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Psychogenic dyspepsia — Clinical Guidelines

Overview

Functional dyspepsia is a common gastrointestinal disorder characterized by chronic upper abdominal symptoms such as epigastric pain, early satiety, and bloating, without identifiable organic causes 1 18.

Diagnosis

Key Diagnostic Criteria: Symptoms lasting ≥1 month, including postprandial fullness, early satiety, epigastric pain or burning, and no evidence of structural disease on endoscopy 1 18.

Recommended Tests: Initial evaluation should rule out organic causes (e.g., Helicobacter pylori infection, peptic ulcer disease) through endoscopy, serology, and breath tests 1 14 25.

Grading: Symptoms are often categorized based on predominant symptom patterns (e.g., ulcer-like, dysmotility-like, non-specific pain) 1 16.

Management

First-Line Treatments:

- Prokinetic Agents: Limited evidence; consider for dysmotility-like symptoms 23. - Psychological Interventions: Brief psychodynamic-interpersonal psychotherapy may be beneficial for chronic, intractable cases 39.

Adjunctive Treatments:

- Helicobacter pylori Eradication: Beneficial in some patients, particularly if infected 14 22. - Postbiotics: Inactivated Lactobacillus reuteri as adjuvant therapy shows promise in H. pylori eradication trials 4. - Antispasmodics: May provide symptomatic relief 21.

Special Populations

Pediatrics: Limited specific guidelines; focus on symptom management and psychological support 7 8.

Elderly: Consider comorbidities and polypharmacy impacts; tailored psychological support may be necessary 9.

Comorbidities: Address sleep disorders, as they may exacerbate symptoms 17.

Key Recommendations

Rule Out Organic Causes: Perform endoscopy and relevant tests to exclude structural abnormalities (Evidence: Strong 1 14).

Consider Psychological Interventions: For chronic, intractable cases, brief psychodynamic-interpersonal psychotherapy can be effective (Evidence: Moderate 39).

Evaluate H. pylori Status: Eradicate H. pylori in infected patients as it may improve symptoms (Evidence: Moderate 14 22).

Tailored Symptomatic Relief: Use prokinetic agents or antispasmodics based on symptom profile (Evidence: Weak 23).

Monitor and Manage Comorbidities: Address associated conditions like sleep disorders to improve overall symptom management (Evidence: Moderate 17).

References

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Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2025. link 4 Ivashkin V, Maev I, Poluektova E, Sinitsa A, Avalueva E, Mnatsakanyan M et al.. Efficacy and Safety of Postbiotic Contained Inactivated Lactobacillus reuteri ( Limosilactobacillus reuteri ) DSM 17648 as Adjuvant Therapy in the Eradication of Helicobacter pylori in Adults With Functional Dyspepsia: A Randomized Double-Blind Placebo-Controlled Trial. Clinical and translational gastroenterology 2024. link 5 Tran KT, Mai BH, Ta L, Dao LV, Tran HV, Tran MK et al.. Vietnam Association of Gastroenterology consensus for the diagnosis and treatment of functional dyspepsia. La Clinica terapeutica 2024. link 6 Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review. Gastroenterology 2023. link 7 He S, Chen L, Wang P, Xi X. 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Psychogenic dyspepsia