Functional dyspepsia is a common disease that is often misdiagnosed. In an article published in Gut and Liver, Dr. Talley discussed current advances in the diagnosis and treatment of the condition.
Functional dyspepsia is a disease that usually presents with early satiety, feeling of fullness after meals, and a burning epigastric pain without any abnormal endoscopy findings. Because the symptoms of functional dyspepsia are similar to other gastrointestinal diseases, it is often misdiagnosed.
In a recent article published in Gut and Liver, Nicholas J. Talley discussed challenges and advancements in the diagnosis and treatment of functional dyspepsia. Dr. Talley stated that the current Rome III criteria used as a guideline in diagnosing functional dyspepsia has suboptimal specificity and sensitivity, similar to previously published diagnostic criteria. One interesting finding is that the strongest indicator of functional dyspepsia is early satiety. Differentiating functional dyspepsia from other gastrointestinal diseases remains challenging, as symptoms tend to overlap with gastroparesis, gastrointestinal reflux disease (GERD), brainstem disease, and cannabis ingestion. A thorough history and physical examination can help narrow possible diagnoses. Upper gastrointestinal endoscopy may also help in differentiating functional dyspepsia from GERD, with the former having unremarkable endoscopy findings. Duodenal biopsies may also aid in the diagnosis of functional dyspepsia, as patients have an increased number of eosinophils.
Medications targeting Helicobacter pylori, prokinetic agents, antacids, and antidepressants are currently used in the treatment of functional dyspepsia. However, patients given high dose proton pump inhibitors respond poorly to therapy. Meta-analysis data reveal that the use of H2 blockers for suppressing gastric acid levels is more efficacious than proton pump inhibitors in the treatment of functional dyspepsia. Monteleukast, an eosinophil stablilizer used in the treatment of asthma, was also found to improve the clinical outcomes of pediatric patients diagnosed with functional dyspepsia. Acupuncture was also proposed as an additional mode of treatment; however, studies assessing this method show a high risk of bias.
Overall, the study suggests that functional dyspepsia is a common disease that can affect a person’s quality of life. Diagnosis and treatment are still symptom driven, but the findings of duodenal eosinophilia may open up new diagnostic and treatment methods in the future.
Written By: Karla Sevilla