Treatment Guidance of Functional Dyspepsia for Community Pharmacist

Abstract

Functional dyspepsia is a common disorder in drug store and an important problem which affects to public health system. Functional dyspepsia is defined as discomfort of upper abdominal region, in the absence of any organic disease by upper gastrointestinal endoscopy. Functional dyspepsia is classified into two types by predominant symptoms, postprandial distress syndrome (PDS) such as postprandial fullness or early satiation and epigastric pain syndrome (EPS). Community pharmacists have responsibility to provide pharmaceutical care for patients with functional dyspepsia. The first step of pharmaceutical care should assess the medical history, symptom severity and investigate alarm symptoms to consider about treatment settings of patients between drug store or referral to hospital. Treatment of functional dyspepsia should provide both pharmacotherapy with lifestyle modification. Pharmacotherapy should be based on predominant symptoms as follows: 1) prokinetic drugs (e.g. itopride, domperidone, metoclopramide and mosapride) are used as first line therapy for PDS. Selection of prokinetic drugs should focus on efficacy and safety of each medication to rational use for individual patient. For example, domperidone should be avoided in patients with cardiovascular diseases; 2) antisecretory drugs (e.g. proton pump inhibitors and histamine-2 receptor antagonists) are used as first line therapy for EPS. Proton pump inhibitors are more effective than histamine-2 receptor antagonists. For other gastrointestinal drugs such as antacid, which neutralized acid, found ineffective for the treatment of functional dyspepsia.