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Functional dyspepsia

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of functional dyspepsia are prepared by our editorial team based on guidelines from the British Society of Gastroenterology (BSG 2022), the American College of Gastroenterology (ACG/CAG 2017), and the Maastricht V/Florence Consensus Report (Maastricht V/Florence 2017). ...
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Screening and diagnosis

Differential diagnosis: as per Maastricht V/Florence 2017 guidelines, exclude H. pylori gastritis before making a reliable diagnosis of functional dyspepsia.
A
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  • Diagnosis

Diagnostic investigations

Testing for H. pylori: as per BSG 2022 guidelines, obtain noninvasive testing for H. pylori ('test and treat') in all patients with dyspepsia in the absence of alarm features.
A

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  • Laboratory tests

  • Diagnostic imaging

  • Motility testing

  • Gastric emptying testing

  • pH monitoring

Diagnostic procedures

Upper gastrointestinal endoscopy
As per BSG 2022 guidelines:
Perform urgent endoscopy only in the following patients if no other upper gastrointestinal alarm symptoms or signs are reported:
age ≥ 55 years, dyspepsia and weight loss
age > 40 years, coming from an area at an increased risk of gastric cancer or having a family history of gastroesophageal cancer
B
Consider performing non-urgent endoscopy in ≥ 55 years old patients with treatment-resistant dyspepsia or dyspepsia with either a raised platelet count or nausea or vomiting.
C

Medical management

Setting of care
As per BSG 2022 guidelines:
Manage patients with functional dyspepsia referred to secondary care ideally in a specialist clinic with access to an interested clinician, dietetic and lifestyle support with access to efficacious drugs and gut-brain behavioral therapies.
B
Refer patients with functional dyspepsia to gastroenterology in secondary care in the following situations:
diagnostic doubt
severe symptoms
symptoms refractory to first-line treatments
individual patient requesting a specialist opinion
B

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  • H. pylori eradication

  • Acid suppression therapy

  • Prokinetics

  • TCAs

  • Other antidepressants

  • Antipsychotics

  • Anticonvulsants

Nonpharmacologic interventions

Dietary modifications: as per BSG 2022 guidelines, insufficient evidence to recommend dietary therapies, including a diet low in FODMAP, in patients with functional dyspepsia.
I

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  • Physical activity

  • Psychological interventions

  • Alternative and complementary medicine

Patient education

General counseling
As per BSG 2022 guidelines:
Establish an effective and empathic doctor-patient relationship and a shared understanding as the cornerstone of the management of functional dyspepsia, which may also reduce healthcare utilization and improve QoL.
B
Educate patients with functional dyspepsia about the diagnosis, its underlying pathophysiology, and the natural history of the condition including common symptom triggers. Introduce functional dyspepsia as a disorder of gut-brain interaction together with a simple account of the gut-brain axis and how this is impacted by diet, stress, cognitive, behavioral and emotional responses to symptoms and post-infective changes.
B

Follow-up and surveillance

Management of severe or refractory disease: as per BSG 2022 guidelines, involve a multidisciplinary support team in the management of patients with severe or refractory functional dyspepsia.
B
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