Cochrane for Clinicians

Putting Evidence into Practice

The Role of Proton Pump Inhibitor Therapy in Patients with Functional Dyspepsia

 

Am Fam Physician. 2018 Aug 1;98(3):152-153.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are proton pump inhibitors (PPIs) effective in reducing the symptoms of functional dyspepsia?

Evidence-Based Answer

There is moderate-quality evidence that PPIs are more effective than placebo at relieving overall symptoms in patients with functional dyspepsia (number needed to treat [NNT] = 11). Low-quality evidence suggests a small benefit of PPI therapy compared with prokinetics, and little to no benefit of PPI therapy vs. histamine H2 antagonists. Treatment effect was independent of dose or duration of therapy, and the combination of a PPI plus a prokinetic agent did not provide additional benefit.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Functional dyspepsia is a highly prevalent but poorly understood condition, affecting 10% to 15% of the U.S. population and accounting for 3% to 5% of North American primary care visits.2 The definition of functional dyspepsia has evolved over time, most recently characterized in the Rome IV criteria as having one or more of the following: postprandial fullness, early satiety, epigastric pain, or epigastric burning without evidence of structural disease.3 Gastric acid suppression is the most common treatment option, with PPIs being the most widely used agents. Despite their widespread use, the underlying therapeutic mechanism of PPIs in functional dyspepsia remains unclear.4 Given the developing concerns about long-term use of PPIs, including Clostridium difficile infection, pneumonia, and fracture risk,5 the authors of this review sought evidence supporting their clinical application.

This Cochrane review included 25 randomized controlled trials and 8,453 adult patients who met criteria for a diagnosis of functional dyspepsia. Included trials compared treatment with an orally administered PPI of any type to treatment with placebo, H2 antagonists (e.g., cimetidine [Tagamet]), or prokinetics (e.g., metoclopramide [Reglan]). Treatment duration

Author disclosure: No relevant financial affiliations.


The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of Defense, the U.S. Army, the U.S. Air Force, or the Uniformed Services University of the Health Sciences.

References

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1. Pinto-Sanchez MI, Yuan Y, Hassan A, Bercik P, Moayyedi P. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev. 2017;(11):CD011194....

2. Lacy BE, Weiser KT, Kennedy AT, Crowell MD, Talley NJ. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther. 2013;38(2):170–177.

3. Stanghellini V, Chan FK, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150(6):1380–1392.

4. Talley NJ. Review article: functional dyspepsia—should treatment be targeted on disturbed physiology? Aliment Pharmacol Ther. 1995;9(2):107–115.

5. Wilhelm SM, Rjater RG, Kale-Pradhan PB. Perils and pitfalls of long-term effects of proton pump inhibitors. Expert Rev Clin Pharmacol. 2013;6(4):443–451.

6. Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia [published correction appears in Am J Gastroenterol. 2017;112(9):1484]. Am J Gastroenterol. 2017;112(7):988–1013.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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