Functional Dyspepsia & Current Research

Dyspepsia is characterized by the presence of chronic symptoms without mucosal lesions or structural abnormalities for at least three months.¹ The etiology of functional dyspepsia is not well understood, but motility disorders, visceral hypersensitivity has been elucidated.  Inflammation after helicobacter pylori infection and evanescent ulcers are also associated with functional dyspepsia. Food intolerance and psychosocial factors may also contribute to the pathophysiology of dyspepsia. Pyrosis suggests a variety of imbalances in the gastrointestinal tract, such as hypochlorhydria or hyperchlorhydria. Stomach acid imbalance is a known mechanism in functional disorders like dyspepsia.

Functional gastrointestinal disorders are symptom-based, and do not rely on morphological changes to make a diagnosis. As a result, making a diagnosis can be difficult, but investigating the root causes can be revealing. Symptoms of upper gastrointestinal dysfunction may overlap other syndromes, such as irritable bowel syndrome.

Gastrointestinal motility is suspected to contribute to the etiology of functional dyspepsia. The enteric nervous system relies on the enteroendocrine cells to produce serotonin, which regulates vascular tone, pain perception, and gut motility.² Without adequate serotonin, peristalsis and smooth muscle relaxation or contraction within the gut will be affected.  Additionally, sex hormones (estrogen, progesterone and testosterone) appear to demonstrate significant effects on serotonin receptors and serotonin metabolism.

Risk factors for the development of dyspepsia include NSAIDS, bisphosphonate, corticosteroids, carbohydrate malabsorption, food intolerances, and anxiety.

Patients with functional dyspepsia and H.pylori infection often have metallic taste in their mouth due to side effect of triple antibiotic treatment. In patients completing antibiotic treatment for eradication of H.pylori 58 of 75 patients experienced a metallic taste in their mouth after completing triple antibiotics containing clarithromycin, metronidazole, and amoxicillin.³ Honey and green tea have both been investigated in research completed by Boyanova et al. ⁴ demonstrating lowering risk of H.pylori infection. Honey alters the pH of the stomach, and appears to have an osmotic effect. Both green and black teas contain polyphenolic catechins, which inhibit gastric inflammation. The analysis of the study show a lower risk in participants consuming honey 1 or more days a week and green/black tea consumers compared to non-consumers.

Iberogast is an herbal combination of eight herbs that have been shown effective in the treatment of functional disorders of the gastrointestinal tract by targeting the enteric nervous system.⁵ The herbal combination consists of the following herbs: Chelidonii herba, Cardui mariae fructus, Melissae folium, Carvi fructus, Liquiritiae radix, Angelicae radix, Matricariae flos, and Menthae piperitae folium. Iberogast (STW5) has shown effective in the treatment of dyspepsia targeting sympathetic receptors; reducing adrenaline responses in the fundus of the stomach.⁶ Iberogast has also been shown effective in cases where there is resistant stress response in the stomach.

Chaihu-Shugan-San (CSS) is a Chinese formulation composed of Radix Bupleuri, Pericarpium Citri Reticulatae, Radix Paeonia Alba, Radix Glycyrrhizae,

Fructus Aurantii, Rhizoma Chuanxiong, and Rhizoma Cyperi, which has been used to treat various gastrointestinal disorders. The formulation appears to alter the gastric motility, and acts as a protkinetic. In a meta-analysis of Chaihu- Shugan powder completed in 2013, including 2,527 patients with chronic gastritis, efficacy was evaluated compared to chemotherapy.⁷ Results of the analyses show a significant increase in symptom improvement compared to chemotherapy.

1.           Domino, Frank J. The 5-minute Clinical Consult Standard. Philadelphia, PA: Wolters Kluwer Health; 2015. 380-381 p.

2.           Sandberg-Lewis, S. Functional Gastroenterology.  Portland, OR: NCNM Pres; 2009. 24-34. 

3.           Ghosh P, Kandhare AD, Gauba D, Raygude KS, Bodhankar SL. Determination of efficacy, Adverse drug reactions and cost effectiveness of three triple drug regimens for the treatment of Helicobacter pylori infected acid peptic disease patients. Asian Pacific J Trop Dis. 2012;2(SUPPL2):S783-S789. doi:10.1016/S2222-1808.12.60265-5.

4.           Boyanova L, Ilieva J, Gergova G, Vladimirov B, Nikolov R, Mitov I. Honey and green/black tea consumption may reduce the risk of Helicobacter pylori infection. Diagn Microbiol Infect Dis. 2015;82(1):85-86. doi:10.1016/j.diagmicrobio.2015.03.001.

5.           Saller, R., Pfister-Hotz, G., Iten, F., Melzer, J., & Reichling, J. (2002). [Iberogast: a modern phytotherapeutic combined herbal drug for the treatment of functional disorders of the gastrointestinal tract (dyspepsia, irritable bowel syndrome)--from phytomedicine to" evidence based phytotherapy." A systematic review]. Forschende Komplementarmedizin und klassische Naturheilkunde= Research in complementary and natural classical medicine, 9, 1-20.

6.           Abdel-Aziz H, Wadie W, Zaki HF, et al. Novel sequential stress model for functional dyspepsia: Efficacy of the herbal preparation STW5. Phytomedicine. 2015;22(5):588-595. doi:10.1016/j.phymed.2015.03.012.

7.           Qin F, Liu J-Y, Yuan J-H. Chaihu-Shugan-San, an oriental herbal preparation, for the treatment of chronic gastritis: A meta-analysis of randomized controlled trials. J Ethnopharmacol. 2013;146(2):433-439. doi:10.1016/j.jep.2013.01.029.