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2017 ; 11
(3
): 349-357
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Functional Dyspepsia: Advances in Diagnosis and Therapy
#MMPMID28452210
Talley NJ
Gut Liver
2017[May]; 11
(3
): 349-357
PMID28452210
show ga
Functional dyspepsia (FD) is a common but under-recognized syndrome comprising
bothersome recurrent postprandial fullness, early satiety, or epigastric
pain/burning. Epidemiologically, there are two clinically distinct FD syndromes
(although these often overlap clinically): postprandial distress syndrome (PDS;
comprising early satiety or meal-related fullness) and epigastric pain syndrome.
Symptoms of gastroesophageal reflux disease overlap with FD more than expected by
chance; a subset has pathological acid reflux. The pretest probability of FD in a
patient who presents with classical FD symptoms and no alarm features is high,
approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as
a diagnosis. One of the most exciting observations in FD has been the consistent
finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T
cells, signaling intestinal inflammation, and increased cytokines have been
detected in the circulation, and elevated tumor necrosis factor-? levels have
been significantly correlated with increased anxiety. Postinfectious
gastroenteritis is a risk factor for FD. Therapeutic options remain limited and
provide only symptomatic benefit in most cases. Only one therapy is known to
change the natural history of FD-Helicobacter pylori eradication. Treatment of
duodenal eosinophilia is under investigation.