Functional dyspepsia redefined: evidence supporting inflammatory dyspepsia – a systematic review
Gastroenterology and Hepatology from Bed to Bench,
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2 Esfand 2026
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Page 1-15 (e9)
https://doi.org/10.22037/ghfbb.v19i01.3287
Abstract
Aim: With growing evidence linking food antigens to inflammation and symptoms, our objective was to review the evidence for the impact of dietary factors on Functional dyspepsia (FD) pathogenesis.
Background: FD is a common gastrointestinal disorder characterised by postprandial fullness, early satiety, epigastric pain, and burning.
Methods: A systematic search of MEDLINE, EMBASE, PsycINFO, Scopus, and Cochrane databases was conducted for studies published between January 2000 and December 2024. Eligible studies included adults (≥18 years) with FD diagnosed using the Rome criteria. Data were synthesised narratively, and the risk of bias was assessed using ROBIS, RoB 2.0, and ROBINS-I tools.
Results: Fourteen studies met inclusion criteria, evaluating seven key dietary categories: FODMAPs/wheat, prebiotics/probiotics, capsaicin, peppermint–caraway and cinnamon oils, herbal therapies, medications, and ginger-based interventions. High-FODMAP foods, gluten, and capsaicin were linked to symptom exacerbation, with some studies noting impaired epithelial barrier function, immune activation, or microbiota alterations. Interventions with anti-inflammatory or microbiota-modulating effects, including probiotics, peppermint–caraway oil, herbal formulations, and ginger-based supplements, were found to mitigate symptoms.
Conclusion: Our findings show that specific dietary components can be implicated in inducing inflammation and symptoms in FD. Stress and anxiety might be another triggering factor for FD; hence, we see the utility of antidepressants in some cases. Since the symptoms are related to inflammation in most cases, we propose using ‘inflammatory dyspepsia’ to represent the true presentation for those patients with inflammation detected in their gastrointestinal mucosa. Large-scale randomised trials are needed to confirm findings and refine dietary guidelines.
- Diet
- Food
- functional abdominal pain
- Functional Dyspepsia (FD)
- functional dyspepsia
How to Cite
References
1. Stanghellini V, Chan FKL, Hasler WL, Malagelada JR, Suzuki H, Tack J, et al. Gastroduodenal disorders. Gastroenterology 2016;150:1380-92.
2. Pryor J, Burns GL, Duncanson K, Horvat JC, Walker MM, Talley NJ, et al. Functional dyspepsia and food: immune overlap with food sensitivity disorders. Curr Gastroenterol Rep 2020;22:51.
3. Lee MJ, Jung HK, Lee KE, Mun YC, Park S. Degranulated eosinophils contain more fine nerve fibers in the duodenal mucosa of patients with functional dyspepsia. J Neurogastroenterol Motil 2019;25:212-21.
4. Shah A, Fairlie T, Brown G, Jones MP, Eslick GD, Duncanson K, et al. Duodenal eosinophils and mast cells in functional dyspepsia: a systematic review and meta-analysis of case-control studies. Clin Gastroenterol Hepatol 2022;20:2229-42.
5. Wauters L, Ceulemans M, Frings D, Lambaerts M, Accarie A, Toth J, et al. Proton pump inhibitors reduce duodenal eosinophilia, mast cells, and permeability in patients with functional dyspepsia. Gastroenterology 2021;160:1521-31.
6. Ceulemans M, Jacobs I, Wauters L, Vanuytsel T. Immune activation in functional dyspepsia: bystander becoming the suspect. Front Neurosci 2022;16:831761.
7. Zhang X, Chen L, Zhang T, Gabo R, Wang Q, Zhong Z, Yao M, Wei W, Su X. Duodenal microbiota dysbiosis in functional dyspepsia and its potential role of the duodenal microbiota in gut-brain axis interaction: a systematic review. Front Microbiol 2024;15:1409280.
8. Vanheel H, Vanuytsel T, Farré R, Tack J. Authors' response: Impaired duodenal mucosal integrity and low-grade inflammation in functional dyspepsia. Gut 2015;64:357-8.
9. Goyal O, Nohria S, Batta S, Dhaliwal A, Goyal P, Sood A. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet versus traditional dietary advice for functional dyspepsia: a randomized controlled trial. J Gastroenterol Hepatol 2022;37:301‐9.
10. Du L, Shen J, Kim JJ, He H, Chen B, Dai N. Impact of gluten consumption in patients with functional dyspepsia: a case-control study. J Gastroenterol Hepatol 2018;33:128-33.
11. Zhang J, Wu HM, Wang X, Xie J, Li X, Ma J, et al. Efficacy of prebiotics and probiotics for functional dyspepsia: a systematic review and meta-analysis. Medicine 2020;99:e19107.
12. Agah S, Akbari A, Heshmati J, Sepidarkish M, Morvaridzadeh M, Adibi P, et al. Systematic review with meta-analysis: effects of probiotic supplementation on symptoms in functional dyspepsia. J Funct Foods 2020;68.
13. Fuhrer M, Vogelsang H, Hammer J. A placebo controlled trial of an oral capsaicin load in patients with functional dyspepsia. Gastroenterology 2011;140:802.
14. Lee SY, Masaoka T, Han HS, Matsuzaki J, Hong MJ, Fukuhara S, et al. A prospective study on symptom generation according to spicy food intake and TRPV1 genotypes in functional dyspepsia patients. Neurogastroenterol Motil 2016;28:1401-8.
15. Li J, Lv L, Zhang J, Xu L, Zeng E, Zhang Z, et al. A Combination of peppermint oil and caraway oil for the treatment of functional dyspepsia: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2019;2019:7654947.
16. Chumpitazi BP, Kearns GL, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther 2018;47:738-52.
17. Tong JZ, Qu B, Wang BB, Bai M. Pathogenesis of functional dyspepsia. World Chin J Digestol 2013;21:785-90.
18. Zobeiri M, Parvizi F, Shahpiri Z, Heydarpour F, Pourfarzam M, Memarzadeh MR, et al. Evaluation of the effectiveness of cinnamon oil soft capsule in patients with functional dyspepsia: a randomized double-blind placebo-controlled clinical trial. Evid Based Complement Alternat Med 2021;2021:6634115.
19. Wang X, Liu MA, He J, Zhao WZ, Wang YX, Yang LQ, et al. Dietary therapy of the herbal porridge improves the symptoms of functional dyspepsia: a randomized, double-blind, placebo-controlled, clinical trial. Food Sci Nutr 2024;12:2104‐14.
20. Vinson B, Fink C, Wargenau M, Talley NJ, Holtmann G. Double-blind, randomized, 8-week multicenter study of the efficacy and safety of STW 5-II versus placebo in functional dyspepsia. JGH Open 2024;8:e13054.
21. Giacosa A, Guido D, Grassi M, Riva A, Morazzoni P, Bombardelli E, et al. The effect of ginger (Zingiber officinalis) and artichoke (Cynara cardunculus) extract supplementation on functional dyspepsia: a randomised, double-blind, and placebo-controlled clinical trial. Evid Based Complement Alternat Med 2015;2015:915087.
22. Di Pierro F, Giovannone M, Saponara M, Ivaldi L. Effectiveness of a nutraceutical supplement containing highly standardized perilla and ginger extracts in patients with functional dyspepsia. Minerva Gastroenterol Dietol 2020;66:35-40.
23. Pagano E, Souto EB, Durazzo A, Sharifi‐Rad J, Lucarini M, Souto SB, et al. Ginger (Zingiber officinale Roscoe) as a nutraceutical: Focus on the metabolic, analgesic, and antiinflammatory effects. Phytother Res 2021;35:2403-17.
24. Pittayanon R, Yuan Y, Bollegala NP, Khanna R, Leontiadis GI, Moayyedi P. Prokinetics for functional dyspepsia. Cochrane Database Syst Rev 2018;10:CD009431.
25. Talley NJ, Holtmann G, Walker MM. Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology. J Gastroenterol 2015;50:601-13.
26. Rostami K, Ensari A, Marsh MN, Srivastava A, Villanacci V, Carroccio A, et al. Gluten induces subtle histological changes in duodenal mucosa of patients with non-coeliac gluten sensitivity: a multicentre study. Nutrients 2022;14:2487.
27. Goyal O, Nohria S, Batta S, Dhaliwal A, Goyal P, Sood A. Low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet versus traditional dietary advice for functional dyspepsia: a randomized controlled trial. J Gastroenterol Hepatol 2022;37:301-9.
28. Du L, Shen J, Kim JJ, He H, Chen B, Dai N. Impact of gluten consumption in patients with functional dyspepsia: a case–control study. J Gastroenterol Hepatol 2018;33:128-33.
29. Burns GL, Potter M, Mathe A, Bruce J, Minahan K, Barnes JL, et al. TRAV26-2 T-Cell receptor expression is associated with mucosal lymphocyte response to wheat proteins in patients with functional dyspepsia. Clin Transl Gastroenterol 2023;14:e00638.
30. Führer M, Vogelsang H, Hammer J. A placebo-controlled trial of an oral capsaicin load in patients with functional dyspepsia. Neurogastroenterol Motil 2011;23:918‐e397.
31. Liu T, Wan Y, Meng Y, Zhou Q, Li B, Chen Y, et al. Capsaicin: a novel approach to the treatment of functional dyspepsia. Mol Nutr Food Res 2023;67:e2200793.
32. Moayyedi P, Soo S, Deeks J, Forman D, Harris A, Innes M, et al. Systematic review: Antacids, H2-receptor antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer dyspepsia. Aliment Pharmacol Ther 2003;17:1215-27.
33. Shen X, Xie A, Li Z, Jiang C, Wu J, Li M, et al. Research progress for probiotics regulating intestinal flora to improve functional dyspepsia: a review. Foods 2024;13:151.
34. Igarashi M, Nakae H, Matsuoka T, Takahashi S, Hisada T, Tomita J, et al. Alteration in the gastric microbiota and its restoration by probiotics in patients with functional dyspepsia. BMJ Open Gastroenterol 2017;4:e000144.
35. Tziatzios G, Gkolfakis P, Papanikolaou IS, Mathur R, Pimentel M, Giamarellos-Bourboulis EJ, et al. Gut microbiota dysbiosis in functional dyspepsia. Microorganisms 2020;8:691.
36. Shah A, Talley NJ, Holtmann G. Current and future approaches for diagnosing small intestinal dysbiosis in patients with symptoms of functional dyspepsia. Front Neurosci 2022;16:830356.
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