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2016 ; 31
(3
): 444-56
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Functional dyspepsia: new insights into pathogenesis and therapy
#MMPMID27048251
Talley NJ
Korean J Intern Med
2016[May]; 31
(3
): 444-56
PMID27048251
show ga
One in 10 people suffer from functional dyspepsia (FD), a clinical syndrome
comprising chronic bothersome early satiety, or postprandial fullness, or
epigastric pain or burning. Postprandial distress syndrome (PDS, comprising early
satiety and/or postprandial fullness) and epigastric pain syndrome (EPS) are
increasingly accepted as valid clinical entities, based on new insights into the
pathophysiology and the results of clinical trials. Diagnosis is based on the
clinical history, and exclusion of peptic ulcer and cancer by endoscopy. Evidence
is accumulating FD and gastroesophageal ref lux disease are part of the same
disease spectrum in a major subset. The causes of FD remain to be established,
but accumulating data suggest infections and possibly food may play an important
role in subsets. FD does not equate with no pathology; duodenal eosinophilia is
now an accepted association, and Helicobacter pylori infection is considered to
be causally linked to dyspepsia although only a minority will respond to
eradication. In those with EPS, acid suppression therapy is a first line therapy;
consider a H2 blocker even if proton pump inhibitor fails. In PDS, a prokinetic
is preferred. Second line therapy includes administration of a tricyclic
antidepressant in low doses, or mirtazapine, but not a selective serotonin
reuptake inhibitor.
|Anti-Bacterial Agents/therapeutic use
[MESH]
|Antidepressive Agents, Tricyclic/therapeutic use
[MESH]