Functional dyspepsia (FD) is a highly prevalent and challenging disorder which impacts patients' quality of life and poses a considerable socioeconomic burden. Given the vagueness of the definition of FD based on the current Rome III criteria's expert opinion, the diagnosis of FD continues to be one of exclusion. Despite efforts to better define what constitutes FD, validity of such diagnostic criteria remains controversial given the lack of a distinct pathophysiologic mechanism.
New insights into the pathophysiology of FD have expanded our treatment options for the syndrome. This review will discuss the current pharmacologic treatments of FD with particular focus on the more robust randomized controlled trials to date.
Recently, the understanding of the pathophysiology of FD has evolved with novel hypothesis such as sensorimotor abnormalities of the stomach or duodenum, genetic polypmorphisms, psychological comorbidities, food sensitivities and allergies, and immune dysregulation found to be possibly responsible for its pathogenesis. Despite the expanding knowledge about the likely multifactorial pathophysiology of FD, its treatment remains a challenge.
"Functional dyspepsia is diagnosed using the Rome III criteria (Tack et al 2006). However, due to the vague description of the disease diagnosis is based on exclusion (Moshiree et al 2013). Our understanding of the relationship between abnormal gastric motility and functional dyspepsia is far from complete (Miwa et al 2011), and the need for long-term monitoring of gastric motility in association with functional dyspepsia is obvious because its symptoms and associated factors are poorly understood (Kindt et al 2010). "
[Show abstract][Hide abstract] ABSTRACT: The stomach plays a critical role in digestion, processing ingested food mechanically and breaking it up into particles, which can be effectively and efficiently processed by the intestines. When the motility of the stomach is compromised, digestion is adversely affected. This can lead to a variety of disorders. Current diagnostic techniques for gastric motility disorders are seriously lacking, and are based more on eliminating other possibilities rather than on specific tests. Presently, gastric motility can be assessed by monitoring gastric emptying, food transit, intragastric pressures, etc. The associated tests are usually stationary and of relatively short duration. The present study proposes a new method of measuring gastric motility, utilizing the attenuation of an oscillator-induced electrical signal across the gastric tissue, which is modulated by gastric contractions. The induced high-frequency oscillator signal is generated within the stomach, and is picked up transluminally by cutaneous electrodes positioned on the abdominal area connected to a custom-designed data acquisition instrument. The proposed method was implemented in two different designs: first a transoral catheter was modified to emit the signal inside the stomach; and second, a gastric retentive pill was designed to emit the signal. Both implementations were applied in vivo on two mongrel dogs (25.50 kg and 25.75 kg). Gastric contractions were registered and quantitatively compared to recordings from force transducers sutured onto the serosa of the stomach. Gastric motility indices were calculated for each minute, with transluminal impedance measurements and the measurements from the force transducers showing statistically significant (p < 0.05) Pearson correlation coefficients (0.65 ± 0.08 for the catheter-based design and 0.77 ± 0.03 for the gastric retentive pill design). These results show that transcutaneous intraluminal impedance measurement has the potential with further research and development to become a useful diagnostic technique.
[Show abstract][Hide abstract] ABSTRACT: Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.
[Show abstract][Hide abstract] ABSTRACT: Dyspepsia is a common and complex condition consisting of chronic upper gastrointestinal symptoms. A rational approach to diagnosis and treatment of dyspepsia includes identifying those patients with alarm symptoms and referring them for prompt endoscopy. Those without alarm symptoms can be differentiated into patients who do and do not have symptoms consistent with gastroesophageal reflux disease. In the absence of predominant heartburn and regurgitation, patients should be tested and treated for Helicobacter pylori. Functional (nonulcer) dyspepsia is a multifactorial disorder with several possible pathophysiologic mechanisms, but no clear guidelines for therapy. There is some evidence of efficacy of proton pump inhibitors, antisecretory agents, antidepressants, and psychotherapy for functional dyspepsia.
The Medical clinics of North America 05/2014; 98(3):549-564. DOI:10.1016/j.mcna.2014.01.007 · 2.61 Impact Factor
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