Evidence-based clinical practice guidelines for functional dyspepsia

Hiroto Miwa, Motoyasu Kusano, Tomiyasu Arisawa, Tadayuki Oshima, Mototsugu Kato, Takashi Joh, Hidekazu Suzuki, Kazunari Tominaga, Koji Nakada, Akihito Nagahara, Seiji Futagami, Noriaki Manabe, Akio Inui, Ken Haruma, Kazuhide Higuchi, Koji Yakabi, Michio Hongo, Naomi Uemura, Yoshikazu Kinoshita, Kentaro SuganoTooru Shimosegawa

Research output: Contribution to journalReview article

88 Citations (Scopus)

Abstract

General interest in functional gastrointestinal disorders is increasing among Japanese doctors as well as patients. This increase can be attributed to a number of factors, including recent increased interest in quality of life and advances in our understanding of the pathophysiology of gastrointestinal disease. Japan recently became the world’s first country to list “functional dyspepsia” as a disease name for national insurance billing purposes. However, recognition and understanding of functional dyspepsia (FD) remain poor, and no standard treatment strategy has yet been established. Accordingly, the Japanese Society of Gastroenterology (JSGE) developed an evidence-based clinical practice guideline for FD, consisting of five sections: concept, definition, and epidemiology; pathophysiology; diagnosis; treatment; and prognosis and complications. This article summarizes the Japanese guideline, with particular focus on the treatment section. Once a patient is diagnosed with FD, the doctor should carefully explain the pathophysiology and benign nature of this condition, establish a good doctor–patient relationship, and then provide advice for daily living (diet and lifestyle modifications, explanations, and reassurance). The proposed pharmacological treatment is divided into two steps: initial treatment including an acid inhibitory drug (H2RA or PPI) or prokinetics, (strong recommendation); second-line treatment including anxiolytics, antidepressants, and Japanese traditional medicine (weak recommendation). H. pylori eradication, strongly recommended with a high evidence level, is positioned separately from other treatment flows. Conditions that do not respond to these treatment regimens are regarded as refractory FD. Patients will be further examined for other organic disorders or will be referred to specialists using other approaches such as psychosomatic treatment.

Original languageEnglish
Pages (from-to)125-139
Number of pages15
JournalJournal of gastroenterology
Volume50
Issue number2
DOIs
Publication statusPublished - 2015 Feb 6

Keywords

  • Algorithm
  • Antianxiety drug
  • Antidepressant
  • Chronic gastritis
  • Dyspepsia
  • Guideline
  • H. pylori associated dyspepsia
  • H. pylori eradication treatment
  • Japanese traditional medicine
  • Prokinetics
  • Proton pump inhibitor

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Miwa, H., Kusano, M., Arisawa, T., Oshima, T., Kato, M., Joh, T., Suzuki, H., Tominaga, K., Nakada, K., Nagahara, A., Futagami, S., Manabe, N., Inui, A., Haruma, K., Higuchi, K., Yakabi, K., Hongo, M., Uemura, N., Kinoshita, Y., ... Shimosegawa, T. (2015). Evidence-based clinical practice guidelines for functional dyspepsia. Journal of gastroenterology, 50(2), 125-139. https://doi.org/10.1007/s00535-014-1022-3