Abstract
Functional dyspepsia (FD) is a common disorder of gut-brain interaction, characterised by upper gastrointestinal symptom profiles that differentiate FD from the irritable bowel syndrome (IBS), although the two conditions often co-exist. Despite food and eating being implicated in FD symptom induction, evidence-based guidance for dietetic management of FD is limited. The aim of this narrative review is to collate the possible mechanisms for eating-induced and food-related symptoms of FD for stratification of dietetic management. Specific carbohydrates, proteins and fats, or foods high in these macronutrients have all been reported as influencing FD symptom induction, with removal of ‘trigger’ foods or nutrients shown to alleviate symptoms. Food additives and natural food chemicals have also been implicated, but there is a lack of convincing evidence. Emerging evidence suggests the gastrointestinal microbiota is the primary interface between food and symptom induction in FD, and is therefore a research direction that warrants substantial attention. Objective markers of FD, along with more sensitive and specific dietary assessment tools will contribute to progressing towards evidence-based dietetic management of FD.
Highlights
Functional dyspepsia is one of the commonest disorders of gut-brain interaction, previously termed functional gastrointestinal disorders (FGIDs), FD is further categorized into epigastric pain syndrome (EPS), or eating-related post-prandial distress syndrome (PDS) [2]
A short term low FODMAP diet trial may be appropriate for engaged, motivated people with FD who report symptoms following ingestion of high FODMAP foods or with suspected Small intestinal bacterial overgrowth (SIBO)
This paper provides guidance on how progress towards a more differential dietetic management approach may be achieved in FD management, and recommendations on how clinicians involved in FD management can collaborate on improving models of care for FD
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. A recent study reported that service reorientation towards a ‘dietitian-first’ gastroenterology clinic model in Australia for people with gastrointestinal symptoms (and no ‘red flags’ for structural disease) led to low re-referral rates up to 24 months post-discharge and lower health service usage compared to people who consulted through the traditional model of care [26] Together, these findings indicate that dietary intervention is a cornerstone strategy in IBS management. Nutrients 2021, 13, 1109 of presentation scenarios for people seeking dietary management advice for the condition, we believe that a differential dietary management approach for FD is needed This model would encompass the presentation history, primary symptoms, possible aetiology and pathophysiology be considered in formulation of a staged exclusion diet.
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