| Invited Lecture(JSGE) |
| Fri. November 22nd 9:00 - 9:30 Room 11: Portopia Hotel South Wing Topaz |
| Functional dyspepsia: Gastric or duodenal disorder? | |||
| Jan Tack | |||
| Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven | |||
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| The underlying pathophysiology of functional dyspepsia is probably multifactorial, involving multiple mechanisms. Traditional views have implicated disordered gastric sensorimotor function, more in particular visceral hypersensitivity, delayed gastric emptying and impaired gastric accommodation in the pathophysiology of FD. These abnormalities are all present in a subset of patients, show some association with the symptom pattern and have been used as therapeutic target. More recent studies have unraveled low-grade inflammatory changes in the duodenum, with increased numbers of mast cells and eosinophils, and increased mucosal permeability, in FD. These findings are associated with PDS symptoms. The basis for these duodenal changes is unclear, but candidate mechanisms are duodenal acid exposure, bile acid exposure, stress, reactions to food allergens and changes in duodenal microbiota. How low-grade inflammation may lead to gastric sensorimotor dysfunction, and how it can be targeted therapeutically is a topic of ongoing research. In addition, cognitive-affective processes including anticipation of pain and its associated anxiety interfere with pain modulatory mechanisms in the brain in FD, leading to increased pain sensitivity and symptom levels. In FD, currently available treatment modalities include acid suppressive drugs, gastroprokinetic drugs, H. pylori eradication therapy, tricyclic antidepressants or psychological therapies. There is evidence, although not always of high quality, of efficacy in subgroups of patients. Proton pump inhibitors are considered to be mainly effective in EPS, but may affect duodenal eosinophilia. Prokinetics may provide benefit to PDS patients, but there is a lack of widely available suitable agents. Tricyclic antidepressants like amitriptyline are only effective for EPS, serotonin/noradrenaline reuptake inhibitors have no proven efficacy, while the atypical antidepressant mirtazapine is effective in FD with weight loss. Very few data are available on dietary interventions to treat FD. Some herbal/nutritional interventions may also improve FD symptoms. A management algorithm based on the Rome IV consensus and the current literature will be presented. The algorithm illustrates the ability to treat FD effectively based on analysis of the symptom pattern and targeted choice of therapeutic agent. |
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