Improving functional dyspepsia outcomes - The role of guidelines, imaging, and patient education.

We thank ASENEM and SEMFYC for their comprehensive review on functional dyspepsia (FD), a prevalent condition with variable therapeutic responses. The review highlights the importance of thorough initial evaluation, including dietary habits, medical history, medication review, physical examination, Helicobacter pylori (Hp) testing, and empirical use of proton pump inhibitors (PPIs) or prokinetics. Endoscopy is reserved for refractory cases or those with alarm symptoms. This approach aligns with primary care practices, where time and access to specialized investigations are limited. Endoscopy is recommended for patients with alarm symptoms or symptom onset after 55-60 years. The review also suggests computed tomography (CT) for patients over 60 with unintentional weight loss to rule out pancreatic cancer, given its diagnostic accuracy for biliopancreatic, liver, and gastrointestinal malignancies. This is supported by the differing prevalence trends of gastric and pancreatic cancer in our country.