This is a new guideline from British Society of Gastroenterology (BSG) on functional dyspepsia, which replaces their previous guideline on dyspepsia. I will outline the main new points in the guideline and then summarise the bits of the guideline I found particularly helpful, or were new to me.
What is new in BSG’s guideline?
- Most patients with dyspepsia have functional dyspepsia (FD).
- In the absence of red flag symptoms and signs, we should diagnose FD if there is bothersome epigastric pain or burning, early satiation and/or postprandial fullness that has been going on for 8w or more.
- There is no evidence that patients with FD overproduce acid.
- FBC should be done on all those over 55.
- Coeliac screening should be done on those who also have features of IBS, but not those with just symptoms of FD.
- H Pylori testing should be done on all those not being referred for endoscopy or CT scan. If positive they should have eradication. This is different to the NICE guideline which advises that we can choose either treating first line, or H
- Pylori testing first line.
- We should explain to patients that FD is a condition of the gut-brain axis. We should explain how the gut-brain axis works and the impact of diet, stress, cognitive, emotional and behavioural responses to symptoms and post-infective changes.
- Tricyclic antidepressants can be used at low dose as second-line management and are effective.
Who is more likely to get functional dyspepsia?
80% of those with symptoms of dyspepsia have FD.
The following features of FD are useful to be aware of:
- It is more likely in females, younger patients, those with other somatoform type symptoms, those with other disorders of the gut-brain axis (eg IBS).
- Up to 50% of patients will also have IBS type symptoms. Functional diarrhoea, functional constipation, functional bloating and distension will all often overlap.
- A history of anxiety / depression makes FD more likely.
- A history of abuse is more common in patients with FD.
- Acute enteric infection is associated with the onset of symptoms (post-infective FD).
- GORD is common in FD (about 1/3 of patients with FD also have GORD). The most common feature in GORD, is pain that radiates up into the chest.
- Around 2/3 of patients will have chronic symptoms.
- Symptoms often fluctuate.
