All patients with functional dyspepsia (FD) should take regular aerobic exercise, a new UK guideline advises, but specific dietary therapies are not recommended for the condition.
FD is a common disorder of gut-brain interaction, affecting approximately 7% of people in the community, wrote the authors of the updated British Society of Gastroenterology guideline, published online in Gut.
Patients should be counselled that it is a chronic disorder, with fluctuating symptoms that can be impacted by diet, stress and cognitive, behavioural, or emotional responses to symptoms.
‘Regular exercise and lifestyle changes, like avoiding certain foods that may trigger symptoms, will be helpful for some patients,’ the guidance stated.
‘However, there is no evidence for any specialised diets for treating FD and restricting diet too much could lead to malnutrition or abnormal eating habits.’
Large trials of diets, including one low in fermentable oligosaccharides, disaccharides and monosaccharides, and polyols (FODMAPs), were needed, the guideline authors said.
All patients should be offered a stool test or breath test to look for Helicobacter pylori infection, the guideline recommended, with infected patients offered eradication therapy.
It was estimated that 5% of dyspepsia in the community was attributable to H. pylori.
Patients without H. pylori infection should be offered empirical acid suppression therapy.
On first-line therapies, the guideline advised:
- Histamine-H2-receptor antagonists were well-tolerated and might be an efficacious treatment for FD.
- Proton pump inhibitors were efficacious and well-tolerated, with patients prescribed the lowest dose that controlled symptoms.
- For prokinetics, most were well-tolerated, but efficacy varied according to drug class, and many were unavailable outside of Asia and the USA.
Tricyclic antidepressants, used as gut-brain modulators, were efficacious as second-line therapy, the guideline advised.
They should be commenced at a low dose (e.g., 10mg amitriptyline once daily) and titrated slowly to a maximum of 30-50mg once daily.
Antipsychotics, such as sulpiride 100 mg four times a day or levosulpiride 25 mg three times a day, might be efficacious as a second-line treatment, they added.
With both classes of drugs, there should be careful explanation to patients about why they were being used and potential side effects.
‘There is some evidence that psychological or behavioural therapies may be beneficial for treating symptoms in FD. These therapies use the fact our brain and upper gut nerves are connected and can influence each other,’ the guideline authors wrote, adding that work was needed to improve the availability of these treatments.
Themes for future research included gaining a better understanding of the pathophysiology of FD and trialling treatment combinations to uncover augmentation between therapies, such as dual therapy with histamine-1 and histamine-2-receptor antagonists.
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