Functional dyspepsia: a complicated name for a common digestive disorder

Functional dyspepsia: a strange-sounding name for a condition you’re surely familiar with, since it affects almost 1 in 10 people, particularly women, smokers, and patients taking non-steroidal anti-inflammatory drugs (ibuprofen, ketoprofen). Functional dyspepsia is a common digestive disorder characterized by chronic pain or discomfort centered on the stomach.

Common symptoms are an unpleasant feeling of being too full after a normal-sized meal, of feeling full when you’ve just started eating, or of pain and/or burning at the bottom of the stomach. All this can last for weeks on end.

From dysbiosis to dyspepsia

While the many causes and mechanisms of functional dyspepsia are still poorly understood, the gut microbiota has been singled out for blame. For example, the Helicobacter pylori bacterium that sometimes makes itself at home in the stomach appears to be a major contributor to the development and progression of the disease, probably via inflammation of the gastrointestinal mucosa and disruption of gut motility.

In more general terms, the gut microbiota as a whole may be involved. This may be both directly (an imbalance in composition and abundance may lead to gut dysfunction) and via the bacterial metabolites it produces, which can have a protective (e.g. short-chain fatty acids (sidenote: Short chain fatty acids (SCFA) Short chain fatty acids (SCFA) are a source of energy (fuel) for an individual’s cells. They interact with the immune system and are involved in communication between the intestine and the brain. Silva YP, Bernardi A, Frozza RL. The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front Endocrinol (Lausanne). 2020;11:25. )  produced by Firmicutes) or harmful (pro-inflammatory sphingolipids produced by Bacteroidetes and Prevotellaceae) effect on the host.

Treatment via the microbiota

One direct consequence of the gastrointestinal microbiota’s involvement in functional dyspepsia is the search for solutions to restore this microbiota, and thus host’s (patient’s) health. Several trials ¹ on patients appear to show that probiotics can significantly improve symptoms by restoring the balance of the gut flora.

Another, slightly more aggressive, approach is the use of broad-spectrum antibiotics which eliminate undesirable bacteria. This nuclear option is highly effective, particularly in women, but causes considerable collateral damage to good bacteria. Hence the need for further research to better understand the mechanisms involved and propose targeted, effective diagnostic methods and treatments.