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World J Gastroenterol. Feb 7, 2020; 26(5): 456-465
Published online Feb 7, 2020. doi: 10.3748/wjg.v26.i5.456
Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives
Marcella Pesce, Martina Cargiolli, Sara Cassarano, Barbara Polese, Barbara De Conno, Laura Aurino, Nicola Mancino, Giovanni Sarnelli
Marcella Pesce, Martina Cargiolli, Sara Cassarano, Barbara Polese, Barbara De Conno, Laura Aurino, Nicola Mancino, Giovanni Sarnelli, Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Naples 80131, Italy
Marcella Pesce, GI Physiology Unit, University College London Hospital, London NW1 2BU, United Kingdom
Author contributions: Pesce M and Sarnelli G conceived the manuscript and contributed to drafting, critical revision and editing; Cargiolli M, Polese B and Cassarano S carried out literature review and analysis and contributed to writing the manuscript. De Conno B, Aurino L and Mancino N contributed to this paper with literature review and analysis and editing; all authors gave final approval of the paper.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Giovanni Sarnelli, MD, PhD, Associate Professor, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini 5, Naples 80131, Italy.
Received: November 15, 2019
Peer-review started: November 15, 2019
First decision: December 12, 2019
Revised: December 24, 2019
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 7, 2020

Hypervigilance and symptoms anticipation, visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia (FD) patients. Many patients recognize meals as the main triggering factor; thus, dietary manipulations often represent the first-line management strategy in this cohort of patients. Nonetheless, scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms, resulting in non-standardized nutritional approaches. Most dietary advises are indeed empirical and often lead to exclusion diets, reinforcing in patients the perception of “being intolerant” to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology (i.e., hypervigilance and symptom anticipation). Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals (i.e., dietitians) are only available in tertiary referral settings. This in turn, can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia. In this review, we aim at evaluating the relationship between dietary habits, macronutrients and specific foods in determining FD symptoms. We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients, providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.

Keywords: Functional dyspepsia, Dietary habits, Food intolerances, Fermentable oligosaccharides, disaccharides, monosaccharides and polyols, Gluten-sensitivity, Diet

Core tip: The spread on the internet of indiscriminate exclusion diets and food intolerance tests often reinforces in patients with functional dyspepsia (FD) the idea of being allergic or intolerant to foods. Physicians are often uncertain regarding the contribution of specific foods in FD and the lack of guidelines and dedicated dietitians, ultimately, leads to conflicting and uneven dietary advises. Here, we provide a pathophysiological-based review of the putative causal relationship between specific foods and symptoms generation in FD and then provide an evidence-based standardized dietary approach, applicable in clinical practice. Moving forward, international guidelines are eagerly awaited to standardize FD dietary management.