Functional Dyspepsia (FD): Patient FAQs Answered (With Professor Nicholas Talley)

Functional dyspepsia (FD) is an often debilitating gastroenterological condition that afflicts millions of people around the world. It is divided into two subtypes — one dominated by epigastric pain and another by postprandial symptoms — and has long posed a challenge for clinicians and patients alike.

Australian neurogastroenterologist and researcher Nicholas J. Talley has been at the forefront of studying this previously poorly understood condition and has conducted extensive research into the gut-brain axis.

I used the opportunity to ask Professor Talley various questions about the current state of play in FD treatment - and what us patients could look forward to down the line. Professor Talley served as a member of the Rome Foundation for 17 years, was appointed to the consultant staff of the Mayo Clinic in 1993, and has published over 100 research papers into various aspects of gastroenterology including in the world's leading medical journals.

With thanks to:

Professor Talley and the staff at the University of Newcastle, Australia.

The participants and moderation team of the functional dyspepsia Facebook group who sent in a large amount of questions ahead of this interview (unfortunately we didn't have time to cover them all.)

== Transcript ==

  / functional-dyspepsia-fd-a-conversation-wit...  

More about Laureate Professor Nicholas Talley:
https://en.wikipedia.org/wiki/Nichola...

Functional Dyspepsia Support Group (Facebook):
  / 631375776967058  

Highlights:
  / functional-dyspepsia-fd-insights-for-patie...  

== Timestamps ==

Introduction - 00:00
Start of interview - 02:33
Functional dyspepsia - what we do we know about the causes - 04:00
What are attitudes like among specialists about FD? - 07:53
Epigastric pain syndrome (EPS) vs postprandial distress syndrome (PDS): how separate are they and does the distinction matter for treatment? - 09:28
Current medication approaches to FD encompassing PPIs, prokinetics, and low dose antidepressants- 10:44
The use of antidepressants in FD - 13:17
Dietary interventions for FD - 14:52
Treating functional dyspepsia with psychiatric comorbidities such as mood disorders - 17:40
The connection between FD and small intestinal bacterial overgrowth (SIBO) - 19:20
Is there a connection between FD and autoimmunity? - 20:30
The drug development pipeline - 22:00
How long until new drugs might become available? - 24:20
Is there a connection between GERD, IBS, and FD? - 25:20

== Soundbites & Nuggets Of Interest ==

On a cure for FD:
"A cure for this condition is on the horizon which is very, very exciting."

On the difference between EPS and PDF:
"Epigastric pain syndrome is probably a separate condition."

On PPIs' inflammatory effect:
"What's really fascinating about PPIs is that they're anti-inflammatory ... they reduce the small intestinal inflammation that you see on those biopsies. We believe that the reason they work [for FD] is because they're anti-inflammatory ... not because they suppress acid production."

On the connection between food and FD:
"Foods probably drive the inflammation in some people. Diet is a very understudied part of this problem."

"I send all my FD patients to a dietitian to help manage their symptoms with me."

"We believe that [stomach] inflammation may be one of the drivers of increased anxiety in patients in some people with this people. That they have increased anxiety and that's being driven by their gut."

"Sometimes people have longstanding gut problems and it can take a while for things to get back to the more normal patterns."

"For FD, we're not currently certain what the best probiotic is. So that makes it a little bit complex to treat right now."

On SIBO:
"We don't know whether small bacterial overgrowth is driving the syndrome or just exists alongside it."

Autoimmunity:
"If the hypothesis on the connection between autoimmunity and the gut is true, we may be able to one day treat autoimmune disease through the gut."

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