Functional Dyspepsia, 2016

Nicholas J. Talley; Marjorie M. Walker; Gerald Holtmann


Curr Opin Gastroenterol. 2016;32(6):467-473. 

In This Article

Central Dysregulation

The gut is abnormal in a subset with functional dyspepsia, but it is central processing that is required to precipitate the symptom experience. An excellent systematic review summarizes the accumulating evidence of brain dysfunction in cases with functional dyspepsia compared with healthy controls from 16 studies (including three gut distention studies).[28] A number of brain area changes have been observed in areas that process sensory signals and emotions as well as control homeostasis. The results, however, have not been consistent between studies, and disease controls (such as patients with nongut chronic pain) have not been included to assess the specificity of the findings. In another interesting report by Tominaga et al.,[29] the potential role of central serotonin pathways was examined in a small study using PET with a compound that specifically binds the serotonin transporter (SERT). The binding potential of SERT was upregulated in functional dyspepsia in both the thalamus and midbrain, correlating with symptoms, which suggests a key role for central serotonin pathways in functional dyspepsia.