders such as functional dyspepsia. Although data regarding the effectiveness of psychotherapeutic therapies for dyspepsia are still too sparse to draw absolute conclusions, it does appear that addressing life stress and improving coping mechanisms can be a useful adjunct to traditional therapies once organic gastrointestinal disease has been excluded.
There is increasing evidence that some gastroprokinetics drugs (e.g. , domperidone, metoclopramide, simethicone) may be superior to placebo in treatment of FD, but probably only a minority responds ; those with meal-related symptoms may have the best response(1,18).
3. Talley N.J., Zinsmeister A.R., Schleck C.D. Dyspepsia and dyspepsia subgroups: a population based study. Gastroenterology 1992; 102: 1259-1268.
4. Agreus L., Svardsudd K., Nyren O. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology 1995; 109: 671-680.
5. Koloski N.A., Talley N.J., Boyce P.M. Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors. Am J Gastroenterol 2001; 96: 1340-1349.
6. Talley N.J., Boyce P., Jones M. Dyspepsia and health care seeking in a community: how important are psychological factors? Dig Dis Sci 1998; 43: 1016-1022.
7. Fischler B., Tack J., De Gucht V. Heterogeneity of symptom pattern, psychosocial factors, and pathophysiological mechanisms in severe functional dyspepsia. Gastroenterology 2003; 124: 903-910.
8. Henningsen P., Zimmermann T., Sattel H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003; 65: 528-533.
9. Tack J., Caenepeel P., Fischler B. Symptoms associated with hypersensitivity to gastric distention in functional dyspepsia. Gastroenterology 2001; 121: 526-535.
10. Simrén M., Vos R., Janssens J. Unsuppressed postprandial phasic contractility in the proximal stomach in functional dyspepsia: relevance to symptoms. Am J Gastroenterol 2003; 98 (10): 2169-2175.
11. Tack J., Bisschops R., Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology 2004; 127: 1239-1255.
12. Tack J., Piessevaux H., Coulie B. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 1998; 115 (6): 1346-1352.
13. Sarnelli G., Caenepeel P., Geypens B. Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol 2003; 98: 783-788.
14. Talley N.J., Verlinden M., Jones M. Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility- like dyspepsia? Am J Gastroenterol 2001; 96: 1422-1428.
15. Piessevaux H., Tack J., Walrand S. Intragastric distribution of a standardized meal in health and functional dyspepsia: correlation with specific symptoms. Neurogastroenterol Motil 2003; 15: 447-455.
16. McNally M.A., Talley N.J. Current treatments in functional dyspepsia. Curr Treat Options Gastroenterol. 2007; 10 (2): 157-168.
17. Moayyedi P., Soo S, Deeks J. Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Sys Rev 2005; (1): CD002096.
18. Moayyedi P., Feltbower R., Brown J. Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial. Leeds HELP Study Group. Lancet 2000; 355:1665-1669.
19. Malfertheiner P., Megraud F., O'Morain C. European Helicobacter Pylori Study Group (EHPSG). Current concepts in the management of Helicobacter pylori infection-The Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther 2002; 16: 167-180.
20. Hamilton-Miller J.M. The role of probiotics in the treatment and prevention of Helicobacter pylori infection. Int J Antimicrob Agents. 2003; 22 (4): 360-366.
21. Aiba Y., Suzuki N., Kabir A.M. Lactic acid-mediated suppression of Helicobacter pylori by the oral administration of Lactobacillus salivarius as a probiotic in a gnotobiotic murine model. Am J Gastroenterol 1998; 93 (11): 2097-2101.
22. Wang K.Y., Li S.N., Liu C.S. Effects of ingesting Lactobacillus- and Bifidobacterium-containing yogurt in subjects with colonized Helicobacter pylori. Am J Clin Nutr 2004; 80: 737-741.
23. Talley N.J., Verlinden M., Snape W. Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther 2000; 14: 1653-1661.
24. Marcos A., Wärnberg J., Nova E. The effect of milk fermented by yogurt cultures plus Lactobacillus casei DN-114001 on the immune response of subjects under academic examination stress. Eur J Nutr 2004; 43 (6): 381-389.
25. Calvert E.L., Houghton L.A., Cooper P. Long-term improvement in functional dyspepsia using hypnotherapy. Gastroenterology 2002; 123: 1778-1785.
