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Germany's updated S1 guideline reshapes functional dyspepsia care by introducing a more focused diagnostic strategy and personalized treatment pathway supported by current clinical evidence.
Functional dyspepsia (FD), a common disorder of gut–brain interaction (DGBI), remains a common yet clinically challenging disorder because of its variable symptom presentation and absence of identifiable structural disease. The updated German S1 guideline offers practical recommendations to standardize diagnosis and optimize patient management.
(a) Diagnosis
The guideline estimates that around 1 in 10 people are affected by FD, making it one of the most common upper gastrointestinal (GI) disorders. Diagnosis should be guided by Rome IV criteria, with clinicians first excluding organic pathology before confirming FD.
The recommended evaluation includes:
The guideline discourages routine use of gastric emptying studies, esophageal pH monitoring, and other specialized investigations unless the clinical picture suggests alternative diagnoses such as gastroparesis or gastroesophageal reflux disease (GERD).
(b) Treatment
The guideline places patient education and lifestyle modification at the center of care, recommending dietary counselling, smoking cessation, and regular physical activity before escalating therapy.
Introduce psychoeducation early and consider cognitive behavioral therapy, psychodynamic psychotherapy, or hypnotherapy to improve global symptoms and quality of life. For patients requiring medication, the guideline recommends tailoring therapy to symptom profile rather than adopting a one-size-fits-all approach. Treatment options are as follows:
Gastroenterology Research and Practice
S1 Guideline of the German Society for Neurogastroenterology and Motility (DGNM) on Functional Dyspepsia (FD), a Disorder of Gut–Brain Interaction (DGBI) [English Language Edition]
M. Storr et al.
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