Volume 33, Issue 9 e14238
ORIGINAL ARTICLE

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia

Lucas Wauters

Lucas Wauters

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

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Ram Dickman

Ram Dickman

Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikwa, Israel

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Vasile Drug

Vasile Drug

University of Medicine and Pharmacy Gr T Popa Iasi and University Hospital St Spiridon, Iasi, Romania

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Agata Mulak

Agata Mulak

Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland

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Jordi Serra

Jordi Serra

University Hospital Germans Trias I Pujol and Centro de Investigación Biomédica en Red de enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain

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Paul Enck

Paul Enck

Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany

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Jan Tack

Corresponding 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]

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ESNM FD Consensus GroupAnna Accarino

Anna Accarino

CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain

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Giovanni Barbara

Giovanni Barbara

Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

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Serhat Bor

Serhat Bor

Division of Gastroenterology, School of Medicine, Ege University, Izmir, Turkey

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Benoit Coffin

Benoit Coffin

Université de Paris and AP-HP Hôpital Louis Mourier, Paris, France

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Maura Corsetti

Maura Corsetti

NIHR Nottingham Biomedical Research Centre (BRC), Hospitals NHS Trust and the University of Nottingham, Nottingham, UK

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Heiko De Schepper

Heiko De Schepper

Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium

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Dan Dumitrascu

Dan Dumitrascu

2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

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Adam Farmer

Adam Farmer

Wingate Institute of Neurogastroenterology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK

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Guillaume Gourcerol

Guillaume Gourcerol

Physiology Department, Rouen University Hospital, Rouen, France

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Goran Hauser

Goran Hauser

Medical Faculty Rijeka, University of Rijeka and Clinical Hospital Centre Rijeka, Rijeka, Croatia

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Trygve Hausken

Trygve Hausken

Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway

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George Karamanolis

George Karamanolis

Gastroentrology Unit, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece

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Daniel Keszthelyi

Daniel Keszthelyi

Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands

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Carolin Malagelada

Carolin Malagelada

CIBERehd and Departament de Medicina, Digestive System Research Unit, University Hospital Vall D'Hebron, Barcelona, Spain

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Tomislav Milosavljevic

Tomislav Milosavljevic

Department of Gastroenterology, Euromedik Hospital Belgrade, Belgrade, Serbia

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Jean Muris

Jean Muris

Department of General Practice, Caphri Institute, Maastricht University, Maastricht, The Netherlands

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Colm O’Morain

Colm O’Morain

Department of Medicine, Trinity College Dublin and National Clinical Lead for Gastroenterology and Hepatology, Royal College Physicians Ireland, Dublin, Ireland

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Athanassos Papathanasopoulos

Athanassos Papathanasopoulos

Private Practice, Ioannina, Greece

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Daniel Pohl

Daniel Pohl

Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland

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Diana Rumyantseva

Diana Rumyantseva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

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Giovanni Sarnelli

Giovanni Sarnelli

Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

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Edoardo Savarino

Edoardo Savarino

Gastroenterology Unit, Departmento of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

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Jolien Schol

Jolien Schol

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

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Arkady Sheptulin

Arkady Sheptulin

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

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Annemieke Smet

Annemieke Smet

Laboratory of Experimental Medicine and Pediatrics and InflA−Med Centre of Excellence, University of Antwerp, Antwerp, Belgium

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Andreas Stengel

Andreas 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

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Olga Storonova

Olga Storonova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia

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Martin Storr

Martin Storr

Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany

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Hans Törnblom

Hans Törnblom

Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden

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Tim Vanuytsel

Tim Vanuytsel

Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

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Monica Velosa

Monica Velosa

Sheba Medical Center, Tel Hashomer, Israel

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Marek Waluga

Marek Waluga

Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland

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Natalia Zarate

Natalia Zarate

Gastrointestinal Physiology Unit, University College London Hospital, London, UK

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Frank Zerbib

Frank Zerbib

CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque and Gastroenterology Department, Université de Bordeaux, INSERM CIC, Bordeaux, France

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First published: 29 September 2021
Citations: 16

These 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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