Functional Dyspepsia in Clinical Practice Current Recommendations and Future Perspectives

Abstract

Background:
Functional dyspepsia (FD) is a common disorder of gut–brain interaction and a major cause of chronic upper gastrointestinal symptoms and impaired quality of life. Current evidence challenges the traditional view of FD as solely a gastric motility disorder and indicates a multifactorial pathophysiology involving motor dysfunction, visceral hypersensitivity, duodenal immune activation, epithelial barrier impairment, gut microbiota alterations, and dysregulated gut–brain communication.

Aim:
To review current knowledge of the pathophysiology, clinical presentation, diagnosis, and evidence-based management of FD, with emphasis on emerging therapeutic targets and precision medicine.

Material and methods:
A narrative review was conducted using international clinical guidelines, systematic reviews, meta-analyses, randomized controlled trials, and translational studies concerning FD diagnosis, treatment, and recent advances in disease mechanisms.

Results:
FD is a heterogeneous disorder in which several overlapping biological mechanisms contribute to symptom generation. Diagnosis is primarily based on the Rome IV criteria after exclusion of structural disease. Established management includes lifestyle modification, Helicobacter pylori eradication, proton pump inhibitors, prokinetics, neuromodulators, and psychological therapies. Emerging approaches targeting the duodenal microenvironment, epithelial barrier, gut microbiota, and gut–brain axis are promising. Nevertheless, treatment efficacy remains modest because of biological heterogeneity and the lack of validated biomarkers for patient stratification.

Conclusions:
The evolving understanding of FD supports a shift from empirical symptom-based treatment toward individualized, mechanism-informed care. Future research should focus on clinically applicable biomarkers, improved phenotyping, and high-quality clinical trials to enable precision medicine and improve long-term outcomes.