Functional dyspepsia: Causes, treatments and new directions

Unfortunately, no medications exist specifically for improving stomach accommodation. However, buspirone (Buspar), a medication normally used for anxiety, is thought to improve stomach accommodation as well, and has been shown in a small number of studies to be effective in treating FD. Medications that make the stomach empty more quickly can also be tried for FD. However, many prokinetic medications are associated with significant adverse effects, and only one that has been studied for FD, metoclopramide (Reglan), is available for clinical use in the United States.

Recent research has also suggested that modifying the activity of the vagus nerve (the largest nerve carrying signals between the brain and the stomach), via electrical stimulation of the skin of the ear, may improve gastric accommodation. However, research into this treatment is in its early stages, and its effectiveness in relieving symptoms has not yet been studied in large groups of patients.

Limitations of current treatments open the door for novel treatments

While studies have shown that the above-mentioned treatments work better than placebo, many patients do not experience significant symptom improvement with them. Indeed, even the most effective FD medications only resolve symptoms in one out of six patients. As a result of this limited effectiveness, recent studies have looked at remedies not traditionally used in Western medicine.

For example, a recent Chinese study, published in the Annals of Internal Medicine, showed that a four-week course of acupuncture treatments eliminated symptoms in a greater percentage of individuals with distress after meals than a similar group receiving sham acupuncture treatments. Though additional studies are needed to confirm these findings, this study suggests that acupuncture could be an option for those with difficult-to-manage FD symptoms.

Understandable frustration, justifiable hope

FD remains a significant challenge for patients and physicians alike. Some may take comfort that FD is not a dangerous condition in terms of putting patients at increased risk of death. (One study of over 8,000 patients followed for 10 years showed no increase in risk of mortality in people with FD compared to those without FD).

Still, the bothersome and frequent symptoms remain a source of frustration for many. Yet hope does exist for those suffering with the condition, both from the judicious use of existing, evidence-based treatments and the potential emergence of novel treatments in the future.

(Vikram Rangan, M.D., is a contributor to Harvard Heart Publications.)