Materiały źródłowe

• #1 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  Functional dyspepsia is a common and benign gastrointestinal disorder that presents similarly to other conditions, making it difficult to diagnose. […] Although the exact mechanism of functional dyspepsia is poorly understood, its pathophysiology is complex. Functional dyspepsia has 3 subtypesepigastric pain syndrome, postprandial distress syndrome, and a combination of the 2each thought to result from different mechanisms. Traditionally, functional dyspepsia has been attributed to disturbances in both macroscopic and microscopic gastric physiological factors. […] Although the exact mechanism is poorly understood, the pathophysiology of functional dyspepsia is complex, involving several different mechanisms thought to contribute to each subtype. Traditionally, disturbances in gastric physiologic factors, including both macroscopic and microscopic mechanisms, have been attributed to functional dyspepsia.

• #2 Functional dyspepsia in adults – UpToDate

  https://www.uptodate.com/contents/functional-dyspepsia-in-adults

  Dyspepsia is a common symptom with an extensive differential diagnosis and a heterogeneous pathophysiology. […] Up to 80 percent of individuals with symptoms of dyspepsia have functional (idiopathic, nonulcer) dyspepsia. Many authorities regard it as a disorder of gut-brain interaction, similar to irritable bowel syndrome, globus, and other symptom-based gastrointestinal disorders. […] The prevalence of functional dyspepsia ranges from 5 to 16 percent worldwide. […] Several factors are modestly associated with an increased risk of dyspepsia, including female sex, smoking, Helicobacter pylori infection, use of nonsteroidal anti-inflammatory agents, elevated body mass index, acute gastroenteritis, and specific psychiatric comorbidities. […] The association between acute gastroenteritis and the subsequent development of functional dyspepsia is well established. The prevalence of postinfectious functional dyspepsia in adults is approximately 10 to 13 percent.

• #3 The Usefulness of Symptom-based Subtypes of Functional Dyspepsia for Predicting Underlying Pathophysiologic Mechanisms and Choosing Appropriate Therapeutic Agents

  https://www.jnmjournal.org/journal/view.html?uid=1680&vmd=Full&

  Functional dyspepsia (FD) is considered to be a heterogeneous disorder with different pathophysiological mechanisms or pathogenetic factors. […] In addition to traditional mechanisms, novel concepts regarding pathophysiologic mechanisms of FD have been proposed. […] Although several classic pathophysiologic mechanisms are suggested to be associated with individual dyspeptic symptoms, symptom-based subtypes of FD are not specific for a certain pathogenetic factor or pathophysiologic mechanism, and may be frequently associated with multiple pathophysiologic abnormalities. […] Novel concepts on the pathophysiology of FD show complex interactions between pathophysiologic mechanisms and pathogenetic factors, and prediction of underlying mechanisms of individual patients simply by the symptom pattern or symptom-based subtypes may not be accurate in a considerable proportion of cases.

• #3 The Usefulness of Symptom-based Subtypes of Functional Dyspepsia for Predicting Underlying Pathophysiologic Mechanisms and Choosing Appropriate Therapeutic Agents

  https://www.jnmjournal.org/journal/view.html?uid=1680&vmd=Full&

  Therefore, subtyping by the Rome criteria appears to have limited value to guide therapeutic strategy, suggesting that the addition of objective parameters or subclassification reflecting physiologic or pathologic tests may be necessary for the targeted therapeutic approaches, particularly when therapeutic agents targeting novel mechanisms are available.

• #4 Dyspepsia pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Dyspepsia_pathophysiology

  The symptoms of functional dyspepsia are directly caused by two major pathophysiological abnormalities in gastric motility and visceral sensitivity. These mechanisms occur in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle. […] The symptoms of functional dyspepsia (FD) are directly caused by two major physiological abnormalities: abnormal gastric motility and visceral hypersensitivity. […] If the basis of this model of FD pathogenesis is excessive responsiveness of gastrointestinal function to stress and external stimuli, psychosomatic approaches to alter stress perception could be important treatment options.

• #5

  https://journals.lww.com/jcge/fulltext/2005/05003/Pathophysiology_and_Treatment_of_Functional.6.aspx?generateEpub=Article%7Cjcge:2005:05003:00006%7C10.1097/01.mcg.0000156109.97999.d1%7C

  Functional dyspepsia is a highly prevalent symptom complex and a heterogenous disorder. Recent studies showed potential associations between specific pathophysiologic disturbances and dyspeptic symptoms. Delayed gastric emptying reported in about 30% of patients with functional dyspepsia is associated with the symptoms of postprandial fullness, nausea, and vomiting. Impaired gastric accommodation present in 40% of functional dyspepsia patients is found to be associated with early satiety. Hypersensitivity to gastric distension is observed in 37% of functional dyspepsia patients and associated with the symptoms of postprandial pain, belching, and weight loss. Psychosocial factors and altered response to duodenal lipids or acid have also been identified as pathophysiologic mechanisms. […] Therapeutic options are still limited but targeted therapy directed at the underlying pathophysiology seems desirable. Thus, efforts to further elucidate underlying pathophysiologic mechanisms and identify the appropriate patient population using some type of pathophysiologic testing will be required.

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

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

  Abnormalities of the gastric sensorimotor function have been identified in both GP and FD and can overlap. In addition to delayed gastric emptying, these abnormalities include impaired post-meal gastric accommodation, hypersensitivity to gastric distention, altered duodenal sensitivity to lipids or acids, abnormal intestinal motility, and central nervous system dysfunction. […] The pathogenesis of FD is currently attributed to a compound of upper gastrointestinal motility and visceral hypersensitivity disorders combined by the enteric nerve system. Pathophysiological abnormalities of FD include changes in the gastric emptying rate (either delayed or accelerated), impairment of gastric accommodation, gastric or duodenal hypersensitivity to certain nutrients found in food, and gastric or duodenal distension.

• #7

  https://link.springer.com/article/10.1007/s00535-019-01550-4

  Over almost 30 years since functional dyspepsia (FD) was defined, researchers have endeavored to elucidate the pathophysiology of functional gastrointestinal disorders. […] Now a consensus is emerging that the gastric symptoms of FD are caused mainly by gastric motility abnormalities and gastric hypersensitivity. […] We believe that most of those factors cause FD symptoms by inducing gastric motility abnormalities and gastric hypersensitivity via the duodenum. […] We now believe that the duodenum is at the center of those interactions and is the key organ in the pathophysiology of FD, with various factors causing FD symptoms through their effects on it. […] In summary, we believe that in patients with FD, stimuli to the duodenum induces gastric malfunction, which then causes dyspeptic symptoms.

• #8

  https://link.springer.com/article/10.1007/s00535-019-01550-4

  Dyspepsia occurs because noxious stimuli transmitted from the duodenal mucosa by afferent nerves cause gastric motility abnormalities and gastric hypersensitivity. […] Microinflammation and increased permeability of duodenal mucosa have been inferred to cause that priming, and studies have shown that microinflammation can remain after GI infection and psychological stress can increase mucosal permeability. […] Thus, sensitization and priming of duodenal mucosa as a result of low-grade inflammation and increased mucosal permeability may be related to chronic FD symptoms.

• #9 Novel mechanisms in functional dyspepsia

  https://www.wjgnet.com/1007-9327/full/v12/i5/673.htm

  Despite the high prevalence of FD and its significant impact on social and health care costs, the underlying causal pathways are still obscure. […] Recent evidence supports the relevance of a genetic milieu in FD. […] A prevalence of disturbances in gut motor function of about 20-40% in FD patients is now accepted. […] The disturbances of gastric motor function most often reported in FD include delayed gastric emptying, abnormalities in antral contractility and an impaired accommodation response. […] Delayed gastric emptying has been described in 25-50% of patients with FD. […] Recently, accelerated gastric emptying in FD has also been associated with postprandial fullness, bloating, nausea, and pain, presumably through an early dumping syndrome. […] Gastric accommodation is a vagally mediated reflex that occurs post-prandially, results in reduction of tone, and provides a reservoir for the meal; it enables the stomach to handle increases in intragastric volume without proportional increases of intragastric pressures.

• #10 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/

  Functional dyspepsia is diagnosed when an organic etiology for the symptoms is not identified. […] The etiology of dyspepsia has been poorly defined; however, numerous pathophysiologic mechanisms, most of which are directed at gastroduodenal pathways, have been proposed to explain the disorder. Many mechanisms are currently being investigated as potential causes of functional dyspepsia symptoms. […] Gastric neuromuscular dysfunction, including delayed gastric emptying, impaired gastric fundus relaxation with blunting of postprandial accommodation, and altered gastric mechanosensitivity, has been of particular interest in this area. Up to 70% of patients with functional dyspepsia have abnormal antroduodenal manometry results, and approximately 40% have impaired gastric accommodation. […] There is preliminary evidence concerning the presence of increased postprandial duodenal acid exposure in functional dyspepsia patients with prominent nausea symptoms.

• #11 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

  Patients with functional dyspepsia have disordered accommodation of the proximal stomach both after balloon dilatation of the stomach and after a meal. This is shown in both cases by inadequate relaxation of the fundus. […] Both with an empty stomach and after a meal, patients with functional dyspepsia suffer from visceral hypersensitivity when the gastric fundus is expanded. […] Symptoms of functional dyspepsia occur after infusion of acid into the duodenum and probably result from sensitized pH sensors or insufficient removal of the acid due to impaired motor function of the proximal duodenum. […] The presence of fat in the duodenum triggers the symptoms of functional dyspepsia due to direct neural action, increased sensitivity of enteroendocrine cells, systemic or local elevation of cholecystokinin concentration, and/or increased sensitivity of the cholecystokinin-A receptors.

• #11 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

  Although functional dyspepsia differs in both symptoms and clinical signs from IBS, the other frequently encountered functional disorder in the realm of gastroenterology, with regard to the significance of mental factors in pathogenesis, diagnosis, and treatment there are more similarities than differences between the two diseases. […] This points to pathological central processing of visceral stimuli, e.g., increased vigilance against specific sensations from the gastrointestinal tract. This increased vigilance may arise in the context of postinfectious sensitization.

• #12 Novel mechanisms in functional dyspepsia

  https://www.wjgnet.com/1007-9327/full/v12/i5/673.htm

  Studies by the barostat, scintigraphy, ultrasonography, single photon emission computed tomography (SPECT), and non-imaging assessments have all suggested abnormal accommodation in up to 40% of patients with functional dyspepsia. […] The mechanism of impaired gastric accommodation is, however, not clearly understood. […] Abnormal vagal reflexes may also play a role, because postvagotomy patients have a similar impairment of gastric accommodation, and abnormal vagal function is observed in patients with FD. […] Increased perception to visceral physiological or minor noxious stimuli, i.e., a lower threshold for sensation, has been considered one of major pathophysiologic mechanisms in the functional gastrointestinal disorders. […] Several studies have found dyspeptic patients have lower thresholds for first perception and discomfort or pain during isobaric gastric distension or jejunal distension.

• #13 Functional dyspepsia: Pathogenesis and management

  https://www.wjgnet.com/1007-9327/full/v2/iSuppl1/7.htm

  A wide spectrum of myoelectrical and motor abnormalities have been described in patients with functional dyspepsia: (1) delayed gastric emptying, (2) antral hypomotility, (3) gastric dysrhythmias, (4) chemical gastritis (indirect histologic evidence of duodenogastric reflux or gastroduodenal incoordination), (5) abnormal small bowel transit, and (6) intestinal dysmotility. […] Some patients with functional dyspepsia have a lowered pain threshold to gastric distension or various chemical stimuli including fat and acid. […] Visceral hypersensitivity may be due to an altered threshold of enteric mechanicoreceptors, altered afferent sensory signal processing, or a lowered pain threshold centrally. […] The issue of Helicobacter pylori-induced gastritis and other types of gastritis continues to be controversial.

• #14 Functional dyspepsia – Wikipedia

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

  Additionally, there is proof that up to two thirds of patients with functional dyspepsia have anomalies in the underlying stomach myoelectrical activity, as determined by cutaneous electrogastrography. […] It has been proposed that certain patients with functional dyspepsia may have anomalies in their autonomic nervous system.

• #14 Functional dyspepsia – Wikipedia

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

  Functional dyspepsia (FD) is a common gastrointestinal disorder defined by symptoms arising from the gastroduodenal region in the absence of an underlying organic disease that could easily explain the symptoms. […] The exact cause of functional dyspepsia is unknown however there have been many hypotheses regarding the mechanisms. Theories behind the pathophysiology of functional dyspepsia include gastroduodenal motility, gastroduodenal sensitivity, intestinal microbiota, immune dysfunction, gut-brain axis dysfunction, abnormalities of gastric electrical rhythm, and autonomic nervous system/central nervous system dysregulation. […] Because functional dyspepsia symptoms are complicated and vary so much, the underlying pathophysiology of the disorder is still unknown. The causes of dyspeptic symptoms have been attributed to a number of pathophysiologic processes. These include gastroduodenal motility, gastroduodenal sensitivity, intestinal microbiota, immune dysfunction, gut-brain axis dysfunction, abnormalities of gastric electrical rhythm, and autonomic nervous system/central nervous system dysregulation.

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

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

  Visceral hypersensitivity is considered an important phenomenon that can clarify many unexplained gastrointestinal symptoms. However, the mechanisms of visceral hypersensitivity and triggers of hypersensitivity remain under investigation. […] The number of mast cells and eosinophils in the duodenal mucosa was found to be positively correlated with loss of mucosal integrity in FD. A study from Japan confirmed that the number of eosinophils in the duodenum was higher in patients with FD and that intercellular distance correlated with postprandial fullness and early satiation. […] Patients with GP report identical symptoms of epigastric pain, postprandial fullness, nausea, and vomiting. Many reports describe the poor relationship between gastric emptying and symptoms; however, the responsiveness of both pathophysiology and symptoms to therapeutic interventions, especially when the intervention targets a specific mechanism, more convincingly supports the relationship between pathophysiology and symptoms.

• #16 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  Macroscopic physiological mechanisms include: Gastroesophageal reflux disease (GERD). Delayed gastric emptying, rapid gastric emptying, gastric dysrhythmias, and antral hypomotility. Visceral hypersensitivity alterations in the nervous system, including a lower threshold for pain in the presence of normal gastric compliance, abnormal processing of afferent input in the spinal cord or brain, and dysfunction of mechanoreceptors. […] Microscopic physiologic mechanisms include: Impaired barrier function due to altered sensitivity to duodenal acid or lipids that impair mucosal integrity. Gastroduodenal inflammation characterized by altered lymphocytes, including „gut-homing” lymphocytes, increased eosinophils, and mast cells. Altered gut microbiome and H pylori infection. […] Additional proof of the connection between intestinal inflammation and functional dyspepsia includes the discovery of increased small-bowel homing T lymphocytes in patients suffering from functional dyspepsia. These lymphocytes are positive for both 47-integrin and chemokine receptor 9. This finding is particularly significant because it has been strongly associated with cytokine release, including tumor necrosis factor- (TNF-).

• #16 Functional Dyspepsia – StatPearls – NCBI Bookshelf

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

  Psychological factors such as anxiety and depression can lead to increased activation of the amygdala and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, indicating central processing of visceral stimuli from the gastrointestinal tract. Stress activates the HPA axis, leading to the release of specific hormones from the hypothalamus and pituitary, culminating in the synthesis of cortisol.

• #17 Functional Dyspepsia: Advances in Diagnosis and Therapy

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

  Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. […] One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. […] Familial aggregation of abdominal pain has been reported in FD implying either genes or early life factors must be important in the pathogenesis. […] New evidence suggests anxiety often precedes the onset of FD. […] Gastric emptying is slow in 25% of patients with FD, but symptoms fail to correlate with delayed gastric emptying in this syndrome; in a very small number, rapid gastric emptying has also been documented. […] One of the most exciting observations in FD has been the consistent finding of duodenal eosinophilia in many cases with PDS around the world, following the first report in adults by Talley et al. […] FD is now established to develop after acute bacterial, protozoal or viral gastroenteritis, with a 2.5-fold increased risk.

• #18

  https://ngdc.cncb.ac.cn/openlb/publication/OLB-PM-29791992

  Functional dyspepsia (FD) is a common disorder characterized by chronic epigastric pain or burning, or bothersome postprandial fullness or early satiation, without a definitive organic cause. The pathogenesis of FD is likely heterogeneous. Classically, motor disorders, visceral hypersensitivity, and brain-gut interactions have been implicated in the pathophysiology of FD, but recently an important role for chronic low-grade inflammation and infection in FD has been reported and confirmed. […] Duodenal low-grade inflammation is frequently observed in FD in those with and without documented previous gastroenteritis. Duodenal eosinophils and in some cases mast cells may together or separately play a key role, and immune activation (eg, circulating homing small intestinal T cells) has been observed in FD. Low-grade intestinal inflammation in patients with FD may provoke impairment in motor-sensory abnormalities along the gastrointestinal neural axis.

• #18

  https://ngdc.cncb.ac.cn/openlb/publication/OLB-PM-29791992

  Among FD patients, the risk of developing dyspeptic symptoms after a bout of gastroenteritis is 2.54 (95% CI, 1.76-3.65) at more than 6 months after acute gastroenteritis. Gut host and microbial interactions are likely important, and emerging data demonstrate both quantitative and qualitative changes of duodenal mucosal and fecal microbiota in FD. Food antigens (eg, wheat proteins) may also play a role in inducing duodenal inflammation and dyspepsia. While causation is not established, the hypothesis that FD is a disorder of microscopic small intestinal inflammation in a major subset is gaining acceptance, opening the possibility of novel treatment approaches that may be able to alter the natural history of the disorder.

• #19 Gut Microbiota Dysbiosis in Functional Dyspepsia

  https://www.mdpi.com/2076-2607/8/5/691

  Immune activation seen as low-grade mucosal inflammation, with duodenal mast cells and eosinophils infiltration has been described in FD. […] Gut microbiota and their metabolites interfere with signaling through Toll-like Receptors (TLRs—TLR2, TLR4) and precipitate proinflammatory cytokines production and immune reaction. […] The functional link between gut and central nervous system (CNS) has been identified as an essential component of the FD pathogenesis. […] Intestinal dysbiosis also causes production and release into the bloodstream of a pro-inflammatory endotoxine, lipopolysaccharide (LPS). LPS is a potent factor influencing CNS function and also leads to production of various other inflammatory cytokines that also affect physiological CNS activity, modulating neuropeptides synthesis. […] Intestinal dysbiosis may be associated with symptom generation or exacerbation in a subset of patients with FD through several putative mechanisms.

• #19 Gut Microbiota Dysbiosis in Functional Dyspepsia

  https://www.mdpi.com/2076-2607/8/5/691

  Functional dyspepsia (FD) is one of the most prevalent chronic functional gastrointestinal disorders. Several distinct pathophysiological mechanisms, including gastro duodenal motor disorders, visceral hypersensitivity, brain-gut interactions, duodenal subtle inflammation, and genetic susceptibility, have been implicated in the pathogenesis of the disease, so far. However, emerging evidence suggests that both quantitative and qualitative disturbances of the gastrointestinal microbiota may also be implicated. […] Elucidating these complex interactions constituting the microbiota and host crosstalk, may eventually lead to the discovery of novel, targeted therapeutic approaches that may be efficacious in treating the multiple aspects of the disorder. […] Gastric sensorimotor abnormalities, brain–gut axis deregulation, visceral hypersensitivity, immune activation, altered epithelial barrier permeability, psychological stress, genetic background, and post-infectious low-grade duodenal inflammation are listed among the complex interactions thought to give rise to FD cardinal symptoms.

• #20 Gut Microbiota Dysbiosis in Functional Dyspepsia

  https://www.mdpi.com/2076-2607/8/5/691

  Accumulating evidence have highlighted the potential role of gut microbiota dysbiosis—defined as any qualitative or quantitative alteration in their composition—in the pathogenesis of gastrointestinal and extra-gastrointestinal diseases, as well. […] Given the fact that our treatment strategy for FD remains suboptimal, a detailed understanding of the mechanisms that may relate to the development of the disorder is pivotal in the search for novel therapeutic approaches. […] Evidence from animal and clinical studies imply an intriguing role for intestinal flora in FD, through a number of pathogenic mechanisms which include impaired gastrointestinal motility, visceral hypersensitivity, immune activation, increased mucosal permeability, and central nervous system disorders. […] FD patients appear to have increased intestinal permeability of the duodenal mucosa. This is thought to allow intraluminal triggers to initiate a both local and systemic immune cascade, which leads to altered neuronal signaling, generating the dyspeptic symptoms.

• #21 Therapeutic effects and central mechanism of acupuncture and moxibustion for treating functional dyspepsia: study protocol for an fMRI-based randomized controlled trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-022-06411-9

  Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders, with a high prevalence and significant influence on the quality of life (QoL). […] However, the therapeutic advantage and underlying mechanism between acupuncture and moxibustion for FD remain unclear. […] In Roma IV criteria, FD is defined as a disorder of brain-gut interaction. […] By neuroimaging techniques including PET and MRI, people found that FD patients have significant cerebral functional abnormalities and structural alterations, and the cerebral changes are related to their symptoms. […] Furthermore, studies have suggested that acupuncture treatment can effectively modulate the abnormal cerebral activities to improve dyspepsia symptoms and QoL, and moxibustion treatment also can elicit the cerebral signal changes in FGIDs patients.

• #22 Functional dyspepsia | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/subjects/functional-dyspepsia/nrgastro

  Functional dyspepsia has been defined in various ways, but the diagnostic yield of these definitions has not been well validated. […] Evidence is now emerging that structural abnormalities in the brain might have a role in the pathophysiology of FGIDs. […] Functional dyspepsia is thought to be a heterogeneous disorder, with a wide variety of pathophysiological mechanisms underlying the varied symptoms observed in patients. Here, Vanheel and Farr provide an overview of the pathogenesis of functional dyspepsia, adding insight on the diverse functional and structural changes in the gastrointestinal tract in this condition.

• #23 Functional dyspepsia: new insights into pathogenesis and therapy

  https://www.kci.go.kr/kciportal/landing/article.kci?arti_id=ART002107487

  One in 10 people suffer from functional dyspepsia (FD), a clinical syndrome comprising chronic bothersome early satiety, or postprandial fullness, or epigastric pain or burning. […] Evidence is accumulating FD and gastroesophageal reflux disease are part of the same disease spectrum in a major subset. […] The causes of FD remain to be established, but accumulating data suggest infections and possibly food may play an important role in subsets. […] FD does not equate with no pathology; duodenal eosinophilia is now an accepted association, and Helicobacter pylori infection is considered to be causally linked to dyspepsia although only a minority will respond to eradication.

• #24 Functional dyspepsia: new insights into pathogenesis and therapy

  https://nova.newcastle.edu.au/vital/access/manager/Repository;jsessionid=EA8C9349B8B17D4937D966135947AF2D/uon:24776?f0=bs_metadata.fulltext%3A%22true%22&f1=sm_date%3A%222016%22&sort=sort_ss_sm_creator+desc

  Functional dyspepsia (FD) is a clinical syndrome comprising chronic bothersome early satiety, or postprandial fullness, or epigastric pain or burning. […] Postprandial distress syndrome (PDS, comprising early satiety and/or postprandial fullness) and epigastric pain syndrome (EPS) are increasingly accepted as valid clinical entities, based on new insights into the pathophysiology and the results of clinical trials. […] Evidence is accumulating that FD and gastroesophageal reflux disease are part of the same disease spectrum in a major subset. […] The causes of FD remain to be established, but accumulating data suggest infections and possibly food may play an important role in subsets. […] FD does not equate with no pathology; duodenal eosinophilia is now an accepted association, and Helicobacter pylori infection is considered to be causally linked to dyspepsia although only a minority will respond to eradication.

• #25 Novel mechanisms in functional dyspepsia

  https://www.wjgnet.com/1007-9327/full/v12/i5/673.htm

  The association between Helicobacter pylori infection and pathophysiologic mechanisms has been investigated; however, no consistent differences in the prevalence and severity of individual symptoms, gastric emptying rate, or gastric relaxation after a meal were found between H pylori-positive and H pylori-negative subjects. […] Post-infectious dyspepsia has been recognized as a possible clinical entity. […] In FD patients, a number of psychological and personality factors have been observed, including somatization, depression, and anxiety as well as health seeking behavior and alterations in illness behavior and coping styles. […] Traditional pathophysiological paradigms are still inadequate to explain the variation in the symptoms observed.

• #26 Indigestion – Wikipedia

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

  Functional dyspepsia is a common cause of chronic heartburn. More than 70% of people have no obvious organic cause for their symptoms after evaluation. Symptoms may arise from a complex interaction of increased visceral afferent sensitivity, gastric delayed emptying (gastroparesis) or impaired accommodation to food. Diagnostic criteria for functional dyspepsia categorize it into two subtypes by symptom: epigastric pain syndrome and post-prandial distress syndrome. […] The role of H. pylori in functional dyspepsia is controversial, and treatment for H. pylori may not lead to complete improvement of a patient’s dyspepsia. However, a recent systemic review and meta-analysis of 29 studies published in 2022 suggests that successful treatment of H. pylori modestly improves indigestion symptoms.

• #26 Indigestion – Wikipedia

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

  The pathophysiology for indigestion is not well understood; however, there are many theories. For example, there are studies that suggest a gut-brain interaction, as patients who received an antibiotic saw a reduction in their indigestion symptoms. Other theories propose issues with gut motility, a hypersensitivity of gut viscera, and imbalance of the microbiome. A genetic predisposition is plausible, but there is limited evidence to support this theory.

• #27 Functional dyspepsia | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/functional-dyspepsia

  Functional dyspepsia is a common digestive disorder. […] The gut microbiota appears to be involved in functional dyspepsia. […] Recent clinical trials suggest FODMAPs may be involved in the pathogenesis of functional dyspepsia. […] In functional dyspepsia patients, studies have found dysbiosis throughout the digestive system. […] In those suffering from illnesses such as functional dyspepsia, this balance is not found; instead, dysbiosis is observed throughout the digestive system, from mouth to anus. […] The microbiota’s role in functional dyspepsia is far from limited to the bacteria present, since each of these bacteria secretes various active molecules, both beneficial and harmful, that are closely linked to host health and to the onset and progression of numerous diseases. […] In functional dyspepsia patients, the integrity of the intestinal mucosa is compromised, so much so that it performs its filtering role less effectively.

• #28 Functional dyspepsia | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/functional-dyspepsia

  In functional dyspepsia patients, there appears to be an excessive immune response. […] A proliferation of bacteria in the small intestine may play a role in the pathogenesis of functional dyspepsia. […] This microbiota-gut-brain axis explains why stress can cause stomach ache, or why changes in the gut flora can alter intestinal motility and inform the brain, which in turn can regulate the gut. […] In functional dyspepsia patients, food ingestion may be associated with exaggerated signals from the gastrointestinal tract.

• #29 Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia

  https://www.mdpi.com/2072-6643/13/4/1109

  The duodenal microbiota is crucial in supporting small intestinal digestive functions by fermenting food components and releasing digestive enzymes not otherwise produced by the host. […] Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. […] Delayed gastric emptying in FD may be associated with increased immune cell activation, increased duodenal permeability or low grade inflammation via dysregulation of the neuroimmune system disturbing GI motility and visceral sensitivity. […] The subtle inflammatory and other immune system responses characteristics of FD are not as simple to identify or trial dietary approaches on. […] The potential for an ‘anti-inflammatory’ diet to ameliorate the low grade inflammatory state in FD has not been studied.

• #29 Mechanisms of Food-Induced Symptom Induction and Dietary Management in Functional Dyspepsia

  https://www.mdpi.com/2072-6643/13/4/1109

  Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. […] The combination of its functions and upper GI location have resulted in the duodenum being increasingly implicated in FD pathogenesis. […] Pathological findings in FD include increased peripheral TNF-α, IL-β and gut homing T cells, and duodenal eosinophilia. […] Despite FD symptoms often being associated with eating and FD being as prevalent and debilitating as irritable bowel syndrome (IBS), there is no evidence-based, food-specific hypothesis for FD aetiology and dietary management approaches in FD remain largely undescribed. […] The efficacy of a low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet in FD dietary management does not have the strong evidence base that is apparent for IBS.

• #30 Food-induced immune activation in functional dyspepsia: novel mechanism and therapeutic target?

  https://research.kuleuven.be/portal/en/project/3M230405

  Functional dyspepsia (FD) is a prevalent gastrointestinal (GI) disorder, twice as prevalent as irritable bowel syndrome. […] We hypothesize that specific food antigens can trigger GI symptoms in FD through an increase of mucosal permeability, which can be visualized in real-time by confocal endomicroscopy after local food exposure of the duodenal mucosa. […] We hypothesize that a non-IgE mediated duodenal reaction to luminal nutrients occurs through the activation of the MAS-related G-protein coupled receptor X2, leading to an activation of the eosinophil-mast cell axis. […] Lastly, the eosinophil-driven activation of mast cells might be halted by the locally active corticosteroid budesonide. Such proof-of-principle finding might lead to a paradigm shift from functional dyspepsia to an immune-mediated condition.

• #31

  https://link.springer.com/article/10.1007/s00535-012-0625-9

  Functional dyspepsia (FD), one of the most common conditions in medicine, is a gastrointestinal disorder in which the patient suffers from chronic dyspeptic symptoms such as epigastralgia and a heavy feeling in the stomach despite the absence of organic disease. […] The factors contributing to symptom manifestation in FD probably should be divided into 3 categories: (1) physiological abnormalities that directly induce symptoms, (2) factors that modify those physiological abnormalities, and (3) factors that govern abnormal responses to stress. […] The symptoms of FD are directly caused by two major physiological abnormalitiesabnormal gastric motility and visceral hypersensitivityoccurring in patients who have acquired excessive responsiveness to stress as a result of the environment during early life, genetic abnormalities, residual inflammation after gastrointestinal infections, or other causes, with the process modified by factors including psychophysiological abnormalities, abnormal secretion of gastric acid, Helicobacter pylori infection, diet, and lifestyle. […] If the basis of this model of FD pathogenesis is excessive responsiveness of gastrointestinal function to stress and external stimuli, psychosomatic approaches to alter stress perception could be important treatment options.

• #32 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20250318/New-study-challenges-traditional-view-of-functional-dyspepsia-and-gastroparesis.aspx

  Emerging data suggest that gastric and duodenal microbiota alterations may be linked to FD, while the role of microbiota in GP remains underexplored. […] Understanding the underlying pathophysiological mechanisms may lead to more individualized treatment strategies. […] The authors advocate for a refined classification system that accounts for shared pathophysiology, enabling more precise diagnosis and treatment. […] Future research is required to identify biomarkers that may distinguish FD from GP and confirm their position on a disease spectrum.

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