Volume 88 - 2025 - Fasc.2 - Expert Point of View
Belgian consensus on the management of patients with functional dyspepsia
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: Consensus was reached for 64 statements. The
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.
Recommendations for the diagnosis and management of patients with chronic idiopathic diarrhea: Belgian multidisciplinary expert discussion based on a modified Delphi method
Background: Chronic diarrhea is one of the more common
reasons for referral to a gastro-enterologist. Chronic diarrhea
can have a broad range of causes, making it a disease entity
with a very extensive differential diagnosis. In a proportion of
patients, however, a cause for the chronic diarrhea cannot be
found and these patients are said to have chronic idiopathic
diarrhea (CID).
Methods: A Delphi model was used to establish a diagnostic
strategy for patients presenting with chronic diarrhea that
maximizes the chance for a positive diagnosis while minimizing
the number and invasiveness of the investigations. In addition,
the participating experts sought consensus on the different
treatment options that can be used in these patients.
Results: While a general consensus was reached on the
required diagnostic tests for CID, marked differences were
observed on the treatment preferences and strategies for these
patients among the different experts. The main reason for
this is the lack of solid scientific evidence with the different
treatment options in this setting (i.e., most data have been
generated in patients with IBS-D).
Conclusion: the Delphi-like process that was used for this
initiative proved to be a useful vehicle to fuel discussions on the
management of CID among experts with different backgrounds
and to sketch the current clinical practice.
