TABLE 4.

Summary of the ESNM consensus on FD

Recommendations	Based on statement(s)
Dyspepsia refers to a symptom or set of symptoms that are considered to originate from the gastroduodenal region. Early satiation, postprandial fullness, epigastric pain and epigastric burning are the cardinal dyspeptic symptoms.	1.1, 1.2
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. The vast majority of patients with dyspeptic symptoms and no alarm symptoms in the general population would be identified as FD after investigation (if performed).	1.3, 1.4
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.	1.5
Dyspeptic symptoms often co‐exist with other symptoms such as bloating in the upper abdomen, nausea and belching. Typical reflux symptoms and irritable bowel syndrome often coexists with FD.	1.6, 1.9, 1.11
(Functional) dyspepsia is more prevalent in women than men.	2.2
Acute GI infection and anxiety are risk factors for development of FD.	2.3; 2.6
FD is a major source of healthcare costs, self‐costs to patients and loss of work productivity.	3.1, 3.2, 3.3
FD is associated with a significant decrease in quality of life and with psychosocial co‐morbidities.	3.4, 3.5
Weight loss can be consequence of FD.	3.6
Healthcare consulting behavior in FD is driven by symptom severity and impact, and by psychosocial co‐morbidities.	3.8, 3.9
H. pylori is a cause of symptoms in a subgroup of patients with dyspepsia and normal endoscopy.	4.2
Impaired gastric accommodation, delayed gastric emptying, hypersensitivity to gastric distention and disordered central processing of incoming signals from the gastroduodenal region are pathophysiological mechanisms in FD	4.3, 4.4, 4.6, 4.15
Upper GI endoscopy is mandatory for establishing a diagnosis of FD, but in primary care, dyspepsia can be managed without endoscopy if there are no alarm of risk factors. The endoscopy is mandatory if there are alarm symptoms or risk factors	5.1, 5.2, 5.3
Every patient with dyspeptic symptoms should be tested for H. pylori (Hp) (non‐invasively or at gastroscopy). H. pylori positive FD patients should receive eradication therapy. Patients with dyspepsia and H. pylori positive gastritis should be considered to have FD if symptoms persist 6 to 12 months after H. pylori eradication. Patients with dyspepsia and H. pylori negative gastritis should be considered to have FD.	5.5, 5.6, 5.7, 6.2
FD should be subdivided into EPS and PDS for further diagnostic and therapeutic approach	5.8
PPI‐therapy is an effective therapy for FD.	6.4
In case of severe weight loss in FD, nutritional support may be needed.	6.27
The long‐term prognosis is favorable in the majority of patients with FD, whose life expectancy is similar to that of the general population.	7.1, 7.2