Journal of the Korean Medical Association (대한의사협회지)

Korean Medical Association (대한의사협회)
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Diagnosis and treatment of functional dyspepsia

기능성 소화불량증의 진단 및 치료

  • Shin, Cheol Min (Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Huh, Kyu Chan (Department of Internal Medicine, Konyang University College of Medicine)
  • 신철민 (분당서울대학교병원) ;
  • 허규찬 (건양대학교 의과대학 내과학교실)
  • Received : 2016.03.06
  • Accepted : 2016.03.22
  • Published : 2016.04.10
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Abstract

Functional dyspepsia is defined as the presence of the symptoms that originate from the gastroduodenal area, without evidence of any organic, systemic, or metabolic disease that could explain these symptoms. The pathophysiology of functional dyspepsia includes chronic duodenal inflammation, Helicobacter pylori, excessive gastric acid secretion, dietary factors, and psychosocial, genetic, and environmental factors. However, gastric dysmotility and visceral hypersensitivity are thought to play a major role in the pathogenesis of functional dyspepsia, and other factors may affect gastric motility and visceral hypersensitivity. In the diagnosis of functional dyspepsia, upper gastrointestinal endoscopy is important to rule out organic diseases; an H. pylori test-and-treat strategy is currently not recommended for the initial diagnostic step in Korea where both H. pylori prevalence and gastric incidence are very high. Anti-secretory drugs (proton pump inhibitors and histamine 2 receptor antagonists) and prokinetics can be used as a first-line treatment depending on the patient's symptoms (postprandial distress syndrome vs. epigastric pain syndrome). If initial treatment is not effective, tricyclic antidepressants and/or anxiolytics (fundic relaxants) could be used in selected patients.

Keywords

References

  1. Kim JR. Gastrointestinal disorders. Seoul: Ilchokak; 2011.
  2. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, Stanghellini V. Functional gastroduodenal disorders. Gastroenterology 2006;130:1466-1479. https://doi.org/10.1053/j.gastro.2005.11.059
  3. Jeong JJ, Choi MG, Cho YS, Lee SG, Oh JH, Park JM, Cho YK, Lee IS, Kim SW, Han SW, Choi KY, Chung IS. Chronic gastrointestinal symptoms and quality of life in the Korean population. World J Gastroenterol 2008;14:6388-6394. https://doi.org/10.3748/wjg.14.6388
  4. Rhie SY, Choi CH, Lee HW, Do MY, Lee SH, Han SP, Huh C, Kim HJ, Kim JW, Kim JG, Chang SK, Park SM. The frequency of functional dyspepsia subtypes and its related factors for health check up subjects. J Neurogastroenterol Motil 2007;13:31-37.
  5. Min BH, Huh KC, Jung HK, Yoon YH, Choi KD, Song KH, Keum B, Kim JW; Functional Dyspepsia Study Group of Korean Society of Neurogastroenterology and Motility. Prevalence of uninvestigated dyspepsia and gastroesophageal reflux disease in Korea: a population-based study using the Rome III criteria. Dig Dis Sci 2014;59:2721-2729. https://doi.org/10.1007/s10620-014-3243-y
  6. Mahadeva S, Ford AC. Clinical and epidemiological differences in functional dyspepsia between the East and the West. Neurogastroenterol Motil 2016;28:167-174. https://doi.org/10.1111/nmo.12657
  7. Tack J, Talley NJ. Functional dyspepsia: symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 2013;10:134-141. https://doi.org/10.1038/nrgastro.2013.14
  8. Talley NJ, Locke GR, Saito YA, Almazar AE, Bouras EP, Howden CW, Lacy BE, DiBaise JK, Prather CM, Abraham BP, El-Serag HB, Moayyedi P, Herrick LM, Szarka LA, Camilleri M, Hamilton FA, Schleck CD, Tilkes KE, Zinsmeister AR. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled Study. Gastroenterology 2015;149:340-349.e2. https://doi.org/10.1053/j.gastro.2015.04.020
  9. Park JM, Choi MG, Cho YK, Lee IS, Kim JI, Kim SW, Chung IS. Functional gastrointestinal disorders diagnosed by Rome III questionnaire in Korea. J Neurogastroenterol Motil 2011;17:279-286. https://doi.org/10.5056/jnm.2011.17.3.279
  10. Kim SE, Park HK, Kim N, Joo YE, Baik GH, Shin JE, Seo GS, Kim GH, Kim HU, Kim HY, Kim SM, Seo JH, Park EH, Cho SI. Prevalence and risk factors of functional dyspepsia: a nationwide multicenter prospective study in Korea. J Clin Gastroenterol 2014;48:e12-e18. https://doi.org/10.1097/MCG.0b013e31828f4bc9
  11. Lee SY, Lee KJ, Kim SJ, Cho SW. Prevalence and risk factors for overlaps between gastroesophageal reflux disease, dyspepsia, and irritable bowel syndrome: a population-based study. Digestion 2009;79:196-201. https://doi.org/10.1159/000211715
  12. Miwa H, Watari J, Fukui H, Oshima T, Tomita T, Sakurai J, Kondo T, Matsumoto T. Current understanding of pathogenesis of functional dyspepsia. J Gastroenterol Hepatol 2011;26 Suppl 3:53-60. https://doi.org/10.1111/j.1440-1746.2011.06633.x
  13. Quartero AO, de Wit NJ, Lodder AC, Numans ME, Smout AJ, Hoes AW. Disturbed solid-phase gastric emptying in functional dyspepsia: a meta-analysis. Dig Dis Sci 1998;43:2028-2033. https://doi.org/10.1023/A:1018803129779
  14. Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology 2004;127:1239-1255. https://doi.org/10.1053/j.gastro.2004.05.030
  15. Willert RP, Woolf CJ, Hobson AR, Delaney C, Thompson DG, Aziz Q. The development and maintenance of human visceral pain hypersensitivity is dependent on the N-methyl-Daspartate receptor. Gastroenterology 2004;126:683-692. https://doi.org/10.1053/j.gastro.2003.11.047
  16. Wang WH, Huang JQ, Zheng GF, Xia HH, Wong WM, Liu XG, Karlberg J, Wong BC. Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebocontrolled trials. Clin Gastroenterol Hepatol 2007;5:178-185. https://doi.org/10.1016/j.cgh.2006.09.012
  17. Suzuki H, Moayyedi P. Helicobacter pylori infection in functional dyspepsia. Nat Rev Gastroenterol Hepatol 2013;10:168-174. https://doi.org/10.1038/nrgastro.2013.9
  18. Moayyedi P, Soo S, Deeks J, Forman D, Mason J, Innes M, Delaney B. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia:Dyspepsia Review Group. BMJ 2000;321:659-664. https://doi.org/10.1136/bmj.321.7262.659
  19. Talley NJ, Riff DS, Schwartz H, Marcuard SP. Double-blind placebo-controlled multicentre studies of rebamipide, a gastroprotective drug, in the treatment of functional dyspepsia with or without Helicobacter pylori infection. Aliment Pharmacol Ther 2001;15:1603-1611. https://doi.org/10.1046/j.1365-2036.2001.01074.x
  20. Miwa H, Ghoshal UC, Gonlachanvit S, Gwee KA, Ang TL, Chang FY, Fock KM, Hongo M, Hou X, Kachintorn U, Ke M, Lai KH, Lee KJ, Lu CL, Mahadeva S, Miura S, Park H, Rhee PL, Sugano K, Vilaichone RK, Wong BC, Bak YT. Asian consensus report on functional dyspepsia. J Neurogastroenterol Motil 2012;18:150-168. https://doi.org/10.5056/jnm.2012.18.2.150
  21. Jee SR, Jung HK, Min BH, Choi KD, Rhee PL, Kang YW, Lee SI; Korean Society of Neurogastroenterology and Motility. Guidelines for the treatment of functional dyspepsia. Korean J Gastroenterol 2011;57:67-81. https://doi.org/10.4166/kjg.2011.57.2.67
  22. Li XB, Liu WZ, Ge ZZ, Chen XY, Shi Y, Xiao SD. Helicobacter pylori "test-and-treat" strategy is not suitable for the management of patients with uninvestigated dyspepsia in Shanghai. Scand J Gastroenterol 2005;40:1028-1031. https://doi.org/10.1080/00365520510023206
  23. Carvalho RV, Lorena SL, Almeida JR, Mesquita MA. Food intolerance, diet composition, and eating patterns in functional dyspepsia patients. Dig Dis Sci 2010;55:60-65. https://doi.org/10.1007/s10620-008-0698-8
  24. Filipovic BF, Randjelovic T, Kovacevic N, Milinic N, Markovic O, Gajic M, Filipovic BR. Laboratory parameters and nutritional status in patients with functional dyspepsia. Eur J Intern Med 2011;22:300-304. https://doi.org/10.1016/j.ejim.2011.01.012
  25. Blum AL, Arnold R, Stolte M, Fischer M, Koelz HR. Short course acid suppressive treatment for patients with functional dyspepsia: results depend on Helicobacter pylori status. The Frosch Study Group. Gut 2000;47:473-480. https://doi.org/10.1136/gut.47.4.473
  26. Goves J, Oldring JK, Kerr D, Dallara RG, Roffe EJ, Powell JA, Taylor MD. First line treatment with omeprazole provides an effective and superior alternative strategy in the management of dyspepsia compared to antacid/alginate liquid: a multicentre study in general practice. Aliment Pharmacol Ther 1998;12:147-157. https://doi.org/10.1046/j.1365-2036.1998.0284f.x
  27. Veldhuyzen van Zanten SJ, Jones MJ, Verlinden M, Talley NJ. Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis. Am J Gastroenterol 2001;96:689-696. https://doi.org/10.1111/j.1572-0241.2001.03521.x
  28. Holtmann G, Talley NJ, Liebregts T, Adam B, Parow C. A placebo-controlled trial of itopride in functional dyspepsia. N Engl J Med 2006;354:832-840. https://doi.org/10.1056/NEJMoa052639
  29. Talley NJ, Tack J, Ptak T, Gupta R, Giguere M. Itopride in functional dyspepsia: results of two phase III multicentre, randomised, double-blind, placebo-controlled trials. Gut 2008;57:740-746. https://doi.org/10.1136/gut.2007.132449
  30. Huang X, Lv B, Zhang S, Fan YH, Meng LN. Itopride therapy for functional dyspepsia: a meta-analysis. World J Gastroenterol 2012;18:7371-7377. https://doi.org/10.3748/wjg.v18.i48.7371
  31. Hongo M, Harasawa S, Mine T, Sasaki I, Matsueda K, Kusano M, Hanyu N, Nakada K, Shibata C. Large-scale randomized clinical study on functional dyspepsia treatment with mosapride or teprenone: Japan Mosapride Mega-Study (JMMS). J Gastroenterol Hepatol 2012;27:62-68. https://doi.org/10.1111/j.1440-1746.2011.06949.x
  32. Bang CS, Kim JH, Baik GH, Kim HS, Park SH, Kim EJ, Kim JB, Suk KT, Yoon JH, Kim YS, Kim DJ. Mosapride treatment for functional dyspepsia: a meta-analysis. J Gastroenterol Hepatol 2015;30:28-42.
  33. Kim ER, Min BH, Lee SO, Lee TH, Son M, Rhee PL. Effects of DA-9701, a novel prokinetic agent, on gastric accommodation in conscious dogs. J Gastroenterol Hepatol 2012;27:766-772. https://doi.org/10.1111/j.1440-1746.2011.06924.x
  34. Choi MG, Rhee PL, Park H, Lee OY, Lee KJ, Choi SC, Seol SY, Chun HJ, Rew JS, Lee DH, Song GA, Jung HY, Jeong HY, Sung IK, Lee JS, Lee ST, Kim SK, Shin YW. Randomized, controlled, multi-center trial: comparing the safety and efficacy of DA-9701 and itopride hydrochloride in patients with functional dyspepsia. J Neurogastroenterol Motil 2015;21:414-422. https://doi.org/10.5056/jnm14117
  35. Jung HK, Lee KJ, Choi MG, Park H, Lee JS, Rhee PL, Kim N, Park KS, Choi SC, Lee OY, Huh KC, Song GA, Hong SJ, Sohn CI, Jung HY, Lee YC, Rew JS, Jee SR, Kwon JG. Efficacy of DA-9701 (Motilitone) in functional dyspepsia compared to pantoprazole: a multicenter, randomized, double-blind, non-inferiority study. J Neurogastroenterol Motil 2016 Jan 22 [Epub]. http://dx.doi.org/10.5056/jnm15178.
  36. Matsueda K, Hongo M, Tack J, Saito Y, Kato H. A placebocontrolled trial of acotiamide for meal-related symptoms of functional dyspepsia. Gut 2012;61:821-828. https://doi.org/10.1136/gutjnl-2011-301454
  37. Hojo M, Miwa H, Yokoyama T, Ohkusa T, Nagahara A, Kawabe M, Asaoka D, Izumi Y, Sato N. Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. J Gastroenterol 2005;40:1036-1042. https://doi.org/10.1007/s00535-005-1687-8
  38. Van Oudenhove L, Kindt S, Vos R, Coulie B, Tack J. Influence of buspirone on gastric sensorimotor function in man. Aliment Pharmacol Ther 2008;28:1326-1333. https://doi.org/10.1111/j.1365-2036.2008.03849.x
  39. Tack J, Janssen P, Masaoka T, Farre R, Van Oudenhove L. Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Clin Gastroenterol Hepatol 2012;10:1239-1245. https://doi.org/10.1016/j.cgh.2012.06.036
  40. Ford AC, Luthra P, Tack J, Boeckxstaens GE, Moayyedi P, Talley NJ. Efficacy of psychotropic drugs in functional dyspepsia:systematic review and meta-analysis. Gut 2015 Nov 13 [Epub]. http://dx.doi.org/10.1136/gutjnl-2015-310721.

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