Functional dyspepsia: approaches to diagnosis and treatment in the context of Russian clinical practice

Introduction. Functional dyspepsia (FD) remains one of the most prevalent and diagnostically challenging disorders of the gastrointestinal tract. Despite the existence of the Rome IV Consensus and regional clinical guidelines, strategies for managing FD patients vary significantly across countries. Key differences pertain to diagnostic criteria, indications for esophagogastroduodenoscopy (EGD), and therapeutic approaches, particularly in the management of refractory FD. Objective. To analyze international and Russian approaches to the diagnosis and treatment of FD, with a focus on identifying the most effective and evidence-based clinical strategies. Key points. A comparative analysis of current clinical guidelines reveals significant discrepancies in FD diagnostic criteria. In some countries, a diagnosis can be established if symptoms persist for one month, whereas the Rome IV criteria require a minimum duration of six months. Indications for EGD also vary, in Russia it is recommended for patients presenting with alarm symptoms or those over the age of 40—45 years. To date, there is no standardized approach to treating refractory FD, although the use of agents traditionally employed for idiopathic gastroparesis appears to be a promising avenue. Conclusion. FD management necessitates an individualized approach that considers regional healthcare characteristics. There is a need to revise rigid diagnostic timelines and standardize treatment strategies for refractory FD. Further research should focus on optimizing therapeutic strategies and exploring novel pathophysiologically justified treatment modalities.