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EAST-EUROPEAN CONSENSUS ON MANAGEMENT OF FD

Jolien Schol 1, Monika Albertova Martinovicova 2, Peter Banovcin 3, Mirela Basic Denjagic 4, József Czimmer 5, Dorota Wasko-Czopnik 6, Jiri Dolina 7, Andrey Dorofeyev 8, Dan Lucian Dumitrascu 9, Adelina Nicoleta Galica 10, László Herszényi 11, Ludek Hrdlicka 12, Predrag Jovanovic 13, Stefan Konecny 7, Radek Kroupa 14, Miodrag Krstic 15, Samra Cato-Mehmedbasic 16, Tomica Milosavljevic 17, Agata Mulak 18, Oleg Shvets 19, Ilja Tachecí 20, Meri Trajkovska 21, Zuzana Vackova 22, Eduard Veseliny 23, Marek Waluga 24, Jan Tack 1

Affiliations

1 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

2 University Hospital Poliklinikou Milosrdní bratia, spol. s r.o, Bratislava, Slovakia

3 Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia

4 University Clinical Center Clinic for Internal Diseases, Tuzla, Bosnia and Herzegovina

5 University of Pécs, Clinical Centre, Medical School, Pécs, Hungary

6 Medical University Wroclaw, Wroclaw, Poland

7 University Hospital Brno, Brno, Czechia

8 Donetsk National Medical University | DNMU, Donetsk, Ukraine

9 Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania

10 Fan S. Noli University, Korçe, Albania

11 Medical Centre, Hungarian Defence Forces, Budapest, Hungary

12 ResTrial GastroEndo Ltd., Prague, Czechia

13 University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina

14 University Hospital and Faculty of Medicine Masaryk's University, Brno, Czechia

15 Clinical Centre of Serbia Clinic for Gastroenterology, Belgrade, Serbia

16 Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina

17 University of Belgrade Clinical Center of Serbia Gastroenterology and Hepatolog, Belgrade, Serbia

18 Katedra I Klinika Gastroenterologii I Hepatologii Uniwersytet Medyczny Wroclaw, Wroclaw, Poland

19 National University of Life and Environmental Sciences of Ukraine., Kyiv, Ukraine

20 Charles University Faculty of Medicine, University Hospital in Hradec Kralove, Hradec Kralove, Czechia

21 Clinic of Gastroenterohepatology, Skopje, North Macedonia

22 University Military Hospital Prague, Prague, Czechia

23 Medical school of PJ Safarik University, Kosice, Slovakia

24 Medical University of Silesia, Faculty of Medical Sciences in Katowice, Sosnowiec, Poland

Summary

AI Generated

An East-European expert consensus on functional dyspepsia involving 24 experts from 10 countries diverges from European guidelines by mandating early endoscopy regardless of alarm features and shows limited agreement on treatment options beyond H.pylori eradication.

Upper endoscopy with H.pylori testing is considered mandatory for FD diagnosis even in the absence of alarm symptoms, with 83% and 92% consensus respectively, contrasting with broader European recommendations
H.pylori eradication if present achieved 92% consensus as a treatment approach, representing the strongest agreement among therapeutic interventions
No consensus was reached on PPI therapy as initial or effective treatment despite 71% and 67% agreement, and prokinetics as a group received only 46% support, though itopride showed 75% agreement
Most other therapeutic modalities received minimal support, including neuromodulators, probiotics, rifaximin, behavioral treatments, and complementary approaches
This consensus may be most relevant to gastroenterologists practicing in East-European settings with higher H.pylori prevalence and different resource availability

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Abstract

Introduction

A recent European consensus recommended upper gastrointestinal endoscopy with H.pylori(HP) testing in the work-up of functional dyspepsia (FD) and considered only HP-eradication and proton pump inhibitor (PPI) therapy as validated treatment options (1).

Aims & Methods

Our aim was to evaluate differences and approaches chosen in FD management in East-Europe, which is characterized by a higher prevalence of HP-infection and different availability of treatments.
Twenty-four experts from ten East-European countries voted on 95 statements concerning definition, epidemiology, diagnosis and treatment of FD. Experts voted for agree strongly(A+), with minor(A) or major(A-) reservation or disagree strongly(D+), with major(D) or minor(D-) reservation. Consensus was defined as total agreement of at least 80%.

Results

All experts agreed to the definition and subtypes of FD, defined by the Rome IV criteria. The frequent presence of overlapping reflux symptoms(83% consensus) or irritable bowel syndrome(88%) was also accepted. There was consensus upon gastrointestinal infection and anxiety as risk factors for developing FD but not for smoking, antibiotic use or NSAIDs.
To establish a diagnosis of FD, HP testing(92%) and upper endoscopy(83%) is considered mandatory, even in the absence of alarm symptoms. Other tests such as abdominal ultrasound, gastric emptying test and esophageal pH-impedance monitoring were not considered useful. Subtyping FD into the postprandial distress syndrome(PDS) and epigastric pain syndrome(EPS) subgroups was supported for optimizing diagnostic and therapeutic approach(83%).
92% of experts agreed that HP should be eradicated if present. No consensus was reached for PPI as the most appropriate initial(71%) or effective(67%) therapy. Similarly, there was no consensus on the therapeutic efficacy of diet(67%), H2-blockers(50%), D2-receptor antagonists(46% for PDS), or prokinetics as a group (46%), but there was a tendency to support itopride as effective(75%). There was no support for trimebutine(29%), prucalopride(38%), herbal agents(38%), rifaximin(33%), probiotics(25%), neuromodulators(17-58%) or for behavioral treatments such as hypnotherapy(29%), cognitive behavioral therapy(50%), acupuncture(8%), mindfulness(25%).

Conclusion

In contrast to the European consensus, the East-European consensus on FD insists on early diagnostic endoscopy, regardless of alarm features. There is lack of consensus regarding treatment modalities for this highly prevalent condition, but there was a tendency to support PPI as first-line treatment and itopride as effective therapy.

References

1. Wauters, L., et al. (2021). "United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on functional dyspepsia." United European Gastroenterol J 9(3): 307-331.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Gastroparesis, dyspepsia, and beyond (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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When chronic constipation ends and chronic intestinal pseudo-obstruction (CIPO) starts

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When chronic constipation ends and chronic intestinal pseudo-obstruction (CIPO) starts

Carolina Malagelada 1

Affiliations

1 Hospital Universitari Vall d`Hebron, Barcelona, Spain

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Abstract

Event

UEG Week Barcelona 2026

Topics

Neurogastroenterology & Motility Primary Care

Session

Controversies in lower GI: disorders of gut–brain interaction

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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THE IMPACT OF FODMAP RESTRICTION AND REINTRODUCTION ON THE GUT MICROBIOTA OF PATIENTS WITH IRRITABLE BOWEL SYNDROME AND ITS ASSOCIATION WITH CLINICAL RESPONSE

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THE IMPACT OF FODMAP RESTRICTION AND REINTRODUCTION ON THE GUT MICROBIOTA OF PATIENTS WITH IRRITABLE BOWEL SYNDROME AND ITS ASSOCIATION WITH CLINICAL RESPONSE

Arnau Vich Vila 1, Karen Van den Houte 2, Karen Routhiaux 2, Florencia Carbone 3, Muriel Derrien 1, Jan Tack 4, Jeroen Raes 1

Affiliations

1 Vlaams Instituut voor Biotechnologie, Leuven, Belgium

2 KU Leuven, Leuven, Belgium

3 University of Leuven, Leuven, Belgium

4 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

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Abstract

Introduction

The pathophysiological mechanism involved in irritable bowel syndrome (IBS) is thought to be multifactorial, involving the gut-brain axis and the immune system. Despite this complexity, dietary restriction of fermentable oligo-, dis-, mono- saccharides, and polyols (FODMAPs) has become the first line of treatment, improving symptoms in up to 80% of patients (1). FODMAPs are poorly absorbed in the small intestine and serve as a substrate for the colonic microbiota, which has been proposed as a key mediator of FODMAP tolerance and symptom development. Considering that both the gut microbiota and the (in)tolerance to individual FODMAPs are highly personalised (2), there is a growing need to understand the host-microbiota interactions underlying individual responses to FODMAP restriction and intake. This personalised interplay may be key to more targeted dietary interventions for IBS.

Aims & Methods

We aimed to disentangle the role of the gut microbiota in FODMAP tolerance by exploring microbial dynamics upon restriction and reintroducing individual FODMAPs. To this end, we performed 16S rRNA gene sequencing of over 1,700 faecal samples from 463 IBS patients participating in two clinical trials: a) The DOMINO trial (3), where primary-care patients underwent a FODMAP-lowering diet and b) A cohort of 117 tertiary-care patients underwent a strict FODMAP-restriction followed by a blinded re-introduction of 6 FODMAPs powders (2). Response to the diet was defined as a reduction of at least 50 points on the IBS symptom severity scale. Linear and logistic mixed models were used to assess the relation between the microbiome, response to dietary intervention, host genetics and 32 blood and faecal parameters.

Results

Participants with dysbiotic microbiota at baseline were shown to be less likely to respond to the dietary restriction (p-value=0.01). These participants also showed higher levels of fecal calprotectin, secretory IgA and eosinophil-derived neurotoxin, suggesting immune activation in this subgroup of IBS patients (p-value<0.05). In both cohorts, limiting FODMAP intake was associated with decreased Bifidobacterium abundance (FDR<0.01). Moreover, a dose-dependent effect was observed as depletion was less severe in the FODMAP-lowering DOMINO diet. This effect was independent of response and IBS subtype. Furthermore, total bacterial biomass did not change during the restriction or the reintroduction period. However, we found 25 significant associations between individual FODMAPs and gut bacteria. The reintroduction of galacto-oligosaccharides and fructans restored the levels of Bifidobacterium, while polyols increased the abundance of Anaerostipes, regardless of participants’ tolerance (FDR<0.05). In addition, we observed distinct dynamics in the gut microbiota associated with the tolerance of specific FODMAPs, although they did not reach significance after multiple testing corrections at the current sample size. For example, participants intolerant to sorbitol showed an increase in Alistipes upon exposure to this compound (p-value<0.05, FDR>0.05).

Conclusion

Our results suggest that microbiota composition at baseline influences the clinical response to FODMAP restriction. A low-FODMAP diet does not induce drastic changes in the microbiome composition, although we confirmed the negative impact of dietary restriction on the abundance of Bifidobacterium. However, the less restrictive DOMINO diet results in a milder depletion, suggesting that moderate FODMAP reduction may better preserve beneficial microbiota while still offering symptom relief. Finally, we found evidence for a link between microbial dynamics and FODMAP tolerance, although this needs to be confirmed in larger cohorts.

References

(1) Staudacher HM, Whelan K The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS Gut 2017;66:1517-1527.
(2) Van den Houte K, Colomier E, Routhiaux K, Mariën Z, Schol J, Van den Bergh J, Vanderstappen J, Pauwels N, Joos A, Arts J, Caenepeel P, De Clerck F, Matthys C, Meulemans A, Jones M, Vanuytsel T, Carbone F, Tack J. Efficacy and Findings of a Blinded Randomized Reintroduction Phase for the Low FODMAP Diet in Irritable Bowel Syndrome. Gastroenterology. 2024
(3) Carbone F, Van den Houte K, Besard L DOMINO Study Collaborators, et al Diet or medication in primary care patients with IBS: the DOMINO study - a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute Gut 2022;71:2226-2232.

Disclosure

JT has given Scientific advice to AlfaWassermann, Allergan, Christian Hansen, Danone, Grünenthal, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Neutec, Novartis, Noventure, Nutricia, Shionogi, Shire, Takeda, Theravance, Tramedico, Truvion, Tsumura, Zealand and Zeria pharmaceuticals, has received research support from Shire, Sofar and Tsumura, and has served on the Speaker bureau for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, Truvion and Zeria. Funding was provided by a Methusalem grant from Leuven University to JT This study was supported by a research grant from the Belgian Health Care Knowledge Centre (KCE).

Event

UEG Week Berlin 2025

Topics

Gut Microbiota Neurogastroenterology & Motility Small Intestine & Nutrition Colorectal

Submission format

Abstract

Session

Lower GI motility II

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Panel discussion: Therapy update - EoE

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Abstract

Event

UEG Week Berlin 2025

Topics

Mechanisms & Personalised Medicine Small Intestine & Nutrition Oesophagus Paediatrics

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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THE IMPACT OF FODMAP RESTRICTION AND REINTRODUCTION ON THE GUT MICROBIOTA OF PATIENTS WITH IRRITABLE BOWEL SYNDROME AND ITS ASSOCIATION WITH CLINICAL RESPONSE

Jeroen Raes

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Magnus Simrén

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Jordi Serra

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Chloé Melchior

UEG Presentation

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

BLOATING AND VISIBLE ABDOMINAL DISTENSION IN IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA: OVERLAPPING OR DISTINCT SYMPTOMS?

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BLOATING AND VISIBLE ABDOMINAL DISTENSION IN IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA: OVERLAPPING OR DISTINCT SYMPTOMS?

Tom van Gils 1, Ryo Katsumata 1, Jóhann Hreinsson 1, Douglas Drossman 2,3, Jan Tack 1,4, Hans Törnblom 1, Boris Le Nevé 5, Laurent Quinquis 5, Rim Hassouna 5, Max Julio Schmulson Wasserman 6, Shrikant I. Bangdiwala 7, Olafur S. Palsson 2, Magnus Simrén 1,2

Affiliations

1 University of Gothenburg, Gothenburg, Sweden

2 University of North Carolina/Chapel Hill, Chapel Hill, United States

3 The Rome Foundation, Raleigh, United States

4 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

5 Danone Global Research & Innovation, Gif-sur-Yvette, France

6 Universidad Nacional Autónoma de México, Mexico City, Mexico

7 McMaster University, Hamilton, Canada

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Abstract

Introduction

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut-brain interaction (DGBI), and bloating and visible abdominal distension are common symptoms among individuals with IBS and/or FD. Bloating refers to a subjective sensation of tension or pressure in the abdomen, which may or may not be reported together with visible abdominal distension. The underlying pathophysiological mechanisms may differ, with bloating suggested to be more related to hypersensitivity and visible abdominal distension to altered motility. The prevalence of these two symptoms in IBS and FD, especially as distinct symptoms, is not well known.

Aims & Methods

The aim was to investigate the link between bloating and distension with IBS and FD. Therefore, we performed a population-based internet survey of adults in the US, UK, and Mexico, including Rome IV IBS and FD diagnostic questions, somatization (PHQ-12), and psychological distress (PHQ-4). Four groups were created: those meeting the Rome IV criteria for IBS only, FD only, both IBS+FD, and a reference group including individuals without IBS, FD and organic diagnoses that could result in IBS- or FD-like symptoms. Within each group, we identified individuals who reported ≥weekly bloating alone (B), ≥weekly visible abdominal distension alone (D), ≥weekly combined B+D, or neither of both. The relationship between B, D and B+D in those with IBS and/or FD vs. the reference group was investigated using logistic regression models.

Results

The analysis included 5,448 participants (49.7% female; mean age 46.5 years, range 18-99), with 131 meeting criteria for IBS only, 360 for FD only, 217 for IBS+FD and 4,740 for the reference group. A larger proportion of individuals with IBS only (64.9%), FD only (50.6%), and especially those with IBS+FD (88.5%) reported bloating and/or visible abdominal distension compared to the reference group (13.7%). In the IBS only group, 16.0% reported bloating alone, 8.4% visible abdominal distension alone, and 40.5% combined bloating and visible abdominal distension. In the FD only group this was 12.8% (B), 8.9% (D), and 28.9% (B+D), and in the IBS+FD group 18.9% (B), 8.3% (D), and 61.3% (B+D), respectively. Reporting bloating alone or combined bloating and visible abdominal distension was strongly linked to fulfilling criteria for IBS only, FD only, and concomitant IBS+FD vs. the reference group, with weaker links for visible abdominal distension in the absence of bloating (Table). After adjusting for age, sex, BMI, psychological distress and somatization, the links persisted. The strongest association was observed between combined bloating and visible abdominal distension (vs. neither) and concomitant IBS+FD (vs. the reference group); adjusted odds ratio 28.6 [95%CI 17.6-46.6].

	IBS without FD vs. reference group Crude OR [95%]	FD without IBS vs. reference group Crude OR [95%CI]	IBS+FD vs. reference group Crude OR [95%CI]
Bloating alone^a	13.7 [8.0-23.6]	7.8 [5.4-11.2]	49.3 [29.1-83.4]
Visible abdominal distension alone^a	5.0 [2.5-9.7]	3.7 [2.5-5.6]	14.9 [8.0-27.9]
Combined bloating and visible abdominal distension^a	14.8 [9.8-22.3]	7.5 [5.8-9.8]	68.4 [44.0-106.5]
	IBS without FD vs. reference group Adjusted OR [95%]^b	FD without IBS vs. reference group Adjusted OR [95%]^b	IBS+FD vs. reference group Adjusted OR [95%]^b
Bloating alone^a	8.5 [4.6-15.5]	4.8 [3.1-7.2]	25.6 [14.5-45.1]
Visible abdominal distension alone^a	3.9 [1.9-7.9]	2.9 [1.9-4.5]	9.3 [4.9-17.9]
Combined bloating and visible abdominal distension^a	8.4 [5.1-13.6]	4.4 [3.2-6.0]	28.6 [17.6-46.6]
Table. Link between bloating and/or visible abdominal distension and IBS and FD ^a ≥weekly bloating and/or visible distension vs. <weekly bloating and distension or neither of both. ^b odds ratio based on logistic regression models, adjusted for age, sex, BMI, psychological distress (PHQ-4), and somatization (PHQ-12).

Conclusion

Bloating and visible abdominal distension as distinct and overlapping symptoms are strongly linked to IBS, FD, and concomitant IBS+FD in the general population. Assessing bloating and visible abdominal distension as separate symptoms may be important to enable individualized treatment for individuals with IBS and FD.

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Colorectal

Submission format

Abstract

Session

Lower GI motility I

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Carolina Malagelada

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Jeroen Raes

Panel discussion: Therapy update - EoE

BLOATING AND VISIBLE ABDOMINAL DISTENSION IN IRRITABLE BOWEL SYNDROME AND FUNCTIONAL DYSPEPSIA: OVERLAPPING OR DISTINCT SYMPTOMS?

Magnus Simrén

$How to manage refractory reflux$

How to manage refractory reflux

Jordi Serra

ARFID and IBS

Chloé Melchior

UEG Presentation

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

$How to manage refractory reflux$

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How to manage refractory reflux

Jordi Serra 1

Affiliations

1 University Hospital Vall d'Hebron, Barcelona, Spain

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Abstract

Event

UEG Week Berlin 2025

Topics

Oesophagus Primary Care Surgery

Session

Managing reflux at multiple levels

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Jeroen Raes

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Magnus Simrén

$How to manage refractory reflux$

How to manage refractory reflux

Jordi Serra

ARFID and IBS

Chloé Melchior

UEG Presentation

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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ARFID and IBS

Chloé Melchior 1

Affiliations

1 Rouen University Hospital, INSERM U1073, CIC-CRB-1404, Rouen, France

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Abstract

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Small Intestine & Nutrition Primary Care

Session

Disorders of gut‐brain interaction: Dietary restrictions

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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When chronic constipation ends and chronic intestinal pseudo-obstruction (CIPO) starts

Carolina Malagelada

THE IMPACT OF FODMAP RESTRICTION AND REINTRODUCTION ON THE GUT MICROBIOTA OF PATIENTS WITH IRRITABLE BOWEL SYNDROME AND ITS ASSOCIATION WITH CLINICAL RESPONSE

Jeroen Raes

Panel discussion: Therapy update - EoE

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Magnus Simrén

$How to manage refractory reflux$

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