Targeting the altered duodenal microenvironment in functional dyspepsia.

Duodenal micro-inflammation and microbial dysregulation are increasingly recognized to play an important role in functional dyspepsia (FD) pathophysiology, previously regarded as a purely functional disorder. With current therapeutic options contested through insufficient efficacy or unfavorable adverse effects profiles, novel treatments directed to duodenal alterations could result in superior symptom control in at least a subset of patients. Indeed, recent advances in FD research provided evidence for anti-inflammatory therapies to relieve gastroduodenal symptoms by reducing duodenal eosinophils or mast cells. In addition, restoring microbial homeostasis by probiotics proved to be successful in FD. As the exact mechanisms by which these novel pharmacological approaches result in clinical benefit often remain to be elucidated, future research should focus on how immune activation and dysbiosis translate into typical FD symptomatology.

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Déclaration de conflit d'intérêts

Declaration of competing interest TV has received a research grant from My®Health to study the effect of spore-forming probiotics in functional dyspepsia. TV and LW have received speaker fees from My®Health. TV and LW are listed as inventors on a patent owned by My®Health regarding the effect of probiotics on IL17-related disorders. TV is supported by a senior clinical research fellowship of the Flanders Research Foundation (FWO Vlaanderen).