Belgian consensus on the management of patients with functional dyspepsia
| Journal | Volume 88 - 2025 |
| Issue | Fasc.2 - Expert Point of View |
| Author(s) | S. Kindt 1 2, J. Arts 3, P. Caenepeel 4, F. de Clerck 5, H. De Schepper 6, H. Louis 7, P. Latour 8, T. Mahler 9, S. Nullens 10 6, H. Piessevaux 11, K. Routhiaux 12, J. Schol 12, M. Surmont 1 2, H. Vafa 13, C. Van de Bruaene 12, K. Van Malderen 6, T. Vanuytsel 12, L. Wauters 12, F. Wuestenberghs 14, J. Tack 12 |
| Full article |
 PAGES 157-178 VIEW FREE PDF |
| DOI | 10.51821/88.1.14136 |
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Affiliations: (1) Vrije Universiteit Brussel (VUB), Brussels Health Campus/Faculty of Medicine and Pharmacy, Vitality Research Group, Laarbeeklaan 103, 1090 Brussels, Belgium
(2) Department of Gastro-enterology and Hepatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels Health Campus, Medische Dienst, Laarbeeklaan 101, 1090 Brussels, Belgium (3) Department of Gastroenterology, AZ Sint-Lucas, Brugge, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (4) Department of Gastroenterology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Genk, Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium; UHasselt, Hasselt, Belgium (5) Department of Gastroenterology, AZ St-Lucas, Gent Belgium; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (6) Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium (7) Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Brussels, Belgium (8) Department of Gastroenterology, Hepatology and Digestive Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium (9) Department of Pediatric Gastroenterology, Hôpital Universitaire de Bruxelles (H.U.B.), HUDERF, Brussels, Belgium (10) ZAS Hospitals Antwerp, Antwerp, Belgium (11) Department of Hepato-gastroenterology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium (12) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (13) Department of Gastroenterology and Hepatology, Chirec Delta Hospital, Brussels, Belgium (14) Sorbonne Paris Nord University, Department of Gastroenterology and Digestive Oncology, Avicenne Hospital, Paris Seine-Saint-Denis University Hospitals (HUPSSD); Greater Paris University Hospitals (AP-HP), Bobigny, France |
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Background: Functional dyspepsia (FD) is a disorder of gutbrain interaction characterised by epigastric pain, epigastric burning, early satiation or postprandial fullness. Despite its high prevalence, clinicians struggle with the diagnosis and management of these patients. Methods: A Delphi consensus was conducted by 20 experts from Belgium, and consisted of a literature review, summarising the existing evidence, and a voting process on 119 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. Results: Belgian consensus underlines the multifactorial aetiology of FD. In addition to the cardinal symptoms, bloating and weight loss are also observed in FD. Functional dyspepsia co-exists with other DGBIs, including IBS. Subtyping based on the postprandial nature of symptoms is recommended. Patients should receive a positive diagnosis. Additional testing is not routinely required before initiating therapy, except in the presence of alarm features or treatment-refractory symptoms, and can consist of upper GI endoscopy, abdominal imaging and gastric emptying testing. The consensus refuted the role of carbohydrate malabsorption testing, pyloric impedance planimetry, pH/impedance monitoring, food allergy testing and permeability testing in FD. Explanation and reassurance, also addressing lifestyle factors, represent the cornerstone of the management. Proton Pump Inhibitors are considered the firstline pharmacological treatment. With the exception of specific neuromodulators, the panel did not achieve consensus for other therapeutic options. This consensus recommends against restrictive diets, invasive endoscopic or surgical treatment, parenteral nutrition, antibiotics, spasmolytics and opioids in the management of FD. Conclusion: A panel of Belgian experts summarised the existing evidence on the aetiology, presentation, diagnosis and treatment of FD with attention to the availability within the Belgian healthcare system. Areas of future research are identified. Keywords: functional dyspepsia, Delphi consensus, diagnosis, treatment, aetiology. |
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© Acta Gastro-Enterologica Belgica. |
