Materiały źródłowe

• #1 The Diagnosis and Treatment of Functional Dyspepsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5938438/

  Functional dyspepsia (FD) is one of the more common functional disorders, with a prevalence of 10-20%. It affects the gastrointestinal tract. […] Functional dyspepsia (synonym: irritable stomach syndrome) is present whenever routine diagnostic investigations, including endoscopy, do not identify any causal structural or biochemical abnormalities. […] On diagnostic work-up, 20 to 30% of patients with dyspepsia are found to have diseases that account for their symptoms. […] The impaired quality of life of patients with functional dyspepsia implies the need for definitive establishment of the diagnosis, followed by symptom-oriented treatment for the duration of the symptomatic interval. […] Confirmation of the diagnosis of functional dyspepsia rests on the typical symptoms and the patients history, and the exclusion of other diseases of the upper gastrointestinal tract and upper abdominal organs that may present with similar dyspeptic symptoms.

• #2 Your functional dyspepsia diagnosis check list | Content for health professionals | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/pro/your-functional-dyspepsia-diagnosis-check-list

  FD affects about 7% of adults but is often misdiagnosed due to overlapping symptoms with reflux, gastroparesis, and IBS. […] Functional dyspepsia is a chronic and remitting disorder originating from the upper gastroduodenal region, characterized by one or more of the following symptoms. […] Functional dyspepsia is a highly prevalent DGBI based on strict Rome IV criteria: 7% of the global population is affected by Functional Dyspepsia. […] The condition is often underdiagnosed, as symptoms may overlap with other gastrointestinal disorders such as gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). […] In the absence of a biomarker, diagnosis relies on symptom criteria of which the Rome IV criteria are the most recent and best validated. […] The diagnosis is based on symptoms according to Rome criteria.

• #3 Rome IV Criteria – Rome Foundation

  https://theromefoundation.org/rome-iv/rome-iv-criteria/

  B1. FUNCTIONAL DYSPEPSIA* Diagnostic criteria** […] One or more of the following: […] Bothersome postprandial fullness […] Bothersome early satiation […] Bothersome epigastric pain […] Bothersome epigastric burning […] AND […] No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms […] *Must fulfill criteria for B1a. PDS and/or B1b. EPS **Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis […] B1a. Postprandial Distress Syndrome (PDS) Diagnostic criteria* Must include one or both of the following at least 3 days a week: […] Bothersome postprandial fullness (i.e., severe enough to impact on usual activities) […] Bothersome early satiation (i.e., severe enough to prevent finishing a regular size meal)

• #4 Functional dyspepsia – Wikipedia

  https://en.wikipedia.org/wiki/Functional_dyspepsia

  Functional dyspepsia is diagnosed based on clinical criteria and symptoms. Depending on the symptoms present people suspected of having FD may need blood work, imaging, or endoscopies to confirm the diagnosis of functional dyspepsia. […] Functional dyspepsia is diagnosed using clinical symptoms and Rome IV criteria, which were recently revised. The clinical examination and patient history should look for alarm symptoms. Alarm symptoms include dysphagia, especially if progressive, or odynophagia, overt gastrointestinal bleeding, such as melena or hematemesis, persistent vomiting, unintentional weight loss, family history of gastric or esophageal cancer, palpable abdominal or epigastric mass or abdominal adenopathy, and signs of iron-deficiency anemia. […] The criteria must be met over the past three months, with the onset of symptoms occurring at least six months before diagnosis and there must be an absence of structural disease evidence that could account for the symptoms, including upper endoscopy.

• #5 Rome IV Criteria – Rome Foundation

  https://theromefoundation.org/rome-iv/rome-iv-criteria/

  No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy) *Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis […] B1b. Epigastric Pain Syndrome (EPS) Diagnostic criteria* Must include one or both of the following symptoms at least 1 day a week: […] Bothersome epigastric pain (i.e., severe enough to impact on usual activities) […] Bothersome epigastric burning (i.e., severe enough to impact on usual activities) […] No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy). *Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

• #6 Functional Dyspepsia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20802

  Functional dyspepsia is further classified into epigastric pain syndrome and PDS. […] Evaluation begins with laboratory tests, including blood count, complete metabolic panel, thyroid function, celiac disease serology, and inflammatory markers. […] The American College of Gastroenterology (ACG) recommends routine use of upper endoscopy in patients aged 60 or older, irrespective of alarm symptoms, and for patients aged 60 or younger if alarm symptoms are present. […] If patients do not respond to treatment, pursuing more specialized testing specific to the symptoms is reasonable. […] Treating functional dyspepsia can be challenging, with the primary goal being symptom control. Initial management involves educating the patient about the diagnosis and discussing treatment expectations.

• #7 Evaluation of dyspepsia – Summary

  https://www.epocrates.com/online/diseases/769/evaluation-of-dyspepsia

  The Rome IV classification subdivides functional dyspepsia into 3 categories: Postprandial distress syndrome (PDS), which is characterized by meal-induced dyspeptic symptoms, such as discomfort, pain, nausea, and fullness; Epigastric pain syndrome (EPS), which refers to epigastric pain, or epigastric burning, that does not occur exclusively postprandially, can occur during fasting, and can even be improved by meal ingestion; Overlapping PDS and EPS, which is characterized by meal-induced dyspeptic symptoms and epigastric pain or burning. […] There is no gold standard for the diagnosis of GERD. The diagnosis is based on a combination of symptom presentation, endoscopic evaluation of esophageal mucosa, reflux monitoring, and response to therapeutic intervention. […] The extent or severity of the patient’s dyspepsia is measured by the patient’s report of the impact of symptoms on quality of life and function.

• #8 Evaluation of dyspepsia – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/769

  Functional dyspepsia (sometimes called nonulcer dyspepsia) refers to a situation where investigations have not revealed a potential cause for the dyspepsia. It is generally reserved for patients with a normal endoscopy whose symptoms do not suggest GERD. […] The Rome IV classification subdivides functional dyspepsia into 3 categories: Postprandial distress syndrome (PDS), which is characterized by meal-induced dyspeptic symptoms, such as discomfort, pain, nausea, and fullness; Epigastric pain syndrome (EPS), which refers to epigastric pain, or epigastric burning, that does not occur exclusively postprandially, can occur during fasting, and can even be improved by meal ingestion; Overlapping PDS and EPS, which is characterized by meal-induced dyspeptic symptoms and epigastric pain or burning. […] The extent or severity of the patient’s dyspepsia is measured by the patient’s report of the impact of symptoms on quality of life and function. The patient’s assessment of the severity of dyspepsia usually relates to the degree to which it affects work, sleep, diet, or leisure.

• #9 Diagnostic Testing for Functional Dyspepsia | IntechOpen

  https://www.intechopen.com/chapters/45727

  Dyspepsia is defined as predominantly midline pain or discomfort located in the upper abdomen. […] When symptoms are chronic or recurrent but without an identifiable structural cause using standard diagnostic tests (usually endoscopy), the condition is usually labelled functional or functional dyspepsia. […] Hence functional dyspepsia is a diagnosis of exclusion, the implication being that symptoms have been investigated without demonstrating an organic or anatomical cause. […] The Rome III criteria for diagnosing functional dyspepsia are persistent or recurrent upper abdominal pain or discomfort for a period of 12 weeks, which need not be consecutive, in the preceding 12 months, with symptoms present more than 25 percent of the time, and an absence of clinical, biochemical, endoscopic, and ultrasonographic evidence of organic disease that would account for the symptoms.

• #10 Functional Dyspepsia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554563/

  Functional dyspepsia is a common and benign gastrointestinal disorder that presents similarly to other conditions, making it difficult to diagnose. This condition is characterized by symptoms such as epigastric pain or burning, early satiety, and postprandial fullness, without any structural abnormalities detected via imaging or endoscopy. Functional dyspepsia affects over 20% of the population and is diagnosed based on symptom-based Rome IV Criteria. […] Diagnosis is based on the Rome IV criteria, which define functional dyspepsia as the presence of one or more symptoms, such as epigastric pain, burning, early satiety, and postprandial fullness, and in the absence of structural disease detectable by imaging or endoscopy. […] The diagnosis of functional dyspepsia is confirmed based on the patients history and the exclusion of other diseases with similar presentations.

• #11

  https://journals.lww.com/dmms/fulltext/2024/19040/diagnosis_of_functional_dyspepsia_an_unsolved.6.aspx

  FD is a diagnosis of exclusion which is made only after ruling out all other gastrointestinal tract diseases. […] There is no specific test for the diagnosis of FD but still some generalized tests which can be correlated with its pathophysiology have been performed on patients complaining of symptoms suggestive of FD for at least a month. […] Hence, based on patient history and excluding other conditions, a final diagnosis is made. […] The diseases that must be ruled out before a diagnosis of FD may be made are peptic ulcer disease, H. Pylori infection, gastroesophageal reflux disease, ulcerative colitis, irritable bowel syndrome, and esophagitis. […] Initial investigations which a general physician could demand before any specific investigation may include complete blood count, electrolytes, glucose level, renal function test, liver function test, and thyroid function test.

• #12 Functional Dyspepsia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20802

  The global prevalence of H pylori infection exceeds 50% and is recognized as a significant risk factor for conditions such as chronic gastritis, peptic ulcers, gastric adenocarcinoma, GERD, and functional dyspepsia. […] After the successful eradication of H pylori, treatment is a 2-step process. The first-line treatment involves a PPI or H2RA for at least 4 weeks. Then, if symptoms persist, subsequent treatment with tricyclic antidepressants (TCAs) or prokinetic agents such as metoclopramide and acotiamide (not available in the United States) is pursued. […] The conditions below should be considered in the differential diagnosis: GERD, H pylori infection, Gastritis, Peptic ulcer disease, Celiac disease, IBS, Small intestinal bacterial overgrowth, Chronic pancreatitis, Gastroparesis, Acute cholecystitis, Gastric carcinoma, Chronic abdominal pain, Biliary pain, Hepatocellular carcinoma, Mesenteric ischemia, Giardiasis, Strongyloidiasis, Sarcoidosis. […] Diagnosis can be challenging, relying on clinical assessment aligned with patient history and symptoms meeting the Rome IV criteria.

• #13 Functional dyspepsia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/functional-dyspepsia/diagnosis-treatment/drc-20375715

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] A healthcare professional most likely will review symptoms and do a physical exam. Several tests can help find the cause of the discomfort and rule out other disorders. These may include: […] Blood tests may help rule out other diseases that can cause symptoms like those of functional dyspepsia. […] A bacterium called Helicobacter pylori (H. pylori). H. pylori can cause stomach problems. H. pylori testing may involve a stool sample, the breath or tissue samples of the stomach taken during endoscopy. […] An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. This allows a medical professional to collect tissue samples to look for infection or inflammation.

• #14 Dyspepsia: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/163484

  A doctor will diagnose dyspepsia if a person has one or more of the following symptoms: […] If there is no identifiable structural or metabolic cause, a doctor will diagnose functional dyspepsia. […] A doctor will ask the person about: […] They may also examine the chest and stomach. This may involve pressing down on different parts of the abdomen to check for areas that may be sensitive, tender, or painful under pressure. […] In some cases, a doctor may use the following tests to rule out an underlying health condition:

• #15 Dyspepsia: Symptoms and Treatment | Doctor

  https://patient.info/doctor/dyspepsia-pro

  Functional dyspepsia (also known as non-ulcer dyspepsia) refers to people with dyspepsia symptoms and normal findings on endoscopy (gastric or duodenal ulcer, gastric malignancy, or oesophagitis have been excluded). […] One large survey found functional dyspepsia rates of 12% in the USA and 8% in Canada and the UK. In people with dyspepsia symptoms who undergo endoscopy, 70-80% have no clinically significant findings, and may be classified as having functional dyspepsia. […] In one study of endoscopic findings, patients with dyspeptic symptoms were found to have: Functional dyspepsia (66%). […] Always check for abdominal mass. […] Test for Helicobacter pylori. […] Routine endoscopic investigation of dyspeptic patients is not necessary but should be considered in patients over the age of 55 in whom: Symptoms persist despite treatment.

• #16 Diagnostic Testing for Functional Dyspepsia | IntechOpen

  https://www.intechopen.com/chapters/45727

  Functional dyspepsia is usually a diagnosis of exclusion; the diagnosis is made after eliminating organic disease or a structural basis for symptoms. […] The physician must decide how many investigations to order before deciding that the patient has a functional disorder. […] Initial investigations may include blood counts, electrolytes, fasting blood sugar, renal function tests and thyroid function tests. […] H.pylori infection can be diagnosed by serology, breath or stool testing. […] Gastric accommodation can be assessed by gastric barotest. […] Scintigraphic imaging lends itself elegantly to the evaluation of functional-dyspepsia due to the inherent strength of dynamic imaging and generating physiological data. […] Currently, it remains the only method to quantitatively measure the rate of gastric emptying.

• #17 British Society of Gastroenterology guidelines on the management of functional dyspepsia | Gut

  https://gut.bmj.com/content/71/9/1697

  Clinicians should be aware that most patients with dyspepsia will have functional dyspepsia (FD) as the underlying cause of their symptoms after investigation (recommendation: strong, quality of evidence: low). […] We recommend that, in the absence of upper gastrointestinal alarm symptoms or signs, clinicians should diagnose FD in the presence of bothersome epigastric pain or burning, early satiation, and/or postprandial fullness of greater than 8 weeks duration (recommendation: strong, quality of evidence: very low). […] We recommend that a full blood count is performed in patients aged 55 years with dyspepsia and coeliac serology in all patients with FD and overlapping irritable bowel syndrome (IBS)-type symptoms (recommendation: strong, quality of evidence: low). […] We recommend that if no other upper gastrointestinal alarm symptoms or signs are reported, urgent endoscopy is only warranted in patients aged 55 years with dyspepsia with weight loss, or those aged 40 years from an area at an increased risk of gastric cancer or with a family history of gastro-oesophageal cancer (recommendation: strong; quality of evidence: very low).

• #18 Approach to the adult with dyspepsia – UpToDate

  https://www.uptodate.com/contents/approach-to-the-adult-with-dyspepsia/print

  The goals of the initial evaluation are as follows: Identify patients who require urgent evaluation, including those with alarm features for gastroesophageal malignancy; Identify patients whose initial evaluation should include upper endoscopy; Identify organic causes of dyspepsia; Generate and narrow the differential diagnosis. […] The presence or absence of alarm features is a key component of the evaluation. […] The diagnostic approach to a patient with dyspepsia is based on the clinical presentation, patient’s age, and presence of alarm features. […] All individuals with dyspepsia should be tested for H. pylori and receive treatment if infection is detected. […] We perform upper gastrointestinal endoscopy in selected patients with dyspepsia to rule out gastroesophageal malignancy and evaluate for organic causes of dyspepsia, such as peptic ulcer disease, gastritis, peptic stricture, or gastric outlet obstruction.

• #19 Dyspepsia: Symptoms and Treatment | Doctor

  https://patient.info/doctor/dyspepsia-pro

  For the uninvestigated patient without alarm features, the NICE guideline suggests the following steps: Test for H. pylori (carbon-13 urea breath test, stool antigen or laboratory serology) and eradicate if positive. […] Where patients show an inadequate response to treatment, consider other diagnoses (eg, gallstones) and/or referral to a specialist.

• #20 Functional Dyspepsia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0115/p84.html

  A test and treat strategy for Helicobacter pylori for all patients younger than 60 years is a safe and effective option before treatment with acid suppression. […] The presence of one alarm feature such as weight loss, anemia, or dysphagia should not be used to recommend endoscopy because each has a positive predictive value of less than 1% for malignancy. […] Endoscopy does not reassure patients with functional dyspepsia or improve quality of life assessments.

• #21 British Society of Gastroenterology guidelines on the management of functional dyspepsia | Gut

  https://gut.bmj.com/content/71/9/1697

  We recommend that non-urgent endoscopy is considered in patients aged 55 years with treatment-resistant dyspepsia or dyspepsia with either a raised platelet count or nausea or vomiting (recommendation: strong, quality of evidence: very low). […] We recommend that all other patients with dyspepsia are offered non-invasive testing for Helicobacter pylori (test and treat) and, if infected, given eradication therapy (recommendation: strong; quality of evidence: high). […] We recommend that patients without H. pylori infection are offered empirical acid suppression therapy (recommendation: strong; quality of evidence: high). […] Referral of patients with FD to gastroenterology in secondary care is appropriate where there is diagnostic doubt, where symptoms are severe, or refractory to first-line treatments, or where the individual patient requests a specialist opinion (recommendation: weak, quality of evidence: low). […] We recommend that gastric emptying testing or 24-hour pH monitoring should not be undertaken routinely in patients with typical symptoms of FD (recommendation: strong, quality of evidence: very low).

• #22 Functional Dyspepsia: Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0115/p84.html

  Functional dyspepsia is defined as at least one month of epigastric discomfort without evidence of organic disease found during an upper endoscopy, and it accounts for 70% of dyspepsia. […] Functional dyspepsia is a diagnosis of exclusion; therefore, evaluation for a more serious disease such as an upper gastrointestinal malignancy is warranted. […] The more specific Rome IV criteria allow for a definitive diagnosis of functional dyspepsia to be made for patients who have normal upper endoscopy findings. […] For patients who have not had an endoscopy, the diagnosis is only likely based on the exclusion of other causes. […] The 2017 ACG/CAG guidelines recommend upper endoscopy be performed for all patients 60 years or older who present with at least one month of dyspepsia symptoms. […] Endoscopy should not be performed routinely for patients younger than 60 years.

• #23

  https://www.bsg.org.uk/web-education/diagnosis-management-of-functional-dyspepsia

  Symptoms alone cannot distinguish FD from organic disease, such as peptic ulcer disease. However, an oesophagogastroduodenoscopy (OGD) is normal in around 80% of cases, meaning that most people with dyspepsia have FD as the cause of their symptoms. […] Patients with dyspepsia should be tested for H pylori infection by checking a stool antigen, or with a breath test. […] The majority of patients with dyspepsia do not need an endoscopy. If no other upper gastrointestinal alarm symptoms or signs are reported, an urgent OGD should only be requested in patients with dyspepsia aged 55 or older with weight loss, or in those aged 40 or older from an area at an increased risk of gastric cancer or with a family history of upper gastrointestinal cancer. […] All patients with dyspepsia should undergo testing for H pylori infection and receive eradication therapy if positive.

• #24 The Diagnosis and Treatment of Functional Dyspepsia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5938438/

  The only instrumental diagnostic examinations thought to be sufficiently accurate are esophagogastroduodenoscopy including investigation for Helicobacter pylori and abdominal ultrasonography. […] Patients whose symptoms do not respond to treatment should be screened for mental disorders such as anxiety, depression, and stress. […] The diagnostic work-up often reveals findings that are attributed endoscopically, and then also histologically, to gastritis. […] The term gastritis as clinical diagnosis should thus be avoided in favor of functional dyspepsia, particularly because the endoscopic and histological finding of gastritis does not correspond to the patients symptoms.

• #25 Functional dyspepsia – Wikipedia

  https://en.wikipedia.org/wiki/Functional_dyspepsia

  Unfortunately, there is currently no reliable biomarker to aid in the diagnosis, and history and clinical examination cannot reliably differentiate functional dyspepsia from organic dyspepsia causes. […] While a negative endoscopy is strictly necessary to validate a functional dyspepsia diagnosis, the majority of dyspepsia patients (80%) have been reported to have no organic abnormalities at endoscopy, with under 10 percent having a peptic ulcer and fewer than 0.5% having gastro-esophageal cancer. […] The most recent guidelines for managing dyspepsia prohibit endoscopic use in patients under 60 years of age because its low yield, even in cases where alarm symptoms are present. […] Differential diagnoses for functional dyspepsia include gastro-oesophageal reflux disease, medication side effects, chronic mesenteric ischemia, symptomatic gallstone disease, sphincter of Oddi dysfunction, biliary dyskinesia, or gallbladder cancer, Crohn’s disease, peptic ulcer disease (and infection with Helicobacter pylori), infiltrative diseases such as eosinophilic gastroenteritis, sarcoidosis, and amyloidosis, gastro-oesophageal malignancy, gastrointestinal complications of parasites such as giardia lamblia, strongyloides, and anisakiasis, gastroparesis, chronic pancreatitis or pancreatic cancer, and hepatocellular carcinoma.

• #26 The Diagnosis and Treatment of Functional Dyspepsia (30.03.2018)

  https://di.aerzteblatt.de/int/archive/article/197088/The-diagnosis-and-treatment-of-functional-dyspepsia

  Functional dyspepsia (FD) is one of the more common functional disorders, with a prevalence of 10-20%. It affects the gastrointestinal tract. […] Typical dyspeptic symptoms in functional dyspepsia include epigastric pain, sensations of pressure and fullness, nausea, and early subjective satiety. […] Functional dyspepsia (synonym: irritable stomach syndrome) is present whenever routine diagnostic investigations, including endoscopy, do not identify any causal structural or biochemical abnormalities. […] Confirmation of the diagnosis of functional dyspepsia rests on: the typical symptoms and the patients history; the exclusion of other diseases of the upper gastrointestinal tract and upper abdominal organs that may present with similar dyspeptic symptoms. […] The only instrumental diagnostic examinations thought to be sufficiently accurate are esophagogastroduodenoscopy including investigation for Helicobacter pylori and abdominal ultrasonography.

• #27 Understanding Functional Dyspepsia

  https://lakecountyin.gov/departments/health/Nursing-Clinic/Diseases-and-Conditions/Gastrointestinal/understanding-functional-dyspepsia

  Diagnosing functional dyspepsia involves a combination of medical history, physical examination, and diagnostic tests to rule out other conditions: […] Diagnostic Tests: – Upper Endoscopy (Gastroscopy): A procedure using a flexible tube with a camera to examine the upper gastrointestinal tract and rule out structural abnormalities, ulcers, or tumors. – Helicobacter pylori Testing: Testing for H. pylori infection through blood tests, stool tests, or breath tests. – Imaging Studies: In some cases, imaging studies such as abdominal ultrasound or CT scan may be used to rule out other conditions. […] Exclusion of Organic Causes: – Ruling Out: Ensuring that symptoms are not due to other gastrointestinal conditions such as peptic ulcers, gastroesophageal reflux disease (GERD), or gallbladder disease.

• #28 The Diagnosis and Treatment of Functional Dyspepsia (30.03.2018)

  https://di.aerzteblatt.de/int/archive/article/197088/The-diagnosis-and-treatment-of-functional-dyspepsia

  In patients who fail to respond to treatment, specialized diagnostic procedures should be carried out on an individual basis. […] The diagnostic work-up often reveals findings that are attributed endoscopically, and then also histologically, to gastritis. […] Appropriate diagnostic investigation and confirmation should not be followed by repeated examination. […] When functional dyspepsia has been confirmed, one of the first treatment measures is exhaustive explanation of the diagnosis and its consequences to the patient. […] Medicinal treatment is primarily recommended as a supportive measure in the symptomatic intervals. […] The following categories of evidence-based medicinal and nonmedicinal treatment are available: Proton pump inhibitors, Helicobacter pylori eradication treatment, Phytotherapy, Antidepressants, Psychotherapy.

• #29 Functional dyspepsia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/functional-dyspepsia/diagnosis-treatment/drc-20375715

  In some cases, other tests may be done to see how well the stomach empties its contents. […] Functional dyspepsia that can’t be managed with lifestyle changes may need treatment. Treatment depends on symptoms. It may combine medicines and behavior therapy. […] Some medicines may help manage symptoms of functional dyspepsia. […] If tests find H. pylori in the stomach, antibiotics may be prescribed along with acid-suppressing medicine. […] For functional dyspepsia, some basic questions to ask include: What tests do I need? […] You’ll likely be asked a few questions, such as: What, if anything, seems to improve your symptoms? […] Avoid doing anything that seems to worsen your symptoms.

• #30

  https://journals.lww.com/dmms/fulltext/2024/19040/diagnosis_of_functional_dyspepsia_an_unsolved.6.aspx

  Patients who do not seem to be responding to therapy and special diagnostic procedures should be carried out according to individual conditions. […] If symptoms of reflux are present, 24-h esophageal pH/impedance monitoring may be beneficial. […] The 13C breath test and gastric emptying scan can both detect possible gastroparesis or gastric emptying problems. […] Additional breath tests to determine carbohydrate intolerance and atypical bacterial colonization may be beneficial in the event of extreme flatulence. […] Patients whose symptoms do not respond to treatment should be screened for mental disorders such as anxiety, depression, and stress. […] A gastric pressure test can be used to determine stomach regulation. […] The Gold standard for visceral hypersensitivity is a barometric pressure test; however, it is intrusive and unpleasant. […] Gastric emptying scintigraphy is a noninvasive, quantitative, and physiological test that is now being used to evaluate patients before and after medication or surgery. […] This test is now commonly regarded as the gold standard for determining gastric emptying.

• #31 Gastroparesis and Functional Dyspepsia: A Blurring Distinction of Pathophysiology and Treatment

  https://www.jnmjournal.org/journal/view.html?uid=1447&vmd=Full

  Gastroparesis and functional dyspepsia are 2 of the most common gastric neuromuscular disorders. […] If patients suspected of having either gastroparesis or functional dyspepsia present with upper gastrointestinal symptoms, they should undergo upper endoscopy to exclude an alternative organic cause. […] Once the diagnosis of gastroparesis or functional dyspepsia is made, treatment should focus on the predominant symptom. […] Although various methods objectively measure gastric emptying, the 4-hour solid phase scintigraphic emptying scan is the most frequently conducted. […] It is critical to clearly distinguish patients with FD from those with GP and to better understand the relationship among alterations in specific symptoms, gastric emptying, and altered peripheral and central sensory responses to gastric stimuli.

• #32 Functional Dyspepsia: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22248-functional-dyspepsia

  Functional dyspepsia is a kind of chronic indigestion. A healthcare provider may diagnose you with functional dyspepsia if they cant find any direct cause for your symptoms. […] Healthcare providers diagnose functional dyspepsia by confirming your symptoms and ruling out other causes. These include chronic acid reflux (GERD) and peptic ulcer disease. […] Functional dyspepsia symptoms can be sporadic. Providers only diagnose it if they: Have been persistent for at least three months, Originally appeared at least six months ago, Arent relieved by burping, passing gas or pooping, Dont meet the criteria for biliary colic or gallbladder pain. […] Once theyve confirmed you have dyspepsia, theyll look to rule out structural causes. […] Tests might include: Blood tests to check for common infections and diseases that might explain your symptoms, Breath tests (urea and hydrogen) to screen for abnormal bacteria in your GI tract, Gastric emptying studies to see how fast or slow your stomach empties into your intestine, Upper endoscopy to look inside your digestive organs for structural issues, or to take a biopsy.

• #33 Functional dyspepsia: Causes, treatments, and new directions – Harvard Health

  https://www.health.harvard.edu/blog/functional-dyspepsia-causes-treatments-and-new-directions-2020070620505

  Many FD patients have an impaired accommodation reflex, and this may contribute to the post-meal discomfort experienced by many people with FD. […] Unfortunately, no medications exist specifically for improving stomach accommodation. […] While studies have shown that the above-mentioned treatments work better than placebo, many patients do not experience significant symptom improvement with them. […] FD remains a significant challenge for patients and physicians alike.

• #34 Functional Dyspepsia: Advances in Diagnosis and Therapy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16055

  The Rome III criteria in terms of distinguishing FD from structural diseases such as peptic ulceration remain no better than previous Rome definitions, with a diagnostic sensitivity of 61% and a specificity of 69%, both suboptimal. […] Meal induced symptoms are an important and increasingly recognized feature of FD. […] An objective test in FD that assesses meal related symptoms is the nutrient test meal. […] The findings correlate with gastric motor and sensory dysfunction and are an indirect measure of gastric accommodation, but are decreased in old age. […] The diagnostic utility of a nutrient test meal has not been investigated in the clinical setting and it remains an investigational tool. […] The diagnosis of FD remains one of exclusion as EGD is required to exclude peptic ulceration, esophagitis and malignancy.

• #35 Functional dyspepsia: Causes, treatments, and new directions – Harvard Health

  https://www.health.harvard.edu/blog/functional-dyspepsia-causes-treatments-and-new-directions-2020070620505

  Functional dyspepsia (FD) is a common condition, loosely defined by some physicians as a stomach ache without a clear cause. […] Those with FD often go through multiple tests like upper endoscopy, CT scan, and gastric emptying study. But despite often-severe symptoms, no clear cause (such as cancer, ulcer disease, or other inflammation) is identified. […] The first step in treatment is usually to check for bacteria called H. pylori that can cause inflammation of the stomach and small intestine. […] For those without H. pylori infection, or with symptoms that persist despite elimination of this bacteria, the next step is usually a trial of a proton-pump inhibitor (PPI). […] Tricyclic antidepressants (TCAs) are another class of medications that are often used to treat FD. […] Addressing these conditions, often with the help of a trained psychiatrist or psychologist, can also improve FD symptoms.

• #36

  https://link.springer.com/article/10.1007/s00535-021-01843-7

  Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. […] The revised guidelines have two major features. The first is the new position of endoscopy in the flow of FD diagnosis. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. […] The second major feature of the revised guidelines is the drug treatment options have been changed to reflect the latest evidence. Gastric acid-secretion inhibitors and prokinetic agents have been divided into different classes and a recommendation grade has been assigned to each class. […] Upper gastrointestinal endoscopy is not required to diagnose FD. FD should be diagnosed on the basis of a comprehensive evaluation of symptoms, age, medical history, presence of H. pylori infection, and laboratory history.

• #37

  https://link.springer.com/article/10.1007/s00535-021-01843-7

  A self-reporting questionnaire is useful for the diagnosis of FD. […] The usefulness of gastrointestinal function tests in clinical practice is not clear. […] Satisfactory relief of symptoms is an important objective in the treatment of FD. […] Proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) are effective for the treatment of FD. […] The acetylcholinesterase (AChE) inhibitor acotiamide is useful, and its use is recommended. […] The Japanese herbal medicine rikkunshito is an effective treatment for FD, and its use is recommended. […] The implementation of psychosomatic internal medical treatment has been proposed because it effectively treated FD. […] FD sometimes recurs, but recurrence is not associated with an increased mortality.

• #38 Functional Dyspepsia: Advances in Diagnosis and Therapy

  https://www.gutnliver.org/journal/view.html?volume=11&number=3&spage=349

  Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. […] The diagnosis of FD remains one of exclusion as EGD is required to exclude peptic ulceration, esophagitis and malignancy. […] The pretest probability of FD in the patient who presents with classical dyspepsia (fullness, satiety, or epigastric pain) and no alarm features however is high, around 0.7 and therefore a provisional diagnosis in clinical practice can be considered in selected cases. […] The complaint that is the strongest indicator of FD is early satiety, a very distinctive symptom now linked to a specific duodenal pathology as discussed below. […] The Rome III criteria in terms of distinguishing FD from structural diseases such as peptic ulceration remain no better than previous Rome definitions, with a diagnostic sensitivity of 61% and a specificity of 69%, both suboptimal.

• #39 Functional dyspepsia – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/functional-dyspepsia.html

  Functional dyspepsia is characterised by troublesome early satiety, fullness, or epigastric pain or burning. […] Diagnosis is clinical, however it requires exclusion of structural gastrointestinal disease. The presence of red flags, such as weight loss or anaemia, should prompt investigation including gastroscopy. […] Correctly diagnosing functional dyspepsia is important to guide appropriate therapy and reduce unnecessary procedures or treatments. […] A typical history of long-standing troublesome early satiety and postprandial fullness is sufficient to make a clinical diagnosis and commence treatment, but often gastroscopy is required. […] It is otherwise reasonable to screen for H. pylori infection by breath or stool antigen test and treat positive cases. Non-steroidal anti-inflammatory drugs should be stopped before either investigation or an empiric trial of therapy, usually a proton pump inhibitor for 24 weeks, in those who are still symptomatic. […] Although symptoms can be significantly troublesome or disabling, there is no long-term effect on mortality. Multiple pharmacological and non-pharmacological therapies are available for patients with functional dyspepsia, giving clinicians several options for managing patients with this condition.

• #40 Functional Dyspepsia & Treatment | Alpha Digestive & Liver Centre

  https://alphagastro.sg/conditions/functional-dyspepsia/

  Functional dyspepsia is a chronic digestive condition that is characterised by persistent or recurrent symptoms of indigestion without a clear identifiable cause. […] Your Gastroenterologist will assess your condition by reviewing your medical history as well as your current signs and symptoms. They will also perform a physical examination and certain investigations like endoscopies and blood tests to rule out any disorders that may mimic dyspepsia. […] It is important, however, to consult your Gastroenterologist as functional dyspepsia may display the same symptoms as other gastrointestinal disorders. Therefore, a detailed assessment from a specialist is often necessary to reach the right diagnosis.

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