Therapy goals
- Improvement of the symptomatology
- Improvement of disease management
- If necessary, freedom from symptoms
Therapy recommendations
- Helicobacter pylori eradication: if Helicobacter pylori is found to be positive, eradication (complete elimination of the pathogen) should be given as first-line therapy (see gastritis/stomach mucosa inflammation for details); recommendation based on a meta-analysis in which eradication was shown to be more effective than placebo. Note: No “test-and-treat” strategy for Helicobacter pylori diagnosis but early endoscopic clarification!
- EPS (epigastric pain syndrome; Epigastric Pain Syndrome): first-line therapy a proton pump inhibitor (acid blocker), followed secondarily by a prokinetic (drug that increases peristalsis of the gastrointestinal tract; see below).
- PDS (postprandial stress syndrome; postprandial distress syndrome): first-line therapy a prokinetic; followed secondarily by a proton pump inhibitor.
- Acid inhibition:
- Proton pump inhibitors (PPIs; acid blockers) for “ulcer-like” and “reflux-like” dyspepsia.
- Ranitidine (H2 antihistamines/H2 blockers/drugs that reverse the effects of histamine).
- If necessary, also alginates, antacids; see also under pyrosis (heartburn).
Note: In non-ulcer dyspepsia, H2 blockers and antacids are suitable as well as proton pump inhibitors.
- Prokinetics: Domperidone (dopamine antagonists), prucalopride (serotonin receptor agonist); also proven effective are: Cisapride, metoclopramide, Itopir, cinitapride, clebopride, mosapride, tegaserod, and acotiamide (but are not available for the treatment of functional dyspepsia in Germany).
- Probiotics: see below supplements.
- Spasmolytics: Butylscopolamine, trospium chloride, peppermint oil (not for heartburn!).
- Antidepressants (second-line therapy): amitriptyline (in low dose), St. John’s wort.
- See also under “Further therapy”.
Further notes
- In FD complaints of the PDS (postprandial stress syndrome; postprandial distress syndrome; see classification below) phenotype, proton pump inhibitors and prokinetics should not be considered first-line therapies.
- Notice: After successful Helicobacter pylori eradication, sustained therapy with a proton pump inhibitor (proton pump inhibitors, PPI; acid blockers) resulted in a 2.44-fold increased risk (95 percent confidence interval: 1.42-4.20) of gastric cancer.
Phytotherapeutics
- STW 5 (effect on motility of the lower esophageal sphincter and colon); evidence level 1; dosage information: 3 × 20 drops.
- Methacarin (active ingredient combination of peppermint and caraway oil); Evidence level 2; Dosage instructions: 2 × 1 capsule.
- Peppermint / caraway oil
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Probiotics: Bifidobacteria, Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Lactobacteria, Saccharomyces boulardii, Saccharomyces cerevisiae.