Esophagus to Small Intestine
Aliment Pharmacol Ther. 2025;61(2):258-267
Clinical trial: Treatment of functional dyspepsia according to subtype compared with empirical proton pump inhibitor
Background: International guidelines recommend contrasting initial treatment strategies for functional dyspepsia (FD).
Aims: To evaluate the efficacy and safety of treatment according to subtypes, compared with empirical proton pump inhibitor (PPI), in the initial treatment of FD.
Methods: The authors performed a single-blinded, randomised controlled trial of adults with FD. In the intervention group (treatment according to subtype), patients were categorised into epigastric pain syndrome (treatment esomeprazole); postprandial distress syndrome (PDS; treatment itopride) and overlap (treatment itopride, maintain, add/or switch to esomeprazole at week 4). The control group received esomeprazole only. The primary efficacy outcome was the assessment of global symptom improvement (primary end point: best 2 points from the 7-point Likert scale) over 8 weeks. Secondary outcomes included assessment of the change in 9 individual upper gastrointestinal symptoms, quality of life (Short-Form Nepean Dyspepsia Index, SF-NDI) and adverse events.
Results: The authors randomised 180 patients (median age: 50; 68.7% female; 56.7% PDS) 1:1 into intervention and control arms. The percentage of patients achieving the primary efficacy outcome were 74.4% and 72.2%, respectively (p = 0.74). The improvement of individual symptoms in both groups were similar. The SF-NDI improved after treatment in both groups (p < 0.001) but there was no significant difference in the degree of change between groups. Rates of adverse events between groups were similar at week 8.
Conclusion: Initial treatment of functional dyspepsia according to subtype was not more effective than empirical proton pump inhibitor alone for up to 8 weeks. Further multicentre studies, with a larger sample size, are recommended to validate these findings.
DOI: 10.1111/apt.18418