I disturbi funzionali del tratto digestivo superiore: aspetti epidemiologici, clinici e terapeutici

Functional disorders of the upper digestive tract, including functional dyspepsia and irritable bowel syndrome with predominant gastric symptoms, represent conditions that are highly prevalent in the general population and are associated with a marked impairment of patients’ quality of life. Functional dyspepsia, characterised by symptoms such as epigastric pain, early satiety and bloating, in the absence of detectable structural abnormalities, is commonly divided into two subtypes: postprandial distress syndrome and epigastric pain syndrome, as described in the Rome IV diagnostic criteria. Although the pathogenesis of these disorders is not completely understood, it is believed that there is a complex interaction between altered gastrointestinal motility, visceral hypersensitivity, gut dysbiosis and dysfunction in the central modulation of visceral signals. Current guidelines recommend a multimodal therapeutic approach, including both pharmacological treatments and lifestyle modifications. First-line drugs for the management of functional dyspepsia include prokinetics, such as domperidone and itopride, and proton pump inhibitors, the latter being indicated mainly in patients with symptoms associated with hyperacidity. In refractory cases, numerous studies support the use of tricyclic antidepressants and serotonin modulators, which appear to bring significant symptomatic improvement. Recently, scientific interest has also turned to the role of the intestinal microbiota in the pathogenesis of functional disorders of the upper digestive tract, opening up prospects for innovative therapies, including the use of probiotics and modulation of the intestinal flora. However, current guidelines emphasize the need for further clinical evidence to consider such approaches as standard of care. In conclusion, although significant progress has been made in the understanding and treatment of these disorders, there remains much room for development with regard to targeted and personalized therapeutic strategies.