Materiały źródłowe

• #1 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. […] For patients younger than 60 years, a test and treat strategy for Helicobacter pylori is recommended before acid suppression therapy. […] All patients should be advised to limit foods associated with increased symptoms of dyspepsia; a diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is suggested. […] Eight weeks of acid suppression therapy is recommended for patients who test negative for H. pylori, or who continue to have symptoms after H. pylori eradication. […] If acid suppression does not alleviate symptoms, patients should be treated with tricyclic antidepressants followed by prokinetics and psychological therapy.

• #2 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. […] No treatment carries an approved indication for functional dyspepsia, but agents of several classes are used off-label. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for Helicobacter pylori or who continue to have dyspeptic symptoms after H pylori eradication. […] Currently, no therapy for functional dyspepsia has US Food and Drug Administration approval. All the agents listed below are used off-label for treating this condition. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H pylori or who continue to have dyspeptic symptoms after H pylori eradication.

• #3 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. […] The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. […] A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. […] Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs).

• #4 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. […] No treatment carries an approved indication for functional dyspepsia, but agents of several classes are used off-label. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for Helicobacter pylori or who continue to have dyspeptic symptoms after H pylori eradication. […] Currently, no therapy for functional dyspepsia has US Food and Drug Administration approval. All the agents listed below are used off-label for treating this condition. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H pylori or who continue to have dyspeptic symptoms after H pylori eradication.

• #5 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  Currently, no therapy for functional dyspepsia has U.S. Food and Drug Administration approval. All the agents listed below are used off-label for treating this condition. […] Famotidine twice daily was found to be more effective than the prokinetic medication mosapride and the antianxiety medication tandospirone in a study in patients with functional dyspepsia. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H pylori or who continue to have dyspeptic symptoms after H pylori eradication. […] A 3-year randomized double-blind trial found pantoprazole was not associated with any adverse event, with the possible exception of an increased risk of enteric infection. […] Antidepressant and antianxiety medications are often used to treat irritable bowel syndrome, but their efficacy in treating functional dyspepsia is less well known.

• #6 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. […] The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. […] A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. […] Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs).

• #7 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #8 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. […] Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD: Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation. […] A firm diagnosis followed by explanation and reassurance are key elements of the therapeutic equation and may help maximize the placebo response if therapy is prescribed. Those with fluctuating symptoms are more likely to respond to placebo. Simple dietary advice may help some patients although randomized controlled trials are lacking. In particular, eating small meals that are low fat is a reasonable starting point.

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

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

  Typical dyspeptic symptoms in functional dyspepsia include epigastric pain, sensations of pressure and fullness, nausea, and early subjective satiety. […] There is as yet no causally directed treatment for functional dyspepsia. Its treatment should begin with intensive patient education regarding the benign nature of the disorder and with the establishment of a therapeutic pact for long-term care. Given the absence of a causally directed treatment, drugs to treat functional dyspepsia should be given for no more than 812 weeks. Proton-pump inhibitors, phytotherapeutic drugs, and Helicobacter pylori eradication are evidence-based interventions. For intractable cases, tricyclic antidepressants and psychotherapy are further effective treatment options. […] When functional dyspepsia has been confirmed, one of the first treatment measures is exhaustive explanation of the diagnosis and its consequences to the patient.

• #10 Functional Dyspepsia (Non-ulcer Dyspepsia)

  https://patient.info/digestive-health/dyspepsia-indigestion/non-ulcer-dyspepsia-functional-dyspepsia

  Functional dyspepsia (non-ulcer dyspepsia) causes pain and sometimes other symptoms in your upper tummy (abdomen). Medication to reduce stomach acid helps in some cases. […] Clearing this infection, if present, helps in some people. […] Treatment for functional dyspepsia. […] This is often helpful. Some people worry that they may have a serious disease such as stomach cancer. Worry and anxiety can make symptoms worse. It may be useful to know that you have functional dyspepsia and not some other disease. […] If you are infected with H. pylori, the first treatment usually tried is to clear the H. pylori infection. However, infection with H. pylori is probably a coincidence rather than a cause in most cases of functional dyspepsia. […] A one-month trial of medication that reduces stomach acid is often advised. This helps in some cases but not all. It may work because the lining of your stomach may be extra sensitive to the acid.

• #11 Functional Dyspepsia – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/functional-dyspepsia/

  For some people, cutting back on caffeine-containing food and drinks, spicy foods, fatty foods like chocolate and pastries, citrus fruit juices, peppermint, fizzy drinks, and tomatoes can be helpful. Eating smaller, more frequent meals can also be beneficial in reducing symptoms. […] A variety of medicines can be used to treat functional dyspepsia. These consist of: Antacids: Aluminium hydroxide, magnesium carbonate, magnesium trisilicate, and other components are found in antacids. They are sold at pharmacies under a variety of brand names and are available as tablets or liquids. They help to neutralise the stomach acid and may have added substances to lessen excessive gas. […] Proton Pump Inhibitors (PPI): These drugs, for example omeprazole or lansoprazole (there are several options), work by stopping the acid production in the stomach to reduce the amount of acid present. […] H2 antagonists: These drugs, such as cimetidine and famotidine, reduce the amount of acid produced in the stomach. […] Antidepressants: These may be used at a very low dose, as they have the effect of calming the muscles of the gut and reduce pain sensation.

• #12 Functional Dyspepsia Treatments | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/functional-dyspepsia/treatments

  Your physician may recommend a combination of treatments for functional dyspepsia, including: […] Lifestyle changes: Eating five or six small meals a day […] Avoiding foods that cause symptoms […] Reducing fat and fiber consumption […] Eliminating alcohol and caffeine […] Avoiding medications that cause symptoms […] Controlling stress and anxiety with behavior modification and other relaxation techniques […] Medications: Antacids, proton pump inhibitors (PPIs) and H-2-receptor antagonists (H2Ras) to reduce stomach acid […] Prokinetics to speed up the stomach or small intestinal emptying process […] Antibiotics, if your physician finds H. pylori bacteria in your stomach or small intestinal bacterial overgrowth […] Antidepressants or anti-anxiety medications to ease the distress and sensation of pain or discomfort […] Peppermint Oils to eliminate cramping, bloating, and gas.

• #13 Functional dyspepsia: What can help? | informedhealth.org

  https://www.informedhealth.org/functional-dyspepsia-what-can-help.html

  Functional dyspepsia isnt dangerous, but it can be distressing and take a long time. There are various ways to relieve the symptoms and make it easier to cope with them in daily life. You can do a lot yourself, even if there’s a lack of good research on the available products and approaches. […] There is no cure-all for functional dyspepsia, but there are some helpful treatments that can relieve the symptoms. Depending on what the main symptoms are for example, pain or a feeling of fullness various approaches can help. The first treatment steps are usually the same: changes in diet, more exercise, and individually selected medication. […] Many people say their symptoms are affected by certain foods or eating habits. Studies show that functional dyspepsia symptoms are sometimes linked to wheat products, fatty foods and caffeine. A lot of people find that it helps to take their time when eating, eat in a pleasant and relaxed environment, chew slowly and thoroughly, eat smaller, more frequent meals rather than a few larger ones, avoid fatty or spicy foods, and keep an eye on whether hot drinks, alcohol, or coffee make the symptoms worse and, if so, avoid or reduce the number of these drinks.

• #14 Managing functional dyspepsia | Medicina Universitaria

  https://www.elsevier.es/en-revista-medicina-universitaria-304-articulo-managing-functional-dyspepsia-X1665579614675951

  Functional dyspepsia is a highly prevalent disease worldwide. Its symptoms are manifested as pain (burning or not) in the upper abdomen and early satiety, postprandial fullness, bloating, nausea and belching. For its study and treatment, it is divided into 2 syndromes: epigastric pain, which is meal unrelated, and postprandial distress, which as the name suggests, are meal related symptoms. These 2 syndromes frequently overlap. […] Within the therapeutic approach of functional dyspepsia, there are important pharmacological and non-pharmacological measures, including: […] Non-pharmacological measures […] a. Diet […] We suggest avoiding foods such as: soft drinks, coffee, tea, chocolate, mint, peppermint, garlic, onion, tomato, pepper, gum, spices and citrus, as well as excessive amounts of fruit and vegetables, especially when symptoms suggest problems with gastric emptying.

• #15 Functional Dyspepsia: Definition, Causes, Symptoms, Diagnosis, More

  https://www.healthline.com/health/functional-dyspepsia

  Psychological interventions may be beneficial in treating those with FD, according to a 2021 review. Interventions may include cognitive behavioral therapy, psychotherapy, hypnotherapy, according to a 2019 review. […] Assessing your diet can be an important first step in managing FD. Factors like what, when, or how you eat may contribute to your symptoms. In some instances, dietary changes can provide long-term relief. […] The following dietary and lifestyle adjustments may help to relieve your FD symptoms: eating smaller meals more frequently rather than larger ones three times daily, skipping high fat foods, as they can slow the emptying of your stomach, prioritizing low FODMAP foods, avoiding smoking or quitting smoking, if you smoke, limiting alcohol intake, limiting caffeine intake, keeping a food journal and avoiding foods that tend to trigger symptoms. […] FD symptoms can interfere with daily activities, so seeking psychological support as part of an overall treatment plan may help you manage FD symptoms.

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

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

  We recommend that all patients with FD are advised to take regular aerobic exercise (recommendation: strong, quality of evidence: very low). […] Eradication therapy is an efficacious treatment for H. pylori-positive patients with FD. Adverse events are more common than with a control therapy (recommendation: strong; quality of evidence: high). […] Proton pump inhibitors (PPIs) are an efficacious treatment for FD. There does not appear to be a dose response, so the lowest dose that controls symptoms should be used. These drugs are well tolerated (recommendation: strong, quality of evidence: high). […] Some prokinetics may be an efficacious treatment for FD. However, efficacy varies according to drug class, and many of these drugs are unavailable outside of Asia and the USA. Most of these drugs are well tolerated (recommendation: weak, quality of evidence: low for acotiamide, itopride, and mosapride, recommendation: strong, quality of evidence: moderate for tegaserod).

• #17 Functional Dyspepsia – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/functional-dyspepsia/

  What treatment is available for functional dyspepsia? Some medication treatments are available from your GP and are called first line medicine treatments (see below.) If this course of treatment is ineffective, you could ask to be sent for specialised care. This could be with a psychologist or a gut doctor (gastroenterologist). Although there is currently no cure for functional dyspepsia, most therapies can help to reduce symptoms to a manageable level. It might be helpful to know that only a small number of people still have severe symptoms after treatment. […] Intentional weight loss may be one of the lifestyle modifications you choose, if your weight is higher than what is considered healthy. If your symptoms happen when you lie down at night, avoid eating three hours before bedtime. It’s a good idea to consume less alcohol and to stop smoking (especially if symptoms worsen with meals). Other health gains may also happen because of these improvements.

• #18 Functional dyspepsia: What can help? | informedhealth.org

  https://www.informedhealth.org/functional-dyspepsia-what-can-help.html

  It can sometimes be helpful to reduce your stress levels and respect your own limits. Various relaxation and stress management techniques can help here. Examples include autogenic training and progressive muscle relaxation. […] If you take medications for other conditions, it can be a good idea to check whether they have an influence. Some things, like iron supplements and medication for rheumatoid arthritis, can cause functional dyspepsia symptoms or make them worse. […] Many people try herbal products to relieve their symptoms. Known as phytotherapy products, these are available without a prescription. Essential oils and extracts of various plants can relieve cramping and prevent inflammation, and might also be able to increase movement in the digestive tract. […] A summary of scientific studies suggests that a combination of peppermint and caraway oil can relieve symptoms of functional dyspepsia. These products aren’t generally recommended for the treatment of functional dyspepsia. But they are considered to be well tolerated.

• #19 Functional Dyspepsia (Non-ulcer Dyspepsia)

  https://patient.info/digestive-health/dyspepsia-indigestion/non-ulcer-dyspepsia-functional-dyspepsia

  Psychological treatments such as cognitive-behavioural therapy (CBT), gut-directed hypnotherapy and psychodynamic psychotherapy may be helpful. These treatments are not always available on the NHS. […] The National Institute for Health and Care Excellence (NICE) recommends the following lifestyle changes: Eat smaller meals and eat your evening meal 3-4 hours before going to bed. Lose weight, if you are obese. If you are a smoker, consider giving up. Don’t drink too much alcohol. […] Most people’s symptoms improve with treatment and become better over time. If you are on long term acid-suppressing medicine, you should have a review with your doctor once a year. A small number of people have long term dyspepsia. In cases where the symptoms do not settle, referral to a specialist clinic may be helpful.

• #20 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. […] For patients younger than 60 years, a test and treat strategy for Helicobacter pylori is recommended before acid suppression therapy. […] All patients should be advised to limit foods associated with increased symptoms of dyspepsia; a diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) is suggested. […] Eight weeks of acid suppression therapy is recommended for patients who test negative for H. pylori, or who continue to have symptoms after H. pylori eradication. […] If acid suppression does not alleviate symptoms, patients should be treated with tricyclic antidepressants followed by prokinetics and psychological therapy.

• #21 Functional Dyspepsia: Evaluation and Management | AAFP

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

  The routine use of complementary and alternative medicine therapies has not shown evidence of effectiveness and is not recommended. […] A low-risk intervention for patients is to encourage dietary modifications to limit foods associated with functional dyspepsia. […] H. pylori test and treat strategies, when compared with endoscopy, are safe, effective, and cost-effective for managing patients with dyspepsia. […] The mainstay of acid suppression includes two classes of medications: PPIs and histamine H2 receptor antagonists. […] A systematic review of psychotropic medications compared with placebo for the treatment of functional dyspepsia included three trials of tricyclic antidepressants (TCAs) and found a reduction in dyspepsia symptoms. […] For patients who have functional dyspepsia with postprandial distress syndrome, which is characterized by meal-related symptoms, prokinetic agents can reduce symptoms.

• #22 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. […] Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD: Helicobacter pylori eradication. Treatment of duodenal eosinophilia is under investigation. […] A firm diagnosis followed by explanation and reassurance are key elements of the therapeutic equation and may help maximize the placebo response if therapy is prescribed. Those with fluctuating symptoms are more likely to respond to placebo. Simple dietary advice may help some patients although randomized controlled trials are lacking. In particular, eating small meals that are low fat is a reasonable starting point.

• #23 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Multiple drug classes have been trialed to treat FD but therapeutic options remain limited and provide in most cases only symptomatic benefit. Only one therapy is known to change the natural history of FD and that is H. pylori eradication therapy. […] Randomized controlled trials have compared eradication therapy with either placebo or acid suppression. […] Proton pump inhibitor (PPI) therapy has become first line treatment for FD but it is important to recognize the majority of patients will fail this approach even if high dose PPI is prescribed. […] Prokinetic therapy overall is superior to placebo based on meta-analysis data of randomized controlled trials but the results are largely driven by cisapride that has limited to no availability and was withdrawn because of concern over QT prolongation and the risk of sudden death.

• #24 Diagnosis and Treatment of Functional Dyspepsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/ot1.html

  Functional dyspepsia is a diagnosis of exclusion. Symptoms must be present for at least six months, and must include one of the following: early satiety, epigastric burning, and postprandial fullness. […] Treatment of functional dyspepsia is nonpharmacologic and pharmacologic. Nonpharmacologic approaches include dietary modification, such as limiting dietary fat, avoiding meals too late in the day, and eating smaller meals. Patients should avoid specific foods if they correlate with symptoms. […] Pharmacologic treatments may be beneficial. There may be a small positive impact on symptoms with H. pylori eradication (number needed to treat = 14), but this should be initiated only with proven infection. […] Although study results are inconsistent, proton pump inhibitors should be tried in patients not infected with H. pylori or in patients not responding to H. pylori eradication, especially those with reflux-predominant symptoms.

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

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

  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. They include: […] Medicines to reduce acid production. These medicines are called H-2-receptor blockers and are available without a prescription. They include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). Stronger versions of these medicines also are available by prescription. […] Medicines that block acid „pumps.” Medicines called proton pump inhibitors shut down the acid „pumps” within acid-secreting stomach cells. […] Antibiotics. If tests find H. pylori in the stomach, antibiotics may be prescribed along with acid-suppressing medicine.

• #26 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. […] The first step in treatment is usually to check for bacteria called H. pylori that can cause inflammation of the stomach and small intestine. If H. pylori is present, the person is treated with a course of antibiotics. […] 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). PPIs, which include omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid), suppress the stomachs acid production. […] 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.

• #27 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  PPIs are recommended for 4 to 8 weeks for patients who initially test negative for H pylori and those with persistent symptoms 4 weeks after the eradication of H pylori confirmed by stool antigen testing, urea breath test, or upper endoscopy-based testing. […] Patients whose symptoms remain refractory after the initial 8 weeks of PPI therapy should discontinue PPIs, with consideration for initiating a TCA. […] A 4- to 8-week course of a prokinetic agent is recommended when the aforementioned therapies fail or when symptoms recur. […] Some patients may find the therapies below effective, although insufficient data exist to support their validation.

• #28 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. […] No treatment carries an approved indication for functional dyspepsia, but agents of several classes are used off-label. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for Helicobacter pylori or who continue to have dyspeptic symptoms after H pylori eradication. […] Currently, no therapy for functional dyspepsia has US Food and Drug Administration approval. All the agents listed below are used off-label for treating this condition. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H pylori or who continue to have dyspeptic symptoms after H pylori eradication.

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

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

  We recommend that all patients with FD are advised to take regular aerobic exercise (recommendation: strong, quality of evidence: very low). […] Eradication therapy is an efficacious treatment for H. pylori-positive patients with FD. Adverse events are more common than with a control therapy (recommendation: strong; quality of evidence: high). […] Proton pump inhibitors (PPIs) are an efficacious treatment for FD. There does not appear to be a dose response, so the lowest dose that controls symptoms should be used. These drugs are well tolerated (recommendation: strong, quality of evidence: high). […] Some prokinetics may be an efficacious treatment for FD. However, efficacy varies according to drug class, and many of these drugs are unavailable outside of Asia and the USA. Most of these drugs are well tolerated (recommendation: weak, quality of evidence: low for acotiamide, itopride, and mosapride, recommendation: strong, quality of evidence: moderate for tegaserod).

• #30 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #31 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Functional dyspepsia is diagnosed on the basis of clinical symptoms and patients medical history; endoscopy can exclude organic diseases such as gastric ulcer and gastric cancer. The first-line therapy for patients with EPS-type functional dyspepsia includes anti-acid therapy such as PPIs, H2-blockers and vonoprazan. First-line treatment of PDS-type functional dyspepsia includes prokinetic drugs such as itopride, metoclopramide and acotiamide. […] Choosing the correct treatment for functional dyspepsia is difficult, and even though the prevalence of functional dyspepsia is increasing, pharmacological therapeutic options remain limited. Development of new drugs to treat the disorder is, therefore, a priority.

• #32 Dyspepsia – American College of Gastroenterology

  https://gi.org/topics/dyspepsia/

  H2 receptor antagonists (H2RAs) include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) and are available both by prescription and over-the-counter. […] Proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium) and are available by prescription. […] Prokinetics such as metoclopramide (Reglan) may be helpful for people who have a problem with the stomach emptying too slowly. […] If testing shows the type of bacteria that causes peptic ulcer disease, the doctor may prescribe antibiotics to treat the condition.

• #33 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #34 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Our general practice is to treat with a proton pump inhibitor for 2 months. If symptoms respond, then we taper off the medication or reduce it to the lowest effective dose. If dyspepsia does not respond to a proton pump inhibitor, we use an individualized approach, discussing the agents listed above and summarized in Table 1.

• #35 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  PPIs are recommended for 4 to 8 weeks for patients who initially test negative for H pylori and those with persistent symptoms 4 weeks after the eradication of H pylori confirmed by stool antigen testing, urea breath test, or upper endoscopy-based testing. […] Patients whose symptoms remain refractory after the initial 8 weeks of PPI therapy should discontinue PPIs, with consideration for initiating a TCA. […] A 4- to 8-week course of a prokinetic agent is recommended when the aforementioned therapies fail or when symptoms recur. […] Some patients may find the therapies below effective, although insufficient data exist to support their validation.

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

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

  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. They include: […] Medicines to reduce acid production. These medicines are called H-2-receptor blockers and are available without a prescription. They include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). Stronger versions of these medicines also are available by prescription. […] Medicines that block acid „pumps.” Medicines called proton pump inhibitors shut down the acid „pumps” within acid-secreting stomach cells. […] Antibiotics. If tests find H. pylori in the stomach, antibiotics may be prescribed along with acid-suppressing medicine.

• #37 Functional Dyspepsia – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/functional-dyspepsia/

  For some people, cutting back on caffeine-containing food and drinks, spicy foods, fatty foods like chocolate and pastries, citrus fruit juices, peppermint, fizzy drinks, and tomatoes can be helpful. Eating smaller, more frequent meals can also be beneficial in reducing symptoms. […] A variety of medicines can be used to treat functional dyspepsia. These consist of: Antacids: Aluminium hydroxide, magnesium carbonate, magnesium trisilicate, and other components are found in antacids. They are sold at pharmacies under a variety of brand names and are available as tablets or liquids. They help to neutralise the stomach acid and may have added substances to lessen excessive gas. […] Proton Pump Inhibitors (PPI): These drugs, for example omeprazole or lansoprazole (there are several options), work by stopping the acid production in the stomach to reduce the amount of acid present. […] H2 antagonists: These drugs, such as cimetidine and famotidine, reduce the amount of acid produced in the stomach. […] Antidepressants: These may be used at a very low dose, as they have the effect of calming the muscles of the gut and reduce pain sensation.

• #38 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  Currently, no therapy for functional dyspepsia has U.S. Food and Drug Administration approval. All the agents listed below are used off-label for treating this condition. […] Famotidine twice daily was found to be more effective than the prokinetic medication mosapride and the antianxiety medication tandospirone in a study in patients with functional dyspepsia. […] Clinical guidelines recommend starting proton pump inhibitor therapy in patients with functional dyspepsia who test negative for H pylori or who continue to have dyspeptic symptoms after H pylori eradication. […] A 3-year randomized double-blind trial found pantoprazole was not associated with any adverse event, with the possible exception of an increased risk of enteric infection. […] Antidepressant and antianxiety medications are often used to treat irritable bowel syndrome, but their efficacy in treating functional dyspepsia is less well known.

• #39 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. […] The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. […] A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. […] Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs).

• #40 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #41 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. […] Once the diagnosis of gastroparesis or functional dyspepsia is made, treatment should focus on the predominant symptom. Recently, various treatment modalities have been developed and validated. Prokinetic agents are generally used as treatment for both gastroparesis and functional dyspepsia. Acid-suppressive therapy, Helicobacter pylori eradication, and use of drugs that enhance gastric accommodation are employed for functional dyspepsia. Psychoactive drugs are also effective in symptom control. […] As the symptoms of gastric sensorimotor disorders do not discriminate FD from idiopathic GP definitively, patients with dyspepsia should be treated based on their predominant symptoms, regardless of the delay in gastric emptying.

• #42 Dyspepsia – American College of Gastroenterology

  https://gi.org/topics/dyspepsia/

  H2 receptor antagonists (H2RAs) include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) and are available both by prescription and over-the-counter. […] Proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium) and are available by prescription. […] Prokinetics such as metoclopramide (Reglan) may be helpful for people who have a problem with the stomach emptying too slowly. […] If testing shows the type of bacteria that causes peptic ulcer disease, the doctor may prescribe antibiotics to treat the condition.

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

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

  Low-dose antidepressants. Low doses of tricyclic antidepressants and antidepressants known as selective serotonin reuptake inhibitors may be recommended. These medicines may block the activity of neurons that control intestinal pain. […] Prokinetics. These medicines help the stomach empty faster and tighten the valve between the stomach and esophagus. This helps to reduce upper belly pain. […] Medicines to relieve nausea. These medicines are called anti-emetics. If you feel like throwing up after eating, anti-emetics may help. […] Working with a counselor or therapist may relieve symptoms that aren’t helped by medicines. A counselor or therapist can show you relaxation techniques to help you cope with your symptoms. You also may learn ways to reduce stress to help manage your symptoms.

• #44 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Acotiamide, an acetylcholinesterase inhibitor that increases acetylcholine release in the enteric nervous system, is efficacious based on a meta-analysis in a dose of 100 mg three times daily but only for PDS, not EPS; it is commercially available in Japan and trials in Europe are progressing. […] In difficult or resistant cases, combination therapy including psychological and centrally acting drug treatment should be considered as the outcomes are likely improved based on limited randomized trial evidence.

• #45

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

  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. […] Dopamine receptor antagonists are useful, and their use is suggested. […] Serotonin-4 (5-HT4) receptor agonists are useful, and their use is suggested. […] Herbal medicines other than rikkunshito may be effective for the treatment of FD, and their use is suggested. […] Tricyclic antidepressants and anxiolytics such as tandospirone are effective for the treatment of FD and have been proposed for use in the treatment of FD patients. […] The implementation of psychosomatic internal medical treatment has been proposed because it effectively treated FD. […] The number of reports of combination therapy is increasing, but further evidence is needed. […] Some studies have found acupuncture to be an effective treatment for FD. […] The efficacy of moxibustion as a treatment for FD is unknown because of little evidence. […] It is recommended that treatment of refractory FD be changed after 48 weeks, but further investigation is needed.

• #46 Managing functional dyspepsia | Medicina Universitaria

  https://www.elsevier.es/en-revista-medicina-universitaria-304-articulo-managing-functional-dyspepsia-X1665579614675951

  Anti-secretory drugs: Both type-2 anti-histaminergic pharmaceuticals (i. e. ranitidine) as well as proton pump inhibitors are medications of moderate efficacy […] Prokinetics: these are useful medications in the treatment of postprandial distress syndrome; however researchers in Us forget them because its therapeutic dosage approaches the level of dosage which causes adverse effects. […] Antidepressants: highly effective medications in the treatment of dyspepsia since they work as visceral analgesics. […] Selective serotonin receptor inhibitors have only proved to have a positive effect over quality of life but not in pain. […] Regarding dyspepsia treatment duration the suggestion is 3 months; however, the use of tricyclic as an option can be considered up to 6 months (there is not a well-established time).

• #47 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Patients should stop the drug if there is no response after taking the standard dose for 8 weeks, and should try to withdraw from the drug within 6 to 12 months, regardless of the response. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, 2 symptoms common in patients with functional dyspepsia. […] In a randomized, double-blind trial, metoclopramide improved symptoms in 83% of patients in the subgroup with regurgitation or heartburn compared with 89% with cisapride, the comparator treatment.

• #48 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Previous studies have reported that metoclopramide is not effective in functional dyspepsia. […] Since refractory functional dyspepsia involves psychiatric manifestations such as depression and anxiety, many physicians prescribe antidepressants for their patients. […] Lu and colleagues reported in a systematic review that TCAs are effective in the treatment of functional dyspepsia symptoms. […] The new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor has been shown to improve gastric motility and gastric emptying in rodents and dogs. […] Double-blind multicenter studies have shown a significant improvement in PDS symptoms such as postprandial fullness, early satiety, upper abdominal bloating in patients treated with acotiamide. […] Rikkunshito has been reported to improve gastric emptying in patients with functional dyspepsia and to decrease other GI symptoms such as abdominal pain, heartburn, and abdominal distension through the improvement impairment of expansion of proximal stomach.

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

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

  TCAs used as gut-brain neuromodulators are an efficacious second-line treatment for FD. They can be initiated in primary or secondary care, but careful explanation as to the rationale for their use is required, and patients should be counselled about their side effect profile (recommendation: strong, quality of evidence: moderate). […] Interpersonal psychodynamic informed psychotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] CBT and metacognitive therapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] Stress management approaches may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low).

• #50 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  Functional dyspepsia has 3 subtypesepigastric pain syndrome, postprandial distress syndrome, and a combination of the 2each thought to result from different mechanisms. […] Initial management involves educating the patient about the diagnosis and discussing treatment expectations. […] The primary treatment focuses on symptom management, as this disorder can be relapsing and remitting. Management primarily focuses on symptom relief, with treatment options including proton pump inhibitors, H2-receptor antagonists, prokinetic agents, and antidepressants. […] Endoscopic evaluation is necessary if alarming symptoms such as weight loss, dysphagia, or vomiting are present. […] Further treatment involves symptom management with proton pump inhibitors (PPIs), H2-receptor antagonists (H2RAs), prokinetic agents, and antidepressants. […] 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.

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

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

  Low-dose antidepressants. Low doses of tricyclic antidepressants and antidepressants known as selective serotonin reuptake inhibitors may be recommended. These medicines may block the activity of neurons that control intestinal pain. […] Prokinetics. These medicines help the stomach empty faster and tighten the valve between the stomach and esophagus. This helps to reduce upper belly pain. […] Medicines to relieve nausea. These medicines are called anti-emetics. If you feel like throwing up after eating, anti-emetics may help. […] Working with a counselor or therapist may relieve symptoms that aren’t helped by medicines. A counselor or therapist can show you relaxation techniques to help you cope with your symptoms. You also may learn ways to reduce stress to help manage your symptoms.

• #52 Functional Dyspepsia: Evaluation and Management | AAFP

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

  The routine use of complementary and alternative medicine therapies has not shown evidence of effectiveness and is not recommended. […] A low-risk intervention for patients is to encourage dietary modifications to limit foods associated with functional dyspepsia. […] H. pylori test and treat strategies, when compared with endoscopy, are safe, effective, and cost-effective for managing patients with dyspepsia. […] The mainstay of acid suppression includes two classes of medications: PPIs and histamine H2 receptor antagonists. […] A systematic review of psychotropic medications compared with placebo for the treatment of functional dyspepsia included three trials of tricyclic antidepressants (TCAs) and found a reduction in dyspepsia symptoms. […] For patients who have functional dyspepsia with postprandial distress syndrome, which is characterized by meal-related symptoms, prokinetic agents can reduce symptoms.

• #53 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Patients should stop the drug if there is no response after taking the standard dose for 8 weeks, and should try to withdraw from the drug within 6 to 12 months, regardless of the response. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, 2 symptoms common in patients with functional dyspepsia. […] In a randomized, double-blind trial, metoclopramide improved symptoms in 83% of patients in the subgroup with regurgitation or heartburn compared with 89% with cisapride, the comparator treatment.

• #54 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

• #55 Functional dyspepsia – Australian Prescriber

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

  Traditionally eating smaller regular low-fat meals is the advice offered, as the stomach and duodenum can process these more easily (a high fat intake slows gastric emptying) and gastric distension is minimised. […] Reducing the amount of acid bathing the duodenum may be helpful. Proton pump inhibitors are superior to placebo in functional dyspepsia. […] In Australia, domperidone is sometimes prescribed but the evidence for efficacy in functional dyspepsia is very limited. […] Fundic relaxors can be considered for people unresponsive to prokinetics. […] Low-dose tricyclic antidepressants are superior to placebo for functional dyspepsia, but they are probably most helpful for those with epigastric pain. […] The microbiome is disturbed in functional dyspepsia. One randomised controlled trial from Hong Kong has reported rifaximin was superior to placebo, although this is currently an expensive off-label therapy and data on relapse and retreatment are not available.

• #56 Diagnosis and Treatment of Functional Dyspepsia | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0201/ot1.html

  Antidepressants were shown to be of benefit in one systematic review. Selective serotonin reuptake inhibitors have not been studied, but tricyclics are thought to have beneficial impact on symptoms through their anticholinergic effect. Doses required for functional dyspepsia are lower than those for depression. Symptom improvement was found at four and eight weeks with one herbal agent, Iberogast.

• #57 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

• #58 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Patients should stop the drug if there is no response after taking the standard dose for 8 weeks, and should try to withdraw from the drug within 6 to 12 months, regardless of the response. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, 2 symptoms common in patients with functional dyspepsia. […] In a randomized, double-blind trial, metoclopramide improved symptoms in 83% of patients in the subgroup with regurgitation or heartburn compared with 89% with cisapride, the comparator treatment.

• #59 Reddit – The heart of the internet

  https://www.reddit.com/r/functionaldyspepsia/comments/182gs5a/functional_dyspepsia_101/

  Other antidepressants – Aside from amitriptyline and mirtazapine, other antidepressants are also prescribed off-label to treat FD. It’s important to note that these antidepressants are not being used to treat depression; the dose is much lower. Be mindful of the possible side effects, including sleepiness. […] Buspirone – a drug used to treat anxiety disorders and improves gastric accommodation by relaxing the fundus (upper portion of the stomach). […] Gabapentin – a medication primarily used to manage seizures and neuropathic pain. This approach is not as established as the aforementioned methods. The rationale behind using gabapentin for FD involves its impact on nerve signaling and its potential to modulate visceral hypersensitivity or abnormal pain perception in the gut. […] Prokinetics – a class of prescription drugs that are designed to improve gastric emptying by stimulating the stomach muscles responsible for peristalsis. These drugs include but aren’t limited to Reglan, Domperidone, Motegrity, and Erythromycin. Reglan may cause serious, irreversible side effects such as tardive dyskinesia (TD), a disorder characterized by uncontrollable, abnormal, and repetitive movements of the face, torso and/or other body parts.

• #60 Reddit – The heart of the internet

  https://www.reddit.com/r/functionaldyspepsia/comments/182gs5a/functional_dyspepsia_101/

  Antiemetics – medications specifically prescribed to alleviate nausea and vomiting. These medications work in various ways to reduce or prevent these symptoms by targeting different pathways in the body that trigger the sensation of nausea or the reflex of vomiting. […] PPIs/H2 Blockers – Medicine that reduces the secretion of stomach acid. This approach reduces burning/GERD symptoms and yields a more alkaline stomach environment to allow the mucosa (inner mucosal lining of the stomach) to heal. However, long-term use of PPI/H2 blockers may have adverse and unintended side effects. […] Cognitive Behavioral Therapy (CBT) – a therapeutic approach that focuses on the relationship between thoughts, feelings, and behaviors. It’s based on the idea that our thoughts influence our emotions and behaviors, and by changing these thoughts, we can change how we feel and act.

• #61 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

• #62 Mirtazapine: A New Treatment for Functional Dyspepsia – European Medical Journal

  https://www.emjreviews.com/gastroenterology/news/mirtazapine-a-new-treatment-for-functional-dyspepsia/

  IMPROVEMENTS in many symptoms of functional dyspepsia have been observed in a pilot study of mirtazapine, an antidepressant. […] Current treatments for functional dyspepsia include acid-suppressive and prokinetic drugs; these can improve gastric accommodation but it is not known if they carry any benefit for other symptoms. […] The antidepressant, mirtazapine, often causes weight gain in patients being treated for depression. This led to the design of a trial to assess its efficacy as a treatment for functional dyspepsia patients with weight loss. […] Patients on mirtazapine also reported an improvement in mean dyspepsia symptom severity questionnaire score at Weeks 4 and 8, a finding that was not seen in patients on placebo. […] Further research is needed to elucidate the full benefits and harms of mirtazapine, although these results are promising. Prof Jan Tack, Faculty of Medicine, University of Leuven, Leuven, Belgium, said: [Mirtazapine] has the potential to become the treatment of choice for functional dyspepsia in patients with weight loss, and evaluation in larger multicentre studies is warranted.

• #63 Functional Dyspepsia: A Review of the Symptoms, Evaluation, and Treatment Options – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/february-2020/functional-dyspepsia-a-review-of-the-symptoms-evaluation-and-treatment-options/

  The effectiveness of prokinetic agents to treat functional dyspepsia is unclear. […] Acotiamide, an acetylcholinesterase inhibitor, has been available in Japan since 2013 and has initiated the approval process in North America and European countries. […] Buspirone, a 5HT1A agonist, has been shown to improve dyspepsia symptoms and gastric accommodation in an RCT that included patients with functional dyspepsia. […] Fifty-eight patients with functional dyspepsia were randomized to either medical therapy alone or with psychotherapy, with great improvement in dyspepsia-related quality-of-life scores in the combination therapy group. […] The currently identified therapies are largely lackluster. This is likely due to numerous potential etiologies driving dyspepsia symptoms, as well as ill-defined underlying mechanisms and targets for therapeutic intervention. Once H pylori infection is ruled out or managed, treatment with a PPI is recommended. If antisecretory therapy is ineffective, neuromodulator therapy, prokinetics, and fundus-relaxing therapies should be considered.

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

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

  Low-dose antidepressants. Low doses of tricyclic antidepressants and antidepressants known as selective serotonin reuptake inhibitors may be recommended. These medicines may block the activity of neurons that control intestinal pain. […] Prokinetics. These medicines help the stomach empty faster and tighten the valve between the stomach and esophagus. This helps to reduce upper belly pain. […] Medicines to relieve nausea. These medicines are called anti-emetics. If you feel like throwing up after eating, anti-emetics may help. […] Working with a counselor or therapist may relieve symptoms that aren’t helped by medicines. A counselor or therapist can show you relaxation techniques to help you cope with your symptoms. You also may learn ways to reduce stress to help manage your symptoms.

• #65 Functional dyspepsia: How to manage the burn and the bloat | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/5/301

  Patients should stop the drug if there is no response after taking the standard dose for 8 weeks, and should try to withdraw from the drug within 6 to 12 months, regardless of the response. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, 2 symptoms common in patients with functional dyspepsia. […] In a randomized, double-blind trial, metoclopramide improved symptoms in 83% of patients in the subgroup with regurgitation or heartburn compared with 89% with cisapride, the comparator treatment.

• #66 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

• #67

  https://www.ijbcp.com/index.php/ijbcp/article/view/1483

  Functional dyspepsia represents a heterogeneous group of gastrointestinal disorders marked by the presence of upper abdominal pain or discomfort. […] Strategies such as acid suppression, prokinetics and H. pylori eradication have been used with some success. […] A commonly used therapeutic approach in its treatment is the use of oral enzymes supplementation therapy. […] This review summarizes the pathophysiology of functional dyspepsia, different pharmacological approaches and focuses on the safety and efficacy of digestive enzymes in managing dyspepsia. […] Banka N, Sawant P, Vartak M, Pawar D. Efficacy and Tolerability of Unienzyme MPS- A Multienzyme Preparation with Simethicone in Patients with Non-ulcer ,Dyspepsia. Indian Medical Gazette. 2001;135(7):294-305. […] Khandke DA, Shirsath PA, Jain SK. Post-Marketing Surveillance Study to Assess the Efficacy and Tolerability of Al5zyme-A Multienzyme Preparation in Patients with Functional Dyspepsia. Indian Medical Gazette. 2013;181-91. […] The efficacy of Combizym in the treatment of Chinese patients with dyspepsia: a multicenter, randomized, placebo-controlled and cross-over study. J Dig Dis. 2009;10(1):41-8.

• #68 Reddit – The heart of the internet

  https://www.reddit.com/r/functionaldyspepsia/comments/182gs5a/functional_dyspepsia_101/

  Antispasmotics – Drugs typically used for IBS that encourage the muscle of the bowel wall to relax. These drugs may have an adverse effect on gastric emptying. […] Natural/Herbal Remedies – Supplements including ginger (natural antiemetic and prokinetic), caraway oil, peppermint (natural antispasmodic), and aloe vera (anti-inflammatory) have been used as natural alternatives to treat FD. […] Diet and Lifestyle Changes. Reducing stress and anxiety as well as avoiding trigger foods (e.g. fatty, acidic, hard-to-digest, alcohol, caffeine, chocolate, greasy foods) may improve quality of life. More frequent but smaller meals and avoiding eating before laying down may also help.

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

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

  Functional dyspepsia is a kind of chronic indigestion. There are many treatment options, but there’s no one solution that works for everyone. […] If tests reveal any underlying factors, like bacterial overgrowth or a motility disorder, your provider will treat those first. But usually, treating these isn’t enough to relieve functional dyspepsia. Your provider will suggest other treatment options to relieve your symptoms. It usually takes a combination of these. […] Medications for functional dyspepsia might include: Antibiotics to treat a bacterial infection, Prokinetics to encourage movement in your GI tract, Acid blockers like proton pump inhibitors (PPIs) or H2 blockers, Tricyclic antidepressants in low doses to calm your nervous system. […] Complementary medicine for functional dyspepsia might include: Plant-based formulas, like peppermint and caraway oil, or a blend called Iberogast, Mind-body relaxation therapies, like meditation and yoga, biofeedback or psychotherapy, Elimination diet to identify food triggers, followed by a revised regular diet, Acupuncture, which has shown some benefits in some studies.

• #70 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

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

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

  The following categories of evidence-based medicinal and nonmedicinal treatment are available: Proton pump inhibitors, Helicobacter pylori eradication treatment, Phytotherapy, Antidepressants, Psychotherapy. […] Numerous multinational randomized controlled trials of proton pump inhibitors (PPI) have demonstrated a significant favorable effect against functional dyspepsia compared with placebo. […] The effect of H. pylori eradication treatment in functional dyspepsia has been the subject of a large number of placebo-controlled trials. […] Phytotherapeutics have long been used in medicine. Numerous placebo-controlled trials have shown a significantly positive effect of phytotherapy compared with placebo in the treatment of functional dyspepsia. […] Antidepressants are used after failure of the above-mentioned treatments. Efficacy has been confirmed for tricyclic antidepressants but not for serotonin reuptake inhibitors. […] Because motility disorders are a possible underlying cause of functional dyspepsia, prokinetics can be considered for treatment.

• #72 Effectivity of treatment for children with functional dyspepsia | Scientific Reports

  https://www.nature.com/articles/s41598-022-05380-y

  As all patients did benefit from any treatment, it is likely that the treatment itself was not accountable for the relief of symptoms, but that most patients benefit from education on the diagnosis, reassurance and a recommendation of a healthy lifestyle. […] Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factor. […] Patients were standardized offered a treatment with STW 5 (Iberogast, an herbal mixture with statistically significant effects on patients epigastric functional symptoms found in double-blind and randomized studies), or a referral to the psychologist for further support. […] In our cohort, patients responded well to the treatment with STW5, but was statistically relevant in boys only.

• #73 Functional dyspepsia: What can help? | informedhealth.org

  https://www.informedhealth.org/functional-dyspepsia-what-can-help.html

  It can sometimes be helpful to reduce your stress levels and respect your own limits. Various relaxation and stress management techniques can help here. Examples include autogenic training and progressive muscle relaxation. […] If you take medications for other conditions, it can be a good idea to check whether they have an influence. Some things, like iron supplements and medication for rheumatoid arthritis, can cause functional dyspepsia symptoms or make them worse. […] Many people try herbal products to relieve their symptoms. Known as phytotherapy products, these are available without a prescription. Essential oils and extracts of various plants can relieve cramping and prevent inflammation, and might also be able to increase movement in the digestive tract. […] A summary of scientific studies suggests that a combination of peppermint and caraway oil can relieve symptoms of functional dyspepsia. These products aren’t generally recommended for the treatment of functional dyspepsia. But they are considered to be well tolerated.

• #74 Highlights in Functional Dyspepsia Treatment From Digestive Disease Week 2017 – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/highlights-in-functional-dyspepsia-treatment-from-digestive-disease-week-2017/

  Caraway Oil/L-Menthol Plus Common Functional Dyspepsia Medications Is Safe and Effective. The use of a caraway oil/L-menthol, site-specific targeting formulation (COLM-SST; FDgard, IM HealthScience) was safe and effective in patients who were already taking usual functional dyspepsia (FD) medications, according to the results of FDREST (FD Reduction Evaluation and Safety Trial). […] Patients taking COLM-SST plus usual FD medications experienced a decrease in symptoms at 2 to 14 days and at 15 to 28 days. In addition, this arm was numerically superior to the placebo arm in all measures. At day 28, clinical global impressions were much or very much improved in 61.2% of the COLM-SST arm vs 48.9% in the placebo arm. […] Approximately three-quarters of patients with postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS) experienced substantial improvement after 4 weeks of COLM-SST plus commonly available FD medications, compared to approximately half of the placebo group.

• #75 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Previous studies have reported that metoclopramide is not effective in functional dyspepsia. […] Since refractory functional dyspepsia involves psychiatric manifestations such as depression and anxiety, many physicians prescribe antidepressants for their patients. […] Lu and colleagues reported in a systematic review that TCAs are effective in the treatment of functional dyspepsia symptoms. […] The new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor has been shown to improve gastric motility and gastric emptying in rodents and dogs. […] Double-blind multicenter studies have shown a significant improvement in PDS symptoms such as postprandial fullness, early satiety, upper abdominal bloating in patients treated with acotiamide. […] Rikkunshito has been reported to improve gastric emptying in patients with functional dyspepsia and to decrease other GI symptoms such as abdominal pain, heartburn, and abdominal distension through the improvement impairment of expansion of proximal stomach.

• #76

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

  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. […] Dopamine receptor antagonists are useful, and their use is suggested. […] Serotonin-4 (5-HT4) receptor agonists are useful, and their use is suggested. […] Herbal medicines other than rikkunshito may be effective for the treatment of FD, and their use is suggested. […] Tricyclic antidepressants and anxiolytics such as tandospirone are effective for the treatment of FD and have been proposed for use in the treatment of FD patients. […] The implementation of psychosomatic internal medical treatment has been proposed because it effectively treated FD. […] The number of reports of combination therapy is increasing, but further evidence is needed. […] Some studies have found acupuncture to be an effective treatment for FD. […] The efficacy of moxibustion as a treatment for FD is unknown because of little evidence. […] It is recommended that treatment of refractory FD be changed after 48 weeks, but further investigation is needed.

• #77 Reddit – The heart of the internet

  https://www.reddit.com/r/functionaldyspepsia/comments/182gs5a/functional_dyspepsia_101/

  Antispasmotics – Drugs typically used for IBS that encourage the muscle of the bowel wall to relax. These drugs may have an adverse effect on gastric emptying. […] Natural/Herbal Remedies – Supplements including ginger (natural antiemetic and prokinetic), caraway oil, peppermint (natural antispasmodic), and aloe vera (anti-inflammatory) have been used as natural alternatives to treat FD. […] Diet and Lifestyle Changes. Reducing stress and anxiety as well as avoiding trigger foods (e.g. fatty, acidic, hard-to-digest, alcohol, caffeine, chocolate, greasy foods) may improve quality of life. More frequent but smaller meals and avoiding eating before laying down may also help.

• #78 Functional Dyspepsia: Evaluation and Management | AAFP

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

  A review of 12 RCTs of patients with functional dyspepsia found a statistically significant benefit of psychological therapy (i.e., cognitive behavior therapy and other forms of psychotherapy) over the control group. […] The ACG does not recommend the routine use of complementary and alternative medicines for the treatment of functional dyspepsia but states that these alternatives can be considered for patients who are motivated.

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

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

  TCAs used as gut-brain neuromodulators are an efficacious second-line treatment for FD. They can be initiated in primary or secondary care, but careful explanation as to the rationale for their use is required, and patients should be counselled about their side effect profile (recommendation: strong, quality of evidence: moderate). […] Interpersonal psychodynamic informed psychotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] CBT and metacognitive therapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] Stress management approaches may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low).

• #80 Reddit – The heart of the internet

  https://www.reddit.com/r/functionaldyspepsia/comments/182gs5a/functional_dyspepsia_101/

  Antiemetics – medications specifically prescribed to alleviate nausea and vomiting. These medications work in various ways to reduce or prevent these symptoms by targeting different pathways in the body that trigger the sensation of nausea or the reflex of vomiting. […] PPIs/H2 Blockers – Medicine that reduces the secretion of stomach acid. This approach reduces burning/GERD symptoms and yields a more alkaline stomach environment to allow the mucosa (inner mucosal lining of the stomach) to heal. However, long-term use of PPI/H2 blockers may have adverse and unintended side effects. […] Cognitive Behavioral Therapy (CBT) – a therapeutic approach that focuses on the relationship between thoughts, feelings, and behaviors. It’s based on the idea that our thoughts influence our emotions and behaviors, and by changing these thoughts, we can change how we feel and act.

• #81 Functional Dyspepsia: Definition, Causes, Symptoms, Diagnosis, More

  https://www.healthline.com/health/functional-dyspepsia

  Psychological interventions may be beneficial in treating those with FD, according to a 2021 review. Interventions may include cognitive behavioral therapy, psychotherapy, hypnotherapy, according to a 2019 review. […] Assessing your diet can be an important first step in managing FD. Factors like what, when, or how you eat may contribute to your symptoms. In some instances, dietary changes can provide long-term relief. […] The following dietary and lifestyle adjustments may help to relieve your FD symptoms: eating smaller meals more frequently rather than larger ones three times daily, skipping high fat foods, as they can slow the emptying of your stomach, prioritizing low FODMAP foods, avoiding smoking or quitting smoking, if you smoke, limiting alcohol intake, limiting caffeine intake, keeping a food journal and avoiding foods that tend to trigger symptoms. […] FD symptoms can interfere with daily activities, so seeking psychological support as part of an overall treatment plan may help you manage FD symptoms.

• #82 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

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

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

  Hypnotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] We recommend a multidisciplinary support team should be involved for patients with severe or refractory FD (recommendation: strong, quality of evidence: low). […] We recommend opioids and surgery should be avoided in patients with severe or refractory FD to minimise iatrogenic harm (recommendation: strong, quality of evidence: very low). […] We recommend early dietitian involvement in patients with severe or refractory FD to avoid an overly restrictive diet (recommendation: strong, quality of evidence: very low).

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

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

  TCAs used as gut-brain neuromodulators are an efficacious second-line treatment for FD. They can be initiated in primary or secondary care, but careful explanation as to the rationale for their use is required, and patients should be counselled about their side effect profile (recommendation: strong, quality of evidence: moderate). […] Interpersonal psychodynamic informed psychotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] CBT and metacognitive therapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] Stress management approaches may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low).

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

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

  TCAs used as gut-brain neuromodulators are an efficacious second-line treatment for FD. They can be initiated in primary or secondary care, but careful explanation as to the rationale for their use is required, and patients should be counselled about their side effect profile (recommendation: strong, quality of evidence: moderate). […] Interpersonal psychodynamic informed psychotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] CBT and metacognitive therapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] Stress management approaches may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low).

• #86 Functional Dyspepsia: Evaluation and Management | AAFP

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

  A review of 12 RCTs of patients with functional dyspepsia found a statistically significant benefit of psychological therapy (i.e., cognitive behavior therapy and other forms of psychotherapy) over the control group. […] The ACG does not recommend the routine use of complementary and alternative medicines for the treatment of functional dyspepsia but states that these alternatives can be considered for patients who are motivated.

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

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

  Functional dyspepsia is a kind of chronic indigestion. There are many treatment options, but there’s no one solution that works for everyone. […] If tests reveal any underlying factors, like bacterial overgrowth or a motility disorder, your provider will treat those first. But usually, treating these isn’t enough to relieve functional dyspepsia. Your provider will suggest other treatment options to relieve your symptoms. It usually takes a combination of these. […] Medications for functional dyspepsia might include: Antibiotics to treat a bacterial infection, Prokinetics to encourage movement in your GI tract, Acid blockers like proton pump inhibitors (PPIs) or H2 blockers, Tricyclic antidepressants in low doses to calm your nervous system. […] Complementary medicine for functional dyspepsia might include: Plant-based formulas, like peppermint and caraway oil, or a blend called Iberogast, Mind-body relaxation therapies, like meditation and yoga, biofeedback or psychotherapy, Elimination diet to identify food triggers, followed by a revised regular diet, Acupuncture, which has shown some benefits in some studies.

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

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

  The primary treatment for FD has been aimed at gastric acid secretion and impaired gut motility. Therefore, prokinetics and acid-inhibitory drugs are the mainstay of treatment for FD. […] Acid suppression therapy with H2 receptor antagonist or proton pump inhibitor is effective in patients with FD. […] Psychosocial factors have been proposed as an important element in the pathophysiology of FD. A recent systematic review showed that psychotropic agents with anxiolytic or antidepressant actions were effective in alleviating FD symptoms. […] Acupuncture is also effective for FD. While most studies have not been rigorously examined, short-term treatment with acupuncture appears to be effective in reducing symptoms in FD patients.

• #89 Functional Dyspepsia (Part II)

  https://consultqd.clevelandclinic.org/functional-dyspepsia-how-to-manage-the-burn-and-the-bloat-part-ii

  In a study of 17 patients with functional dyspepsia, buspirone 10 mg before meals was found to augment fundic accommodation and improve postprandial fullness, bloating and early satiety. […] The Antidepressant Therapy for Functional Dyspepsia trial measured the benefits of amitriptyline and the selective serotonin reuptake inhibitor escitalopram in patients with functional dyspepsia who were not on antidepressants and did not present with depression. […] Gabapentin significantly reduced functional dyspepsia symptoms, but more studies are needed to establish it as a treatment. […] Rifaximin has been shown to improve bloating and pain symptoms in patients with irritable bowel syndrome, two symptoms common in patients with functional dyspepsia. […] STW 5 has demonstrated effects on hypertension and gastric motility and has antioxidative, anti-inflammatory, antacid and gastroprotective properties. […] Acupuncture in a study in patients with functional dyspepsia resulted in significant symptom improvement compared with sham acupuncture. […] Hypnosis induces a conscious state with focused attention, decreased awareness peripherally and increased susceptibility to external suggestion.

• #90

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

  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. […] Dopamine receptor antagonists are useful, and their use is suggested. […] Serotonin-4 (5-HT4) receptor agonists are useful, and their use is suggested. […] Herbal medicines other than rikkunshito may be effective for the treatment of FD, and their use is suggested. […] Tricyclic antidepressants and anxiolytics such as tandospirone are effective for the treatment of FD and have been proposed for use in the treatment of FD patients. […] The implementation of psychosomatic internal medical treatment has been proposed because it effectively treated FD. […] The number of reports of combination therapy is increasing, but further evidence is needed. […] Some studies have found acupuncture to be an effective treatment for FD. […] The efficacy of moxibustion as a treatment for FD is unknown because of little evidence. […] It is recommended that treatment of refractory FD be changed after 48 weeks, but further investigation is needed.

• #91 Functional dyspepsia: What can help? | informedhealth.org

  https://www.informedhealth.org/functional-dyspepsia-what-can-help.html

  If medications like PPIs do not help, treatment with tricyclic antidepressants (TCAs) may be an option. Doctors particularly recommend the use of TCAs for functional dyspepsia if the main symptoms are pain and burning in the upper abdomen. […] Probiotic foods and dietary supplements contain certain microorganisms like lactic acid bacteria. The idea is that they will settle in the digestive tract and help with digestion. There are also prebiotic products that, when absorbed with food, can increase the amount of useful bacteria in the bowel. But it’s not clear whether these products help in functional dyspepsia. […] Prokinetics are thought to increase movement in the digestive tract and make sure that stomach contents are passed on to the bowel more quickly. This is meant to reduce nausea, reflux and feelings of fullness in the upper abdomen. Research suggests that prokinetics can relieve symptoms. […] Apart from medication, there are various other treatments that can be offered in certain situations to treat functional dyspepsia. They include acupuncture and psychotherapy.

• #92 GiKids – Functional Dyspepsia (Non-Ulcer Dyspepsia, Indigestion)

  https://gikids.org/digestive-topics/functional-dyspepsia/

  If your childs main symptom is pain or burning: Acid-blocking medicines can help alleviate symptoms. Antidepressant medications can improve abdominal pain symptoms by targeting nerve hypersensitivity in the gastrointestinal tract. Tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) are specific classes of antidepressants/antianxiety medications that can help treat FD symptoms in children. […] There also is some evidence that probiotics are safe and may help relieve symptoms of FD. […] Treatments to promote relaxation, like counseling, yoga, acupuncture, hypnosis, and guided imagery, also may help. […] If medicines, dietary changes, and lifestyle changes do not help your child, some medical centers can offer a treatment called gastric electrical stimulation, which stimulates the stomach with electrodes. […] It is important to talk to your childs healthcare provider/gastroenterologist about the best treatment plan for their FD symptoms. A combination of lifestyle changes and medication may be recommended to see the most improvement in symptoms.

• #93 Functional dyspepsia: What can help? | informedhealth.org

  https://www.informedhealth.org/functional-dyspepsia-what-can-help.html

  It can sometimes be helpful to reduce your stress levels and respect your own limits. Various relaxation and stress management techniques can help here. Examples include autogenic training and progressive muscle relaxation. […] If you take medications for other conditions, it can be a good idea to check whether they have an influence. Some things, like iron supplements and medication for rheumatoid arthritis, can cause functional dyspepsia symptoms or make them worse. […] Many people try herbal products to relieve their symptoms. Known as phytotherapy products, these are available without a prescription. Essential oils and extracts of various plants can relieve cramping and prevent inflammation, and might also be able to increase movement in the digestive tract. […] A summary of scientific studies suggests that a combination of peppermint and caraway oil can relieve symptoms of functional dyspepsia. These products aren’t generally recommended for the treatment of functional dyspepsia. But they are considered to be well tolerated.

• #94 Integrative Treatment of Reflux and Functional Dyspepsia in Children

  https://www.mdpi.com/2227-9067/1/2/119

  In patients with GERD and FD, an integrative medicine treatment plan may include botanicals, mind-body techniques, sleep hygiene, increasing physical activity, and acupuncture, in addition to pharmacologic therapies. […] After a course of acupuncture, hypnotherapy, and the above interventions, she felt significant improvement in symptoms, with minimal nausea, excellent weight gain, and no further school absences. […] As illustrated by the case report and review of literature, patients with GERD and FD can benefit significantly from an integrative treatment approach. […] Pharmacologic medications such as H2-blockers and PPI’s are effective at treating symptoms. […] However, side effects, long-term risks, and difficulty with discontinuation can limit their use. […] Botanicals such as Iberogast, DGL, and ginger can often provide adjunct symptomatic relief with a good safety profile. […] Furthermore, working with mind-body therapies and acupuncture may improve GERD symptoms, motility, and help with stress reduction.

• #95 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. […] The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. […] A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. […] Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs).

• #96 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #97 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. […] Once the diagnosis of gastroparesis or functional dyspepsia is made, treatment should focus on the predominant symptom. Recently, various treatment modalities have been developed and validated. Prokinetic agents are generally used as treatment for both gastroparesis and functional dyspepsia. Acid-suppressive therapy, Helicobacter pylori eradication, and use of drugs that enhance gastric accommodation are employed for functional dyspepsia. Psychoactive drugs are also effective in symptom control. […] As the symptoms of gastric sensorimotor disorders do not discriminate FD from idiopathic GP definitively, patients with dyspepsia should be treated based on their predominant symptoms, regardless of the delay in gastric emptying.

• #98 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Functional dyspepsia is diagnosed on the basis of clinical symptoms and patients medical history; endoscopy can exclude organic diseases such as gastric ulcer and gastric cancer. The first-line therapy for patients with EPS-type functional dyspepsia includes anti-acid therapy such as PPIs, H2-blockers and vonoprazan. First-line treatment of PDS-type functional dyspepsia includes prokinetic drugs such as itopride, metoclopramide and acotiamide. […] Choosing the correct treatment for functional dyspepsia is difficult, and even though the prevalence of functional dyspepsia is increasing, pharmacological therapeutic options remain limited. Development of new drugs to treat the disorder is, therefore, a priority.

• #99 Effectivity of treatment for children with functional dyspepsia | Scientific Reports

  https://www.nature.com/articles/s41598-022-05380-y

  A systematic meta-analysis of over 6400 studies found high fat food to be the major player in FD. […] The recommendation for a healthy, balanced diet and regular meals. […] Patients, who were advised to foster health-conductive behaviors (abstaining use of tobacco and cannabis, increase physical activity, intake of regular meals etc.) were reported to have a statistically significant quick decline of symptoms after endoscopy. […] An international pediatric committee published a systematic review in 2018 where no evidence was found to support the use of pharmacological drugs. They recommend treating each subtype based on adult data, as more data become available. […] For the epigastric pain syndrome subtype, the use of PPI as first line treatment is recommended. […] Dietary changes impair motility (via CCK) or intestinal dilation and therefore patients with postprandial distress should benefit from those therapeutic approaches, which was not shown in our cohort.

• #100 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. […] The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated differently: acid secretion inhibitors are recommended with patients with EPS, whereas prokinetic drugs as mosapride and acotiamide are recommended for patients with PDS. […] A new drug, acotiamide, a muscarinic antagonist and cholinesterase inhibitor, has been shown to improve gastric motility in rodents and dogs, and to reduce PDS symptoms in patients in double-blind multicenter studies. […] Other emerging treatment options include Rikkunshito, a herbal medicine that improves gastric emptying through 5-hydroxytryptamine (5-HT)2B-mediated pharmacological action, and tricyclic antidepressants (TCAs).

• #101 Management of functional dyspepsia: state of the art and emerging therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5761940/

  The functional dyspepsia subtypes, epigastric pain syndrome (EPS) and PDS, require different treatment; patients with EPS benefit from acid secretion inhibitors, whereas patients with PDS benefit from prokinetic drugs such as mosapride and acotiamide. […] Dietary recommendations in functional dyspepsia include eating smaller meals and avoiding high-fat meals which have been reported to aggravate clinical symptoms such as nausea and abdominal pain more than isocaloric high-carbohydrate meals. […] H2-blockers (histamine H2 receptor antagonists) have been used as a first-line therapeutic drug for functional dyspepsia. […] Although PPIs also have been widely used for the treatment of dyspeptic symptoms in functional dyspepsia, evidence from RCTs suggests that the efficacy of PPIs in functional dyspepsia is limited and may be confined to those patients who have co-existing reflux symptoms.

• #102

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

  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. […] Dopamine receptor antagonists are useful, and their use is suggested. […] Serotonin-4 (5-HT4) receptor agonists are useful, and their use is suggested. […] Herbal medicines other than rikkunshito may be effective for the treatment of FD, and their use is suggested. […] Tricyclic antidepressants and anxiolytics such as tandospirone are effective for the treatment of FD and have been proposed for use in the treatment of FD patients. […] The implementation of psychosomatic internal medical treatment has been proposed because it effectively treated FD. […] The number of reports of combination therapy is increasing, but further evidence is needed. […] Some studies have found acupuncture to be an effective treatment for FD. […] The efficacy of moxibustion as a treatment for FD is unknown because of little evidence. […] It is recommended that treatment of refractory FD be changed after 48 weeks, but further investigation is needed.

• #103 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Acotiamide, an acetylcholinesterase inhibitor that increases acetylcholine release in the enteric nervous system, is efficacious based on a meta-analysis in a dose of 100 mg three times daily but only for PDS, not EPS; it is commercially available in Japan and trials in Europe are progressing. […] In difficult or resistant cases, combination therapy including psychological and centrally acting drug treatment should be considered as the outcomes are likely improved based on limited randomized trial evidence.

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

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

  Hypnotherapy may be an efficacious treatment for global symptoms in FD (recommendation: weak, quality of evidence: very low). […] We recommend a multidisciplinary support team should be involved for patients with severe or refractory FD (recommendation: strong, quality of evidence: low). […] We recommend opioids and surgery should be avoided in patients with severe or refractory FD to minimise iatrogenic harm (recommendation: strong, quality of evidence: very low). […] We recommend early dietitian involvement in patients with severe or refractory FD to avoid an overly restrictive diet (recommendation: strong, quality of evidence: very low).

• #105 Managing functional dyspepsia | Medicina Universitaria

  https://www.elsevier.es/en-revista-medicina-universitaria-304-articulo-managing-functional-dyspepsia-X1665579614675951

  Functional dyspepsia is more complex than we think and therapeutic development seems to be stagnant for some years now. Management guidelines are different based on prokinetic availability; always consider H. pylori eradication as a first choice. […] Therefore my recommendation is to consider the fact that symptoms are the key to establishing a treatment plan, because they can explain whether the patient is hypersensitive and requires a tricyclic, if the patient has gastric relaxation or emptying issues where a prokinetic would be ideal, or if acid is casual and an anti-secretor would be the best option. Even though we must consider that the best option is probably the combination of 2 or more medications based on the symptoms.

• #106 Functional Dyspepsia: Evaluation and Management | AAFP

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

  A review of 12 RCTs of patients with functional dyspepsia found a statistically significant benefit of psychological therapy (i.e., cognitive behavior therapy and other forms of psychotherapy) over the control group. […] The ACG does not recommend the routine use of complementary and alternative medicines for the treatment of functional dyspepsia but states that these alternatives can be considered for patients who are motivated.

• #107 Effectivity of treatment for children with functional dyspepsia | Scientific Reports

  https://www.nature.com/articles/s41598-022-05380-y

  Ultimately this leads to the recommendations as given decades ago, to educate families on the diagnosis, provide reassurance and advocate a healthy lifestyle. Some patients might benefit from medications, small changes in the diet, psychological support or alternative treatment, but success depends on individual, unpredictable factors.

• #108

  https://experts.mcmaster.ca/display/publication695276

  A reasonable treatment approach based on current evidence is to initiate therapy with a daily PPI in H. pylorinegative FD patients. If symptoms persist, a therapeutic trial with a tricyclic antidepressant may be initiated. If symptoms continue, the clinician can possibly initiate therapy with an antinociceptive agent, a prokinetic agent, or some form of complementary and alternative medications, although evidence from prospective studies to support this approach is limited.

• #109 Functional Dyspepsia – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/functional-dyspepsia/

  For some people, cutting back on caffeine-containing food and drinks, spicy foods, fatty foods like chocolate and pastries, citrus fruit juices, peppermint, fizzy drinks, and tomatoes can be helpful. Eating smaller, more frequent meals can also be beneficial in reducing symptoms. […] A variety of medicines can be used to treat functional dyspepsia. These consist of: Antacids: Aluminium hydroxide, magnesium carbonate, magnesium trisilicate, and other components are found in antacids. They are sold at pharmacies under a variety of brand names and are available as tablets or liquids. They help to neutralise the stomach acid and may have added substances to lessen excessive gas. […] Proton Pump Inhibitors (PPI): These drugs, for example omeprazole or lansoprazole (there are several options), work by stopping the acid production in the stomach to reduce the amount of acid present. […] H2 antagonists: These drugs, such as cimetidine and famotidine, reduce the amount of acid produced in the stomach. […] Antidepressants: These may be used at a very low dose, as they have the effect of calming the muscles of the gut and reduce pain sensation.

• #110 Functional Dyspepsia (Non-ulcer Dyspepsia)

  https://patient.info/digestive-health/dyspepsia-indigestion/non-ulcer-dyspepsia-functional-dyspepsia

  Psychological treatments such as cognitive-behavioural therapy (CBT), gut-directed hypnotherapy and psychodynamic psychotherapy may be helpful. These treatments are not always available on the NHS. […] The National Institute for Health and Care Excellence (NICE) recommends the following lifestyle changes: Eat smaller meals and eat your evening meal 3-4 hours before going to bed. Lose weight, if you are obese. If you are a smoker, consider giving up. Don’t drink too much alcohol. […] Most people’s symptoms improve with treatment and become better over time. If you are on long term acid-suppressing medicine, you should have a review with your doctor once a year. A small number of people have long term dyspepsia. In cases where the symptoms do not settle, referral to a specialist clinic may be helpful.

Zobacz więcej