TABLE 3.
All statements with endorsement and references
| Statement | Endorsement | Grade of Evidence | References |
|---|---|---|---|
| 1.1. Dyspepsia refers to a symptom or set of symptoms that is (are) considered to originate from the gastroduodenal region. | Yes | B | 1, 2, 3, 4 |
| 1.2. Early satiation, postprandial fullness, epigastric pain, and epigastric burning are the cardinal dyspeptic symptoms as defined by Rome IV. | Yes | B | 1, 2, 3, 4 |
| 1.3. Functional dyspepsia (FD) is a condition characterized by chronic dyspeptic symptoms in the absence of organic, systemic or metabolic condition(s) that is (are) likely to explain symptoms. | Yes | A | 1, 2, 3, 4 |
| 1.4. The vast majority of patients with dyspeptic symptoms and no alarm symptoms in the general population is identified as FD after investigation (if this would be done). | Yes | A | 1, 4 |
| 1.5. Two main subtypes of FD are distinguished which may overlap: postprandial distress syndrome (PDS) characterized by meal‐induced symptoms (early satiation, postprandial fullness) and epigastric pain syndrome (EPS), with epigastric pain and/or epigastric burning not necessarily associated with a meal. | Yes | B | 1, 3, 10, 11 |
| 1.6. Dyspeptic symptoms often co‐exist with other symptoms such as bloating in the upper abdomen, nausea and belching. | Yes | A | 1, 7 |
| 1.7. Bloating or visible distention in the upper abdomen is a dyspeptic symptom. | No | B | 1, 10, 11 |
| 1.8. The use of pictograms helps to characterize the presence and nature of dyspeptic symptoms. | No | C | 1, 10, 11 |
| 1.9. Typical reflux symptoms (heartburn, regurgitation) often co‐exist with dyspeptic symptoms in the general population. | Yes | A | 12, 13, 14, 15, 16 |
| 1.10. Gastro‐esophageal reflux disease may be distinguished from FD using dedicated questionnaires or good history taking. | No | C | 12, 13, 14, 15, 16 |
| 1.11. Irritable bowel syndrome often coexists with FD. | Yes | A | 12, 13, 14, 15, 16 |
| 2.1. (Functional) dyspepsia occurs at all ages but the highest incidence is in the middle age. | No | B | 12, 13, 14, 15, 16,19, 20, 21, 22 |
| 2.2.(Functional) dyspepsia is more prevalent in women than men | Yes | A | 12, 13, 14, 15, 16,19, 20, 21, 22 |
| 2.3. Acute GI infection is a risk factor for development of FD. | Yes | A | 23, 24, 25, 26, 27 |
| 2.4. NSAID intake is a risk factor for development of FD. | No | C | 28, 29, 30, 31 |
| 2.5. Antibiotic therapy is a risk factor for development of FD. | No | C | 28, 29, 30, 31 |
| 2.6. Anxiety is a risk factor for development of FD | Yes | A | 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 |
| 2.7. Depression is a risk factor for development of FD. | No | B | 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 |
| 2.8. Smoking is a risk factor for development of FD. | No | C | 49, 50, 51, 52, 53, 54 |
| 3.1. FD is a major source of healthcare costs. | Yes | A | 55, 56, 57, 58 |
| 3.2. FD is a major source of self‐costs to patients. | Yes | B | 55, 56, 57, 58 |
| 3.3. FD is an important source of loss of work productivity. | Yes | B | 56, 57, 59 |
| 3.4. FD is associated with a significant decrease in quality of life. | Yes | A | 60, 61, 62 |
| 3.5. FD is associated with psychosocial co‐morbidities such as anxiety and depression | Yes | A | 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 48 |
| 3.6. Weight loss can be consequence of FD | Yes | B | 49, 63, 64, 65, 66, 67 |
| 3.7. In case of weight loss, eating disorders must be ruled out. | No | C | 49, 63, 64, 65, 66, 67 |
| 3.8. Healthcare consulting behavior in FD is driven by symptom severity and impact. | Yes | B | 57, 68, 69, 70 |
| 3.9. Healthcare consulting behavior in FD is driven by psychosocial comorbidity. | Yes | B | 36, 71 |
| 3.10. Healthcare consulting behavior in FD is driven by access to the healthcare system. | No | B | 68, 70, 71 |
| 4.1. Dietary factors underlie symptom generation in FD. | No | C | 57, 73, 74, 75, 76, 77, 78, 79 |
| 4.2. H. pylori is a cause of symptoms in a subgroup of patients with dyspepsia and normal endoscopy. | Yes | B | 80, 81, 82 |
| 4.3. Impaired gastric accommodation is a pathophysiological mechanism in FD. | Yes | B | 63, 67, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93 |
| 4.4. Delayed gastric emptying is a pathophysiological mechanism in FD. | Yes | B | 91, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102 |
| 4.5. Rapid gastric emptying is a pathophysiological mechanism in FD. | No | C | 99, 101, 102 |
| 4.6. Hypersensitivity to gastric distention is a pathophysiological mechanism in FD. | Yes | B | 64, 91, 100, 101, 102, 103, 104, 105, 106, 107, 108 |
| 4.7. Duodenal mucosal alterations are a pathophysiological mechanism in FD. | No | B | 109, 110, 111, 112, 113, 114, 115, 116, 117 |
| 4.8. Altered gastric acid secretion is a pathophysiological mechanism in FD. | No | C | 118, 119, 120 |
| 4.9. Altered release of peptide hormones is a pathophysiological mechanism in FD. | No | C | 121, 122, 123, 124 |
| 4.10. Increased sensitivity to duodenal luminal content is a pathophysiological mechanism in FD. | No | C | 127, 128, 129, 130 |
| 4.11. Altered duodenal microbiota composition is a pathophysiological mechanism in FD. | No | C | 131, 132 |
| 4.12. Impaired vagus nerve function is a pathophysiological mechanism in FD. | No | C | 133, 134, 135, 136, 137, 138 |
| 4.13. Anxiety and stress are pathophysiological mechanisms in FD. | No | B | 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 |
| 4.14. Depression is a pathophysiological mechanism in FD. | No | B | 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 48 |
| 4.15. Disordered central processing of incoming signals from the gastroduodenal region is a pathophysiological mechanism in FD. | Yes | C | 139, 140, 141, 142, 143, 144 |
| 4.16. Genetic factors determine the susceptibility to FD. | No | C | 145, 146, 147, 148 |
| 5.1. Upper GI endoscopy is mandatory for establishing a diagnosis of FD. | Yes | A | 1, 10, 149, 150, 151 |
| 5.2. In primary care, uninvestigated dyspepsia can be managed without endoscopy if there are no alarm of risk factors. | Yes | A | 149, 150, 151 |
| 5.3. Upper GI endoscopy is mandatory if there are alarm symptoms or risk factors. | Yes | A | 1, 10, 149, 150, 151 |
| 5.4. Screening blood test are useful when considering a diagnosis of FD. | No | B | 149, 150, 151 |
| 5.5. Every patient with dyspeptic symptoms should be tested for H. pylori (non‐invasively or at gastroscopy). | Yes | A | 1, 10, 81, 149, 150, 153, 154 |
| 5.6. Patients with dyspepsia and H. pylori positive gastritis should be considered to have FD just if symptoms persist 6 to 12 months after H. pylori eradication. | Yes | B | 1, 81, 155 |
| 5.7. Patients with dyspepsia and HP negative gastritis should be considered to have FD. | Yes | B | 1, 81, 155 |
| 5.8. FD should be subdivided into EPS and PDS for further diagnostic and therapeutic approach. | Yes | B | 3, 11, 156, 157, 158, 159, 160, 161, 162 |
| 5.9. Upper abdominal ultrasound is useful when considering a diagnosis of FD. | No | B | 1, 150, 165, 166 |
| 5.10. A gastric emptying test is useful when considering a diagnosis of FD. | No | B | 1, 91, 150, 167, 168 |
| 5.11. Esophageal pH monitoring is useful in FD to rule out GERD. | No | B | 13, 169, 170, 171 |
| 5.12. Increased duodenal eosinophil count is a marker of FD. | No | C | 13, 169, 170, 171 |
| 5.13. Impaired nutrient volume tolerance is a marker of FD. | No | B | 63, 67, 86, 173, 174, 175, 176 |
| 6.1. Dietary adjustment improves symptoms in FD. | No | C | 57, 73, 74, 75, 76, 77, 78, 79 |
| 6.2. H. pylori positive FD patients should receive eradication therapy. | Yes | A | 1, 81, 150, 160, 177 |
| 6.3. PPI therapy is the most appropriate initial therapy for FD. | No | B | 150, 178, 179, 180, 181, 182, 183, 184, 185, 186 |
| 6.4. PPI therapy is an effective therapy for FD. | Yes | A | 150, 178, 179, 180, 181, 182, 183, 184, 185, 186 |
| 6.5. PPI therapy is most effective for EPS. | No | C | 150, 177, 186 |
| 6.6. Prokinetic therapy is the most appropriate initial therapy for FD. | No | C | 150, 187, 188, 189 |
| 6.7. Prokinetic therapy is an effective therapy for FD. | No | B | 150, 187, 188, 189 |
| 6.8. Prokinetic therapy is most effective for PDS. | No | B | 150, 187, 188, 189 |
| 6.9. Efficacy of prokinetics is not related to their enhancement of gastric emptying rate. | No | B | 150, 187, 188, 189 |
| 6.10. Itopride is effective for FD patients. | No | C | 190, 191, 192, 193 |
| 6.11. Tricyclic antidepressants are effective for epigastric pain syndrome (EPS). | No | B | 194, 195, 196, 197 |
| 6.12. Tricyclic antidepressants are effective for post‐prandial distress syndrome (PDS). | No | B | 194, 195, 196, 197 |
| 6.13. Tricyclic antidepressants are not effective for post‐prandial distress syndrome (PDS). | No | B | 194, 195, 196, 197,194, 195, 196, 197 |
| 6.14. Serotonin reuptake inhibitors are effective for FD. | No | B | 195, 198 |
| 6.15. Serotonin reuptake inhibitors are not effective for FD. | No | B | 195, 198 |
| 6.16. Serotonin noradrenaline reuptake inhibitors are effective for FD. | No | C | 195, 198 |
| 6.17. Serotonin noradrenaline reuptake inhibitors are not effective for FD. | No | C | 195, 198 |
| 6.18. Mirtazapine is effective for post‐prandial distress syndrome patients with weight loss. | No | B | 200, 201 |
| 6.19. 5‐HT1A agonists (tandospirone, buspirone, ….) are effective for PDS. | No | B | 202, 203, 204, 205, 206 |
| 6.20. Herbal therapies are effective for FD patients. | No | B | 209, 210 |
| 6.21. Iberogast (STW‐5) is effective for FD patients. | No | B | 192, 206, 207 |
| 6.22. Rifaximin is effective for FD patients. | No | C | 192, 206, 207 |
| 6.23. Hypnotherapy is effective for FD patients. | No | B | 192, 206, 207 |
| 6.24. Cognitive–behavioral therapy (CBT) is effective for FD patients. | No | B | 213, 214 |
| 6.25. Acupuncture is effective for FD patients. | No | B | 215, 216, 217, 218 |
| 6.26. Mindfulness is effective for FD patients. | No | B | 215, 216, 217, 218 |
| 6.27. In case of severe weight loss in FD, nutritional support may be needed. | Yes | B | 215, 216, 217, 218 |
| 7.1. The long‐term prognosis is favorable in the majority of patients with FD. | Yes | B | 49, 221, 222 |
| 7.2. Life expectancy in FD is similar to the general population. | Yes | A | 224, 225 |