A recent NEJM had a concise review of functional dyspepsia (Talley NJ, Ford AC. NEJM 2015; 373: 1853-63).
With regard to functional dyspepsia in adults, the authors note that using the Rome III criteria, the global prevalence is between 5% and 11%.
While symptoms do not reliably distinguish organic and functional dyspepsia, they note that “with a relatively low rate of identification of organic disease, it is neither desirable nor realistic to perform this test [upper gastrointestinal endoscopy] in all patients with dyspepsia.”
Their review suggests several criteria to consider to help determine who needs endoscopy including age >55 yrs, GI bleeding, dysphagia, persistent vomiting, unintentional weight loss, family history of gastric or esophageal cancer, and iron-deficiency anemia.
With regard to workup, they suggest testing for H pylori non invasively with either breath testing or stool antigen testing. The review covers treatment approaches including acid suppression (“effect is modest”), antidepressants (“tricyclic antidepressants…should be preferred over selective serotonin-reuptake inhibitors”), prokinetic agents, psychological treatments, and complementary approaches. Figure 3 provides a helpful algorithm.
With regard to prognosis, “approximately 15 to 20% of people with functional dyspepsia have persistent symptoms and 50% have resolution of symptoms; in the remaining 30 to 35% of patients symptoms will fluctuate and meet the criteria for another functional gastrointestinal disorder.”
Briefly noted: “Acute Anxiety and Anxiety Disorders are Associated with Impaired Gastric Accommodation in Patients with Functional Dyspepsia” HG Ly et al. Clin Gastroenterol Hepatol 2015; 13: 1584-91.
Related blog posts:
- A 6-Year Study of Amitriptyline, Escitalopram, and Functional …
- Will I Have This Stomach Pain Forever? (Part 1) | gutsandgrowth
- Cyproheptadine for dyspepsia | gutsandgrowth
- Does buspirone help functional dyspepsia? | gutsandgrowth
- Brave New World: Psychotropic Manipulation & Pediatric …
- Anxiety and Functional Abdominal Pain | gutsandgrowth
- HEROES trial | gutsandgrowth
- Born this way | gutsandgrowth
Pingback: Dreaded Nausea | gutsandgrowth
Pingback: Dreaded Nausea (2017) | gutsandgrowth
Pingback: How PPIs Improve Functional Dyspepsia | gutsandgrowth