Medical treatment of functional dyspepsia

Sung Eun Kim

doi:10.7180/kmj.2015.30.1.1

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Review Article Medical treatment of functional dyspepsia: Sung Eun Kim; Kosin Medical Journal 2015;30(1):1-11.
DOI: https://doi.org/10.7180/kmj.2015.30.1.1
Published online: January 20, 2015

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea

Corresponding Author：Sung Eun Kim, Department of Internal Medicine, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-5225 FAX: +82-51-990-5055 E-mail: solefide@hanmail.net

• Received: August 1, 2014 • Accepted: October 8, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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Abstract

Functional dyspepsia (FD) is a condition in which upper abdominal symptoms, such as epigastralgia, postprandial discomfort, and bloating, occur in the absence of any organic or metabolic disease that could explain the symptoms. The prevalence of FD is increasing, presumably because of an increasingly stressful environment, as well as overlap with other motility disorders such as gastroesophageal reflux diseases and irritable bowel syndrome. Numerous studies have attempted to determine the pathophysiological mechanisms of FD and establish effective FD treatment, with little success. Several therapeutic options have been explored, including Helicobacter pylori eradication, proton pump inhibitors, prokinetic agents, anti-depressant and anxiolytic agents, and acotiamide, a recent emerging drug. Through the many trials evaluating the efficacy of drugs for FD treatment, we found that it is necessary to treat according to the symptoms of FD and to use a combination of therapeutic options. Additional well-designed, prospective studies are needed to confirm the management of FD.
Keywords: Acotiamide; Disease management; Functional dyspepsia

Table 1.

Rome III criteria for functional dyspepsia

Diagnostic criteria∗ for functional dyspepsia must include one or more of the following symptoms:

a. Bothersome postprandial fullness

b. Early satiation

c. Epigastric pain

d. Epigastric burning

And, there was no evidence of structural disease that is likely to explain symptoms (including at upper endoscopy).

1. Postprandial distress syndrome

Diagnostic criteria∗ must include one or both of the following symptoms:

a. Bothersome postprandial fullness, occurring after ordinary sized meals, at least several times per week

b. Early satiation that prevents finishing a regular meal, at least several times per week

– Other supportive criteria:

a. Upper abdominal bloating or postprandial nausea or excessive belching can be present

b. Epigastic pain syndrome may coexist

2. Epigastric pain syndrome

Diagnostic criteria∗ must include all of the following symptoms:

a. Pain or burning localized to the epigastrium of at least moderate severity at least once per week

b. The pain is intermittent

c. Not generalized or localized to other abdominal or chest regions

d. Not relieved by defecation or passage of flatus

e. Not fulfilling criteria for gallbladder and sphincter of Oddi disorders

– Other supportive criteria:

a. The pain may be of a burning quality but without a retrosternal component

b. The pain is commonly induced or relieved by ingestion of a meal but may occur while fasting

c. Postprandial distress syndrome may coexist

^∗ Criteria must be fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. This table is modified from reference 2, 15.

Table 2.

Drug classification used in functional dyspepsia

Classification
Histamine-type 2 receptor antagonists (H2RAs)
Proton pump inhibitors (PPIs)
Prokinetics
Dopamine receptor antagonists
Serotonin (5-HT) receptor agonists and antagonists
Motilin receptor agonists
Ghrelin receptor agonists
Muscarinic receptor antagonists
Antidepressants and anxiolytic agents
Tricyclic antidepressants (TCAs)
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
5-HT1A agonists∗

^∗ 5-HT1A agonists also have prokinetic effects.

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Medical treatment of functional dyspepsia

Kosin Med J. 2015;30(1):1-11. Published online January 20, 2015

DOI: https://doi.org/10.7180/kmj.2015.30.1.1

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