Review Article: Functional Dyspepsia and Pregnancy—Effects and Management in a Special Population

Abstract and Introduction

Abstract

Background: Around 10% of Americans meet the Rome IV criteria for functional dyspepsia (FD), with a significantly higher rate in women. FD also has a higher prevalence in women below the age of 50, suggesting that women who are affected are likely to be of reproductive age. Unfortunately, there is a lack of research or evidence-based guidelines on managing FD in pregnancy.

Aims and Methods: To address this issue, we aimed to perform a systematic review of the interactions between FD and pregnancy and managing pre-existing FD in the peripartum and post-partum phases using current lifestyle, pharmacological, non-pharmacological and alternative medicine interventions.

Results: Due to the lack of Rome IV FD-specific data in pregnancy, we instead performed a narrative review on how existing FD interventions could be extrapolated to the pregnant population. Where possible we use the highest level of available evidence or official guidelines to answer these questions, which often involves synthesising treatment and safety evidence of these interventions in other diseases during pregnancy. Finally, we highlight current substantial knowledge gaps requiring further research for the safe management of a pregnant patient with pre-existing FD.

Conclusions: Overall, despite the paucity of knowledge of treating FD during pregnancy, providers can mitigate this uncertainty by planning ahead with the patient. Patients should ideally minimise treatment until after breastfeeding. However, interdisciplinary resources are available to ensure that minimal-risk interventions are maximised, while interventions with more risks, if necessary, are justifiable by both the patient and the care team. Future investigations should continue to elicit the mechanistic relationship between FD and pregnancy while cautiously expanding prospective research on promising and safe therapies in pregnant patients with pre-existing FD.

Introduction

Functional dyspepsia (FD) is a disorder of the gut–brain interaction (DGBI) characterised by epigastric pain, post-prandial fullness or early satiety without disease findings on routine investigations that would otherwise explain the diagnosis. Patients suffering from FD often also have nausea, heartburn, belching and bloating.^[1] Based on the patient's symptoms, there are two main subtypes of FD. Post-prandial distress syndrome (PDS) mainly involves postprandial fullness or early satiety that impacts a patient's quality of life (QOL). Epigastric pain syndrome (EPS) has epigastric pain or burning that also affects a patient's QOL. Patients can have one of these types or both.^[2]

FD affects around 10% of patients in western countries^[3] and often coexists with other DGBIs, resulting in frequent medical visits and a high-cost burden to patients and healthcare systems. Uninvestigated dyspepsia is more common in women than in men at a rate of 25.3% compared to 21.9%.^[4] When Rome IV criteria FD was investigated in an online survey, the rate of FD in women was 1.6 times higher than that in men.^[5] FD has a higher prevalence in women below 50, suggesting that women affected by FD are more likely to be of childbearing age.^[6] Unfortunately, despite these statistics, there is a paucity of research and guidance on managing pre-existing FD during the peri-pregnant and post-pregnant periods.

Currently, FD is managed by medications, supplements, alternative medicines and investigational devices in the general population. For healthcare providers, starting, continuing or stopping these therapies for pre-existing FD during pregnancy or post-partum breastfeeding can be challenging with the lack of gastrointestinal societal guidelines. While the related DGBI, irritable bowel syndrome (IBS) is covered in the 2022 American College of Obstetrician and Gynecologist (ACOG) clinical update on lower gastrointestinal tract disorders, there is minimal coverage of FD in the 2021 ACOG guide to upper gastrointestinal tract, biliary and pancreatic disorders.^[7,8] To address this issue, we performed a systematic literature search (Supplementary). Unfortunately, there was an overall paucity of studies addressing Rome IV FD in pregnancy.^[9] Thus, we changed to a narrative review in lieu of a systematic review, and the scope was expanded to include all existing management of FD and its likely effectiveness in the pregnant population, with special attention to its safety (Table 1). Where possible, we use the highest level of available evidence or official guidelines to answer these questions, which often involves synthesising treatment and safety evidence of these interventions in other diseases during pregnancy. Furthermore, we discuss what is known about the interactions between FD and pregnancy. Finally, we highlight current substantial knowledge gaps and the potential for further research to help improve the management of pre-existing FD in this population.

Aliment Pharmacol Ther. 2023;57(12):1375-1396. © 2023 Blackwell Publishing