Categories
Change Password!
Reset Password!
The newly published S1 guidelines by German experts offer comprehensive, evidence-based recommendations for functional dyspepsia, helping clinicians better address this common gut-brain disorder.
The German Society for Neurogastroenterology and Motility (Deutsche Gesellschaft für Neurogastroenterologie und Motilität [DGNM]) has released a new S1 guideline offering an in-depth framework for diagnosing and managing functional dyspepsia (FD), a prevalent gastrointestinal (GI) disorder affecting around 10% of the global population. This guideline represents a multi-disciplinary collaboration aimed at improving outcomes for FD sufferers.
Diagnosis of FD
FD (irritable stomach) is classified under Disorders of Gut-Brain Interaction (DGBI) and is marked by persistent or recurring upper abdominal discomfort or pain without an identifiable organic cause. The updated guideline follows the internationally recognized Rome IV criteria, but places added emphasis on real-world diagnostic workflows suited to clinical practice in Germany.
It advocates a stepwise approach to diagnosis, beginning with basic lab work, Helicobacter pylori (H. pylori) testing, and abdominal ultrasound, followed by upper GI endoscopy if alarm features (e.g., unintended weight loss, GI bleeding, anemia) are present or symptoms are severe and persistent.
Treatment Strategies
The guideline emphasizes that treatment should be guided by the patient’s symptom pattern and psychological context, recognizing that FD involves complex interactions between the gut and the brain. Key treatment strategies encompass:
1. Patient-Centered Education
Physicians are advised to offer detailed explanations about FD, including the absence of structural disease and the role of stress and food, which can considerably alleviate health anxiety and improve adherence.
2. Nutritional and Lifestyle Interventions
Although no single diet suits all patients, clinicians must assess potential dietary triggers and consider individualized meal adjustments, such as reducing fat intake, smaller meals, and eliminating known irritants like alcohol or coffee.
3. Psychosocial Therapies
Mind-body interventions are essential, especially for those with significant psychosocial stress or psychiatric comorbidities. These include:
4. Pharmacologic Treatments
Drug therapy is symptom-specific and includes:
Importantly, the guideline advocates for judicious medication use, with regular reviews for efficacy and adverse effects. It also highlights the requisition for periodic reassessment, and in complex or refractory cases, referral to a specialized gastroenterology center is advised. The new guidance also recommends testing for and eradicating H. pylori infection in FD patients, especially in high-prevalence areas or if ulcer-like symptoms dominate. Successful elimination can lead to symptom resolution in a subset of patients.
What distinguishes the new guideline is its emphasis on a biopsychosocial model—highlighting that FD cannot be successfully tackled without addressing psychological and behavioral aspects alongside gastrointestinal symptoms. The guideline encourages healthcare providers to build a therapeutic relationship based on empathy, continuity, and shared decision-making.
Zeitschrift für gastroenterologie (German Journal of Gastroenterology)
S1 guideline of the German Society for Neurogastroenterology and Motility (DGNM) on functional dyspepsia (irritable stomach), a disorder of gut-brain interaction (DGBI)
Martin Storr et al.
Comments (0)