Functional dyspepsia is a condition that Nurses are familiar with. In a recent edition of Gastroenterology Practice Review, you can read about the contemporary management and treatment options.
‘The Australian Prescriber has published an article on the management of functional dyspepsia. Functional dyspepsia is upsetting for patients and negatively affects quality of life, but has no long-term impact on life expectancy. The cause of functional dyspepsia is not entirely understood but it is considered to be associated with upper gastrointestinal inflammation and motility disturbances, which may be activated by infection, allergy, or an alteration in the gut microbiome.
Symptoms of functional dyspepsia include premature satiety, feeling full, and epigastric pain or discomfort. About 20% of patients have slow gastric emptying. The symptoms overlap with gastro-oesophageal reflux disease and irritable bowel syndrome, so the disease can often be unrecognised.
While diagnosis is clinical, it requires exclusion of structural gastrointestinal disease. Endoscopy should be performed in patients with new onset in older age, weight loss, vomiting, bleeding, anaemia, family history of upper gastrointestinal cancer, or progressive dysphagia or odynophagia.
Treatment of functional dyspepsia
There are several therapy options available. Patients should routinely receive reassurance, explanation and guidance to decrease stress. Depression should be ruled out by screening questions. For patients with a strong psychological component to their disease, cognitive behavioural therapy may be offered.
Patients should eat smaller, regular low-fat meals. A low FODMAP diet may reduce upper intestinal distension, but evidence is limited in functional dyspepsia. Possible triggers that should be avoided include fatty, fried or spicy foods, carbonated drinks, and wheat.
Decreasing acid within the duodenum may be of benefit. Proton pump inhibitors and H2 receptor antagonists have shown greater acid-reducing properties than placebo in functional dyspepsia. However, proton pump inhibitors have risks associated with long-term use. Antacids and sucralfate are not efficacious.
Prokinetics have been shown to reduce postprandial distress. The evidence for cisapride is good. Domperidone is sometimes prescribed but the evidence for efficacy in functional dyspepsia is limited. Both cisapride and domperidone lengthen the QT interval and must be used with caution; ECG monitoring is recommended. If patients have nausea, a 5HT3 antagonist (ondansetron) is preferred over metoclopramide due to irreversible tardive dyskinesia associated with the latter drug.
For patients who do not respond to prokinetics, fundic relaxants can be offered, such as buspirone or Iberogast.
Low-dose tricyclic antidepressants such as amitriptyline may be of benefit for patients with epigastric pain. Mirtazepine may have efficacy in patients with nausea. The efficacy of selective serotonin reuptake inhibitors and selective noradrenaline reuptake inhibitors is similar to placebo.
Anti-inflammatory properties of the antibiotic rifaximin may relieve symptoms, but data are limited on its use in functional dyspepsia.
You can access the article here>>
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