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FUNCTIONAL DYSPEPSIA REDEFINED: EVIDENCE SUPPORTING INFLAMMATORY DYSPEPSIA – A SYSTEMATIC REVIEW

Lauren Phang 1, Kamran Rostami 2, Alice Hyun Min Kim 1

Affiliations

1 University of Otago, Wellington, New Zealand

2 Palmerston North DHB, Palmerston North, New Zealand

Summary

AI Generated

A systematic review of 14 studies finds that specific dietary factors including FODMAPs, gluten, capsaicin, and herbal remedies significantly influence functional dyspepsia symptoms, prompting the authors to propose reclassifying the condition as inflammatory dyspepsia.

A low FODMAP diet significantly improved functional dyspepsia symptoms (p=0.04), and gluten intake was linked to early satiety (p=0.03).
Capsaicin significantly exacerbated symptoms (p<0.001) and spicy foods were associated with increased gastric fullness (p=0.001).
Peppermint-caraway oil (p<0.00001) and cinnamon oil (p<0.001) demonstrated significant symptom relief, while ginseng-based herbal porridge achieved higher remission rates by day 90 compared to placebo (45.71% vs 20.69%, p=0.036).
Amitriptyline relieved symptoms in 53% of patients, outperforming placebo (40%) and escitalopram (38%), particularly in ulcer-like functional dyspepsia.
The authors propose the term inflammatory dyspepsia to better reflect the role of dietary triggers and immune pathways in symptom generation, though large-scale trials are needed to confirm findings.

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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.

Abstract

Introduction

Functional dyspepsia (FD) is a common yet complex gastrointestinal disorder, characterised by postprandial fullness, early satiety, epigastric pain, and burning. With growing evidence linking diet to inflammation and symptoms, our objective was to review the evidence for the impact of dietary factors on FD symptomatology.

Aims & Methods

A systematic review was conducted to identify dietary components influencing FD symptoms in adults. Databases searched included MEDLINE, EMBASE, PsycINFO, Scopus, and Cochrane, covering January 2000 to December 2024. A total of 14 studies met eligibility criteria, with findings synthesised through narrative analysis.

Results

The search strategy yielded 18,424 articles, of which 14 met the inclusion criteria. Analysis identified seven key dietary components associated with FD: (1) a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet significantly improved symptoms (p = 0.04), while gluten intake was linked to early satiety (p = 0.03); (2) probiotics or prebiotics provided symptom relief (RR 1.15, p = 0.52), with probiotics alone showing a trend toward improved FD scores (RR 1.35, p = 0.061); (3) capsaicin significantly exacerbated symptoms (p < 0.001), and spicy foods were associated with increased gastric fullness (p = 0.001); (4) both peppermint-caraway oil (p < 0.00001) and cinnamon oil (p < 0.001) demonstrated significant symptom relief; (5) ginseng-based herbal porridge led to a higher rate of epigastric symptom remission by day 90 compared to placebo (45.71% vs. 20.69%, p = 0.036), while the STW 5-II formulation (a nine-herb extract) also yielded significant improvement (p = 0.008); (6) prokinetic agents reduced symptom severity (RR 0.81, p < 0.0001), while amitriptyline outperformed both placebo (40%) and escitalopram (38%), relieving symptoms in 53% of patients—particularly those with ulcer-like FD; and (7) ginger/artichoke capsules improved symptoms within 14 days (p = 0.017), while ginger/perilla tablets offered progressive relief over one to two weeks (p < 0.05 and p < 0.01, respectively). Study quality was assessed using ROBIS, RoB 2.0, and ROBINS-I tools. Of the included studies, three were rated as low risk of bias, eight as moderate, and three as serious. Despite adherence to a standardised PRISMA-based search strategy, variability in outcome reporting limited direct comparability across studies.

Table 1

Author	Study type	Outcomes	Author	Study type	Outcomes
Goyal (2022)	RCT	Both low-FODMAP diet and traditional dietary advice significantly improve FD symptoms.	Zobeiri (2021)	RCT	Both cinnamon oil and placebo showed improvements in gastrointestinal symptoms.
Du (2018)	Case-control	Gluten-rich diets may trigger FD symptoms, notably early satiety.	Wang (2024)	RCT	Herbal porridge is an effective and safe option for improving symptoms in FD patients.
Zhang (2020)	Systematic Review and Meta-Analysis	Probiotics and prebiotics showed positive effects on FD symptom scores, but data was limited.	Vinson (2024)	RCT	STW 5-II herbal extract is effective and safe for up to 8 weeks in patients with FD meeting Rome II or IV criteria.
Agah (2020)	Systematic Review and Meta-Analysis	Probiotics may improve GI symptoms in FD patients but high-quality RCTs are required to confirm this.	Pittayanon (2019)	Systematic Review and Meta-Analysis	Prokinetics may help alleviate FD symptoms, but the evidence quality was low.
Fuhrer (2011)	RCT	There is evidence that FD patients show chemical hypersensitivity in response to capsaicin.	Talley (2015)	RCT	Amitriptyline was more effective than both placebo and escitalopram in providing symptom relief, showing a greater benefit in patients with ulcer-like FD.
Lee (2016)	Prospective study	Capsaicin-rich foods likely contribute to feelings of stomach fullness.	Giacosa (2015)	RCT	Ginger and artichoke leaf extracts are safe and effective in treating FD.
Li (2019)	Systematic Review and Meta-Analysis	Peppermint oil and caraway oil is an effective and safe short-term treatment for FD, but evidence quality was low.	Di Pierro (2020)	Retrospective cohort study	The perilla/ginger supplement may serve as an effective natural option for FD.

Conclusion

This review highlights dietary interventions as a promising strategy for managing FD. Our findings show that specific dietary components can be implicated in inducing inflammation and symptoms in FD. Since the symptoms are related to inflammation, we propose using “inflammatory dyspepsia” to represent the true presentation of this form of dyspepsia. Large-scale randomised trials are needed to confirm findings and refine dietary guidelines.

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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