Treatment of functional dyspepsia beyond proton pump inhibitors

Functional dyspepsia (FD) is a disorder of gut-brain interaction, characterized by early satiety, postprandial fullness, burning, and/or epigastric pain.It is divided into two subtypes according to Rome IV criteria, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS).Proton pump inhibitors (PPIs) are the first line of treatment; however, the response rate is only 30%.Therefore, this review presents therapeutic alternatives for patients with FD who do not respond to PPIs.Prokinetics promote gastric emptying; thus, they are a useful alternative in PDS.Regarding central neuromodulators, the evidence is greater with tricyclics; however, mirtazapine is an alternative in EPS and PDS.Rifaximin looks as a potential treatment, and the eradication of Helicobacter pylori (Hp) is controversial since the improvement of symptoms in the short term does not seem to differ from treatment with PPIs, and in the long term, it could be a consequence of the effect of antibiotics in modulating the microbiota rather than the eradication of Hp itself.