Functional dyspepsia affects 10% to 45% of people worldwide, yet a recent systematic review published in Gastroenterología y Hepatología shows that recent therapeutic evidence identifies no intervention that is universally effective for the condition.
Researchers from the University of Barcelona and Hospital Clínic de Barcelona evaluated scientific evidence from the past decade following PRISMA 2020 guidelines. The analysis found that functional dyspepsia, which accounts for over 70% of dyspepsia cases, stems from gut-brain axis disruption and traditionally demonstrates modest therapeutic responses.
While clinical classification into postprandial distress syndrome and epigastric pain syndrome helps guide treatment, the review concluded that this division does not justify rigid therapeutic algorithms.
Standard care typically combines lifestyle adjustments, dietary modifications, Helicobacter pylori eradication when indicated, and empiric medication. Proton pump inhibitors usually serve as first-line therapy, with prokinetics used as alternatives.
Specific interventions showed variable results across clinical profiles.
A low-FODMAP diet did not demonstrate overall clinical superiority compared to traditional dietary advice, except for a specific subgroup of patients experiencing bloating.
“The use of mirtazapine showed clinical signs of benefit in patients experiencing weight loss or early satiety,” Medscape reported.
Conversely, for patients with epigastric pain syndrome, researchers determined that low-dose amitriptyline proved more effective than pantoprazole.
Non-pharmacologic strategies such as herbal medicine, electroacupuncture, transcutaneous auricular vagal stimulation, and multidisciplinary care models showed signs of therapeutic benefit.
“Electroacupuncture has shown promising results in some clinical trials, but we still need studies of higher methodological quality, with larger samples and long-term follow-up, to establish its efficacy with greater certainty, identify the patients who could benefit most, and evaluate its cost-effectiveness,” said Elizabeth Barba Orozco, a co-author of the study, told Medscape.
Regarding alternative products, the study evaluated cannabidiol and determined it was ineffective for treating functional dyspepsia while presenting potential safety issues. Specialists consequently said that routine use of cannabidiol cannot be recommended for this medical indication.
The authors propose a stepwise algorithm beginning with diagnostic evaluation, lifestyle measures, H pylori eradication, and proton pump inhibitors, followed by second-line options tailored to refractory cases. The evidence supports a fully personalized and biopsychosocial approach that accounts for predominant symptoms, nutritional status, and patient preferences.
“I do not believe our results justify immediately abandoning initial empirical treatment in the management of functional dyspepsia as it remains a reasonable and accessible strategy for many patients,” Barba Orozco told Medscape.
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