Mistakes in dyspepsia and how to avoid them

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Mistakes in dyspepsia and how to avoid them

Mark Fox

Summary

AI Generated

Dyspepsia is upper abdominal discomfort with diverse causes including functional dyspepsia, GORD, peptic ulcer disease, and malignancy, and its management is challenging due to broad definition, lack of specific treatments, and psychosocial factors.

Dyspepsia presents with epigastric pain, bloating, early satiety, belching, nausea, and heartburn arising from the upper gastrointestinal tract.
Common causes include functional dyspepsia, gastro-oesophageal reflux disease, peptic ulcer disease, and malignancy.
Endoscopy is not always necessary for diagnosis, and clinical guidelines recommend considering clinical presentation without alarm symptoms.
Management challenges include the broad definition of dyspepsia, lack of specific treatments, and psychosocial issues.
The material addresses 10 common mistakes in diagnosis and treatment, relevant for clinicians managing dyspepsia.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Tack J, Talley N. Functional dyspepsia: symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 2013; 10: 134–141.

Ford AC, Marwaha A, Lim A. What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 830-837 2.

National Institute for Health and Care Excellence NICE. Clinical Guideline 184. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management, https://www.nice.org.uk/guidance/cg184 (2014, accessed 22 February 2024).

Talley N, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100: 2324–2337.

Farré R, Vanheel H, Vanuytsel T. In functional dyspepsia, hypersensitivity to postprandial distention correlates with meal-related symptom severity. Gastroenterology 2013; 145: 566–573.

Vanheel H, Vanuytsel T, Oudenhove L. Postprandial symptoms originating from the stomach in functional dyspepsia. Neurogastroenterol Motil 2013; 25: 911–703.

Ford AC, Marwaha A, Lim A. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8: 401–409.

Hungin AP, C H, Raghunath A. Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30: 331–342.

Ford AC, Forman D, Bailey AG. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut 2007; 56: 321–327.

10.

Rich G, Shah A, Koloski N, et al. A randomized placebo-controlled trial on the effects of Menthacarin, a proprietary peppermint- and caraway-oil-preparation, on symptoms and quality of life in patients with functional dyspepsia. Neurogastroenterol Motil 2017; 29: e13132.

11.

Melzer J, Rösch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004; 20: 1279–1287.

12.

Thomas E, Wade A, Crawford G. Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action)—a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2014; 39: 595–602.

13.

Pinto‐Sanchez MI, Yuan Y, Hassan A, et al. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev 2017; 2017: CD011194.

14.

Pittayanon R, Yuan Y, Bollegala NP, et al. Prokinetics for functional dyspepsia. Cochrane Database Syst Rev 2018; 2018: CD009431.

15.

Kapoor N, Bassi A, Sturgess R. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005; 54: 40–45.

16.

Horowitz N, Moshkowitz M, Leshno M. Clinical trial: evaluation of a clinical decision-support model for upper abdominal complaints in primary-care practice. Aliment Pharmacol Ther 2007; 26: 1277–1283.

17.

Heikkinen M, Pikkarainen P, Takala J. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol 1995; 30: 519–523.

18.

Spiegel BM, Gralnek IM, Bolus R. Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome? Gastrointest Endosc 2005; 62: 892–899.

19.

Soo S, Forman D, Delaney BC. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004; 99: 1817–1822.

20.

Drossman DA, Whitehead WE, Toner BB. What determines severity among patients with painful functional bowel disorders? Am J Gastroenterol 2000; 95: 974–980.

21.

Santonicola A, Siniscalchi M, Capone P. Prevalence of functional dyspepsia and its subgroups in patients with eating disorders. World J Gastroenterol 2012; 18: 4379–4385.

22.

Hay P, Mitchison D, Collado AEL, et al. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. J Eat Disord 2017; 5: 21.

23.

Tucker E, Knowles K, Wright J. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. Aliment Pharmacol Ther 2013; 37: 263–274.

24.

Delaney B, Ford AC, Forman D. Initial management strategies for dyspepsia. Cochrane Database Syst Rev 2005; 4: 001961.

25.

Delaney BC, Qume M, Moayyedi P. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial. BMJ 2008; 336: 651–654.

26.

Wang WH, Huang JQ, Zheng GF. Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials. Clin Gastroenterol Hepatol 2007; 5: 178–185.

27.

Reimer C, Søndergaard B, Hilsted L. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009; 137: 80–87.

28.

Schwizer W, Menne D, Schütze K. The effect of Helicobacter pylori infection and eradication in patients with gastroesophageal reflux disease: a parallel-group, double-blind, placebo-controlled multicenter study. United Eur Gastroenterol J 2013; 1: 226–235.

29.

Fox M, Forgacs I. Gastro-oesophageal reflux disease. BMJ 2006; 332: 88–93.

30.

Stanghellini V, Tack J. Gastroparesis: separate entity or just a part of dyspepsia? Gut 2014; 63: 1972–1978.

31.

Boeckxstaens GE, Hirsch DP, Den Elzen BDJ. Impaired drinking capacity in patients with functional dyspepsia: relationship with proximal stomach function. Gastroenterology 2001; 121: 1054–1063.

32.

Vijayvargiya P, Camilleri M, Chedid V, et al. Effects of Promotility Agents on Gastric Emptying and Symptoms: A Systematic Review and Meta-analysis. Gastroenterology 2019; 156: 1650–1660.

33.

Saleem S, Aziz M, Khan AA, et al. Gastric Electrical Stimulation for the Treatment of Gastroparesis or Gastroparesis-Like Symptoms: A Systemic Review and Meta-Analysis. Neuromodulation J Int Neuromodulation Soc 2024; 27: 221–228.

34.

Labonde A, Lades G, Debourdeau A, et al. Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection. Gastrointest Endosc 2022; 96: 500-508.e2.

35.

Talley NJ, Locke GR, Saito Y. Effect of amitriptyline and escitalopram on functional dyspepsia: A multicenter, randomized controlled study. Gastroenterology 2015; 149: 340-349 2.

36.

Mertens MC, Vries J, Scholtes VP. Prospective 6 weeks follow-up post-cholecystectomy: the predictive value of pre-operative symptoms. J Gastrointest Surg 2009; 13: 304–311.

37.

Luman W, Adams WH, Nixon SN. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut 1996; 39: 863–866.

38.

Fenster LF, Lonborg R, Thirlby RC. What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg 1995; 169: 533–538.

39.

Sperber AD, Morris CB, Greemberg L. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology 2008; 134: 75–84.

40.

Lacy BE, Weiser KT, Kennedy AT. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther 2013; 38: 170–177.

41.

Böhn L, Störsrud S, Törnblom H. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol 2013; 108: 634–641.

42.

Barba E, Burri E, Accarino A. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology 2015; 148: 732–739.

43.

Ward BW, Wu WC, Richter JE. Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol 1987; 82: 215–218.

Abstract

2024 update: Mark Fox
2016 version: Mark Fox

Dyspepsia refers to upper abdominal discomfort that can arise from the upper gastrointestinal tract, with symptoms including epigastric pain, bloating, early satiety, belching, nausea, and heartburn. It is commonly caused by functional dyspepsia, gastro-oesophageal reflux disease (GORD), peptic ulcer disease, or malignancy. Endoscopy is not always necessary for diagnosis, and clinical guidelines recommend considering clinical presentation without alarm symptoms. The management of dyspepsia is challenging due to its broad definition, lack of specific treatments, and psychosocial issues. Here, I discuss 10 common mistakes in diagnosis and treatment.

Topics

Neurogastroenterology & Motility

Published

2024

More Like This:

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

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UEG Standards and Guidelines

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

ABSTRACT

Introduction

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

Results

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

Conclusion

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Paediatrics Primary Care Stomach & H. Pylori

Citation

United European Gastroenterol J.

Published

2025

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Carolina Malagelada

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Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

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UEG Mistakes In Articles

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Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord, Roos E. Pouw

Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Tack J, Talley N. Functional dyspepsia: symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 2013; 10: 134–141.

Talley N, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100: 2324–2337.

Farré R, Vanheel H, Vanuytsel T. In functional dyspepsia, hypersensitivity to postprandial distention correlates with meal-related symptom severity. Gastroenterology 2013; 145: 566–573.

Vanheel H, Vanuytsel T, Oudenhove L. Postprandial symptoms originating from the stomach in functional dyspepsia. Neurogastroenterol Motil 2013; 25: 911–703.

Ford AC, Marwaha A, Lim A. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8: 401–409.

Hungin AP, C H, Raghunath A. Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30: 331–342.

Ford AC, Forman D, Bailey AG. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut 2007; 56: 321–327.

10.

11.

Melzer J, Rösch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004; 20: 1279–1287.

12.

13.

Pinto‐Sanchez MI, Yuan Y, Hassan A, et al. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev 2017; 2017: CD011194.

14.

Pittayanon R, Yuan Y, Bollegala NP, et al. Prokinetics for functional dyspepsia. Cochrane Database Syst Rev 2018; 2018: CD009431.

15.

Kapoor N, Bassi A, Sturgess R. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005; 54: 40–45.

16.

17.

Heikkinen M, Pikkarainen P, Takala J. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol 1995; 30: 519–523.

18.

Spiegel BM, Gralnek IM, Bolus R. Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome? Gastrointest Endosc 2005; 62: 892–899.

19.

Soo S, Forman D, Delaney BC. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004; 99: 1817–1822.

20.

Drossman DA, Whitehead WE, Toner BB. What determines severity among patients with painful functional bowel disorders? Am J Gastroenterol 2000; 95: 974–980.

21.

Santonicola A, Siniscalchi M, Capone P. Prevalence of functional dyspepsia and its subgroups in patients with eating disorders. World J Gastroenterol 2012; 18: 4379–4385.

22.

23.

24.

Delaney B, Ford AC, Forman D. Initial management strategies for dyspepsia. Cochrane Database Syst Rev 2005; 4: 001961.

25.

26.

Wang WH, Huang JQ, Zheng GF. Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials. Clin Gastroenterol Hepatol 2007; 5: 178–185.

27.

Reimer C, Søndergaard B, Hilsted L. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009; 137: 80–87.

28.

29.

Fox M, Forgacs I. Gastro-oesophageal reflux disease. BMJ 2006; 332: 88–93.

30.

Stanghellini V, Tack J. Gastroparesis: separate entity or just a part of dyspepsia? Gut 2014; 63: 1972–1978.

31.

Boeckxstaens GE, Hirsch DP, Den Elzen BDJ. Impaired drinking capacity in patients with functional dyspepsia: relationship with proximal stomach function. Gastroenterology 2001; 121: 1054–1063.

32.

Vijayvargiya P, Camilleri M, Chedid V, et al. Effects of Promotility Agents on Gastric Emptying and Symptoms: A Systematic Review and Meta-analysis. Gastroenterology 2019; 156: 1650–1660.

33.

34.

35.

Talley NJ, Locke GR, Saito Y. Effect of amitriptyline and escitalopram on functional dyspepsia: A multicenter, randomized controlled study. Gastroenterology 2015; 149: 340-349 2.

36.

Mertens MC, Vries J, Scholtes VP. Prospective 6 weeks follow-up post-cholecystectomy: the predictive value of pre-operative symptoms. J Gastrointest Surg 2009; 13: 304–311.

37.

Luman W, Adams WH, Nixon SN. Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut 1996; 39: 863–866.

38.

Fenster LF, Lonborg R, Thirlby RC. What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg 1995; 169: 533–538.

39.

Sperber AD, Morris CB, Greemberg L. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology 2008; 134: 75–84.

40.

Lacy BE, Weiser KT, Kennedy AT. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther 2013; 38: 170–177.

41.

42.

Barba E, Burri E, Accarino A. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology 2015; 148: 732–739.

43.

Ward BW, Wu WC, Richter JE. Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol 1987; 82: 215–218.

Abstract

Proton pump inhibitors (PPIs), first introduced with omeprazole in 1988, revolutionized the treatment of gastric acid-related conditions like gastro-oesophageal reflux disease, gastroduodenal ulcers, and Helicobacter pylori infections. Despite their effectiveness, PPIs are often prescribed for conditions without a proven link to gastric acid, such as dyspepsia and upper abdominal discomfort. Long-term use of PPIs has raised safety concerns, including risks of vitamin and mineral malabsorption, pneumonia, gastrointestinal infections, and dementia. This Mistakes In article addresses nine common mistakes in PPI use and aims to clarify misconceptions about their use.

Topics

Digestive Oncology Oesophagus

Citation

Pouw R.E. and Bredenoord A.J. Mistakes in the use of PPIs and how to avoid them. UEG Education 2017; 17: 15–17.

Published

2024

More Like This:

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

Sadé L Assmann

What's new in Rome V? Part 1 with Maura Corsetti

Pradeep Mundre

Mistakes in Familial Mediterranean Fever and how to avoid them

Gagik Hakobyan

Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Bas L.A.M. Weusten

UEG Standards and Guidelines

Clinical Practice Guideline

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

Sadé L Assmann

Summary

AI Generated

Summary is not available for this content yet.

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Guideline

Abstract

Introduction
The goal of this project was to create an up-to-date joint European clinical practice guideline for the diagnosis and treatment of faecal incontinence (FI), using the best available evidence. These guidelines are intended to help guide all medical professionals treating adult patients with FI (e.g., general practitioners, surgeons, gastroenterologists, other healthcare workers) and any patients who are interested in information regarding the diagnosis and management of FI.

Methods
These guidelines have been created in cooperation with members from the United European Gastroenterology (UEG), European Society of Coloproctology (ESCP), European Society of Neurogastroenterology and Motility (ESNM) and the European Society for Primary Care Gastroenterology (ESPCG). These members made up the guideline development group (GDG). Additionally, a patient advisory board (PAB) was created to reflect and comment on the draft guidelines from a patient perspective. Relevant review questions were established by the GDG along with a set of outcomes most important for decision making. A systematic literature search was performed using these review questions and outcomes as a framework. For each predefined review question, the study or studies with the highest level of study design were included. If evidence of a higher-level study design was available, no lower level of evidence was sought or included. Data from the studies were extracted by two reviewers for each predefined important outcome within each review question. Where possible, forest plots were created. After summarising the results for each review question, a systematic quality assessment using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was performed. For each review question, we assessed the quality of evidence for every predetermined important outcome. After evidence review and quality assessment were completed, recommendations could be formulated. The wording used for each recommendation was dependent on the level of quality of evidence. Lower levels of evidence resulted in weaker recommendations and higher levels of evidence resulted in stronger recommendations. Recommendations were discussed within the GDG to reach consensus.

Results
These guidelines contain 45 recommendations on the classification, diagnosis and management of FI in adult patients.

Conclusion
These multidisciplinary European guidelines provide an up-to-date comprehensive evidence-based framework with recommendations on the diagnosis and management of adult patients who suffer from FI.

Keywords: clinical guidelines, diagnosis, faecal incontinence, fecal incontinence, GRADE, guidelines, ptns, treatment, Sacral neuromodulation, unwanted loss of feces

Publishers

European Society of Neurogastroenterology and Motility, European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Neurogastroenterology & Motility Surgery

Citation

United European Gastroenterol J.2022;10:251–286

Published

2022

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Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

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UEG Podcast Episode

New

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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What's new in Rome V? Part 1 with Maura Corsetti

Maura Corsetti, Pradeep Mundre

Summary

AI Generated

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Abstract

Topics

Neurogastroenterology & Motility

Published

2026

More Like This:

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Mistakes in the use of PPIs and how to avoid them

Albert J. Bredenoord

Guideline for the diagnosis and treatment of Faecal Incontinence—A UEG/ESCP/ESNM/ESPCG collaboration

Sadé L Assmann

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Pradeep Mundre

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Tack J, Talley N. Functional dyspepsia: symptoms, definitions and validity of the Rome III criteria. Nat Rev Gastroenterol Hepatol 2013; 10: 134–141.

Talley N, Vakil N. Guidelines for the management of dyspepsia. Am J Gastroenterol 2005; 100: 2324–2337.

Farré R, Vanheel H, Vanuytsel T. In functional dyspepsia, hypersensitivity to postprandial distention correlates with meal-related symptom severity. Gastroenterology 2013; 145: 566–573.

Vanheel H, Vanuytsel T, Oudenhove L. Postprandial symptoms originating from the stomach in functional dyspepsia. Neurogastroenterol Motil 2013; 25: 911–703.

Ford AC, Marwaha A, Lim A. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol 2010; 8: 401–409.

Hungin AP, C H, Raghunath A. Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30: 331–342.

Ford AC, Forman D, Bailey AG. Initial poor quality of life and new onset of dyspepsia: results from a longitudinal 10-year follow-up study. Gut 2007; 56: 321–327.

10.

11.

Melzer J, Rösch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004; 20: 1279–1287.

12.

13.

Pinto‐Sanchez MI, Yuan Y, Hassan A, et al. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev 2017; 2017: CD011194.

14.

Pittayanon R, Yuan Y, Bollegala NP, et al. Prokinetics for functional dyspepsia. Cochrane Database Syst Rev 2018; 2018: CD009431.

15.

Kapoor N, Bassi A, Sturgess R. Predictive value of alarm features in a rapid access upper gastrointestinal cancer service. Gut 2005; 54: 40–45.

16.

17.

Heikkinen M, Pikkarainen P, Takala J. Etiology of dyspepsia: four hundred unselected consecutive patients in general practice. Scand J Gastroenterol 1995; 30: 519–523.

18.

Spiegel BM, Gralnek IM, Bolus R. Is a negative colonoscopy associated with reassurance or improved health-related quality of life in irritable bowel syndrome? Gastrointest Endosc 2005; 62: 892–899.

19.

Soo S, Forman D, Delaney BC. A systematic review of psychological therapies for nonulcer dyspepsia. Am J Gastroenterol 2004; 99: 1817–1822.

20.

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Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

Topics

Primary Care

Published

2025

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Clinical Practice Guideline

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Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Bas L.A.M. Weusten

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Guideline

Main recommendations

ESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2 – 4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset.

Strong recommendation, high quality of evidence, level of agreement 100 %.

ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM).

Strong recommendation, very low quality of evidence, level of agreement 87.5%.

ESGE recommends against the routine use of botulinum toxin injections to treat patients with non-achalasia hypercontractile esophageal motility disorders (Jackhammer esophagus, distal esophageal spasm). However, if, in individual patients, endoscopic injection of botulinum toxin is chosen, ESGE recommends performing injections into four quadrants of the lower esophageal sphincter and in the lower third of the esophagus.

Strong recommendation, low quality of evidence, level of agreement 78.6%.

ESGE recommends that endoscopic pylorus-directed therapy should be considered only in patients with symptoms suggestive of gastroparesis in combination with objective proof of delayed gastric emptying using a validated test, and only when medical therapy has failed.

Strong recommendation, very low quality of evidence, level of agreement 100 %.

ESGE recommends against the use of botulinum toxin injection in the treatment of unselected patients with gastroparesis.

Strong recommendation, high quality of evidence, level of agreement 92.9%.

ESGE recommends consideration of gastric peroral endoscopic myotomy (G-POEM) in carefully selected patients only, because it is an emerging procedure with limited data on effectiveness, safety, and durability. G-POEM should be performed in expert centers only, preferably in the context of a clinical trial.

Strong recommendation, low quality of evidence, level of agreement 100 %.

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy Neurogastroenterology & Motility

Citation

Endoscopy. 2020 Jun;52(6):498-515

Published

2020

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