United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia
Lucas Wauters
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorRam Dickman
Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
Search for more papers by this authorVasile Drug
University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
Search for more papers by this authorAgata Mulak
Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorJordi Serra
University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
Search for more papers by this authorPaul Enck
Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
Search for more papers by this authorCorresponding Author
Jan Tack
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Correspondence
Jan Tack MD, PhD, Division of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Email: [email protected]
Search for more papers by this authorESNM FD Consensus Group
Search for more papers by this authorAnna Accarino
CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
Search for more papers by this authorGiovanni Barbara
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Search for more papers by this authorSerhat Bor
Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
Search for more papers by this authorBenoit Coffin
Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
Search for more papers by this authorMaura Corsetti
NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
Search for more papers by this authorHeiko De Schepper
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
Search for more papers by this authorDan Dumitrascu
2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Search for more papers by this authorAdam Farmer
Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorGuillaume Gourcerol
Physiology Department, Rouen University Hospital, Rouen, France
Search for more papers by this authorGoran Hauser
Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
Search for more papers by this authorTrygve Hausken
Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
Search for more papers by this authorGeorge Karamanolis
Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorDaniel Keszthelyi
Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
Search for more papers by this authorCarolin Malagelada
CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
Search for more papers by this authorTomislav Milosavljevic
Department of Gastroenterology, Euromedik Hospital Belgrade, Belgrade, Serbia
Search for more papers by this authorJean Muris
Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
Search for more papers by this authorColm O’Morain
Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
Search for more papers by this authorAthanassos Papathanasopoulos
Private Practice, Ioannina, Greece
Search for more papers by this authorDaniel Pohl
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorDiana Rumyantseva
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorGiovanni Sarnelli
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
Search for more papers by this authorEdoardo Savarino
Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Search for more papers by this authorJolien Schol
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorArkady Sheptulin
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorAnnemieke Smet
Laboratory of Experimental Medicine and Pediatrics and InflA−Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorAndreas Stengel
Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany
Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Center of Endoscopy, Starnberg, Germany
Ludwig-Maximilians-University, Munich, Germany
Search for more papers by this authorOlga Storonova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorMartin Storr
Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Search for more papers by this authorHans Törnblom
Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
Search for more papers by this authorTim Vanuytsel
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorMarek Waluga
Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorNatalia Zarate
Gastrointestinal Physiology Unit, University College London Hospital, London, UK
Search for more papers by this authorFrank Zerbib
CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
Search for more papers by this authorLucas Wauters
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorRam Dickman
Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel
Search for more papers by this authorVasile Drug
University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania
Search for more papers by this authorAgata Mulak
Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
Search for more papers by this authorJordi Serra
University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain
Search for more papers by this authorPaul Enck
Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
Search for more papers by this authorCorresponding Author
Jan Tack
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Correspondence
Jan Tack MD, PhD, Division of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Email: [email protected]
Search for more papers by this authorESNM FD Consensus Group
Search for more papers by this authorAnna Accarino
CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
Search for more papers by this authorGiovanni Barbara
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Search for more papers by this authorSerhat Bor
Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey
Search for more papers by this authorBenoit Coffin
Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France
Search for more papers by this authorMaura Corsetti
NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
Search for more papers by this authorHeiko De Schepper
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
Search for more papers by this authorDan Dumitrascu
2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Search for more papers by this authorAdam Farmer
Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Search for more papers by this authorGuillaume Gourcerol
Physiology Department, Rouen University Hospital, Rouen, France
Search for more papers by this authorGoran Hauser
Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia
Search for more papers by this authorTrygve Hausken
Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
Search for more papers by this authorGeorge Karamanolis
Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorDaniel Keszthelyi
Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
Search for more papers by this authorCarolin Malagelada
CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain
Search for more papers by this authorTomislav Milosavljevic
Department of Gastroenterology, Euromedik Hospital Belgrade, Belgrade, Serbia
Search for more papers by this authorJean Muris
Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands
Search for more papers by this authorColm O’Morain
Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland
Search for more papers by this authorAthanassos Papathanasopoulos
Private Practice, Ioannina, Greece
Search for more papers by this authorDaniel Pohl
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorDiana Rumyantseva
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorGiovanni Sarnelli
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
Search for more papers by this authorEdoardo Savarino
Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Search for more papers by this authorJolien Schol
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorArkady Sheptulin
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorAnnemieke Smet
Laboratory of Experimental Medicine and Pediatrics and InflA−Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
Search for more papers by this authorAndreas Stengel
Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine VI, University Hospital Tübingen, and Charité Center for Internal Medicine and Dermatology, Tübingen, Germany
Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Center of Endoscopy, Starnberg, Germany
Ludwig-Maximilians-University, Munich, Germany
Search for more papers by this authorOlga Storonova
I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
Search for more papers by this authorMartin Storr
Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
Search for more papers by this authorHans Törnblom
Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
Search for more papers by this authorTim Vanuytsel
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
Search for more papers by this authorMarek Waluga
Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
Search for more papers by this authorNatalia Zarate
Gastrointestinal Physiology Unit, University College London Hospital, London, UK
Search for more papers by this authorFrank Zerbib
CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France
Search for more papers by this authorThese guidelines were developed with the support of a UEG Activity Grant.
This article is published simultaneously in United European Gastroenterology Journal and Neurogastroenterology and Mobility.
Abstract
Background
Functional dyspepsia (FD) is one of the most common conditions in clinical practice. In spite of its prevalence, FD is associated with major uncertainties in terms of its definition, underlying pathophysiology, diagnosis, treatment, and prognosis.
Methods
A Delphi consensus was initiated with 41 experts from 22 European countries who conducted a literature summary and voting process on 87 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 36 statements.
Results
The panel agreed with the definition in terms of its cardinal symptoms (early satiation, postprandial fullness, epigastric pain, and epigastric burning), its subdivision into epigastric pain syndrome and postprandial distress syndrome, and the presence of accessory symptoms (upper abdominal bloating, nausea, belching), and overlapping conditions. Also, well accepted are the female predominance of FD, its impact on quality of life and health costs, and acute gastrointestinal infections, and anxiety as risk factors. In terms of pathophysiological mechanisms, the consensus supports a role for impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention, Helicobacter pylori infection, and altered central processing of signals from the gastroduodenal region. There is consensus that endoscopy is mandatory for establishing a firm diagnosis of FD, but that in primary care, patients without alarm symptoms or risk factors can be managed without endoscopy. There is consensus that H. pylori status should be determined in every patient with dyspeptic symptoms and H. pylori positive patients should receive eradication therapy. Also, proton pump inhibitor therapy is considered an effective therapy for FD, but no other treatment approach reached a consensus. The long-term prognosis and life expectancy are favorable.
Conclusions and Inferences
A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD.
AUTHOR CONTRIBUTIONS
Drafted consensus questions, drafted literature review sections, set up the voting and summaries access, participated in voting, summarized voting outcomes, reviewed and corrected the manuscript: L. Wauters. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: R. Dickman. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: V. Drug. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: A. Mulak. Drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected the manuscript: J. Serra. Co-initiated the process, obtained funding, drafted consensus questions, drafted literature review sections, participated in voting, reviewed and corrected manuscript content: P. Enck. Co-initiated the process, drafted consensus questions, drafted literature review sections, wrote manuscript sections, participated in voting, wrote manuscript, reviewed and corrected content: J. Tack. Drafted consensus questions, wrote manuscript sections, participated in voting, reviewed and corrected content: All members of the ESNM FD consensus group (A. Accarino, G. Barbara, S. Bor, B. Coffin, M. Corsetti, H. De Schepper, D. Dumitrascu, A. Farmer, G. Gourcerol, G. Hauser, T. Hausken, G. Karamanolis, D. Kestzhelyi, C. Malagelada, T. Milosavljevic, J. Muris, C. O'Morain, A. Papathanasopoulos, D. Pohl, D. Rumyantseva, G. Sarnelli, E. Savarino, J. Schol, A. Sheptulin, A. Smet, A. Stengel, O. Storonova, M. Storr, H. Törnblom, T. Vanuytsel, M. Velosa, M. Waluga, N. Zarate, F. Zerbib).
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