![]() ![]() The resulting guidelines were created from 24 BQs, 9 FRQs, and 7 CQs. Therefore, issues that had already been clarified were handled as background questions (BQs) and questions for which a clear answer was not possible because of insufficient evidence were treated as future research questions (FRQs). Like the previous version of the guidelines, the revised guidelines were also created using the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, it was decided to make the guidelines easier to understand by limiting the number of clinical questions (CQs). In April 2017, on the basis of that rule, the Board of Directors of JSGE made the decision to revise the clinical practice guidelines for FD, and work on the revised guidelines was begun by the Guidelines Creation Committee. In view of the rapid progress in medical research and clinical practice, JSGE has adopted a so-called sunset rule, which is a rule that clinical practice guidelines be revised every 5 years. In this context, clinical practice guidelines for FD were published by the Japanese Society of Gastroenterology (JSGE) in 2014, and the number of copies of those guidelines sold far exceeded that of any other guidelines published by the JSGE, indicating a high level of interest in FD. Factors contributing to the increasing awareness include heightened concerns about quality of life (QOL) that have accompanied improved standards of living in Japan, concern that the stress associated with the growing complexity of modern life is contributing to the occurrence of dyspepsia, and the recognition of “functional dyspepsia” as a disease name for national insurance billing purposes in May 2013. ![]() However, awareness of FD has been increasing gradually. ![]() Although FD is common, the disease name “functional dyspepsia” had not been widely used in routine medical practice because the concept of FD is relatively new and the name is difficult to understand. Functional dyspepsia (FD) is a disorder that presents with chronic manifestation of such symptoms. Many people suffer from dyspeptic symptoms, but the cause is often unclear. The patients not responding to these treatment regimens are regarded as refractory FD. The second-line treatment includes anxiolytics /antidepressant, prokinetics other than acotiamide (dopamine receptor antagonists, 5-HT4 receptor agonists), and Japanese herbal medicines other than rikkunshito. The first-line treatment includes gastric acid-secretion inhibitors, acetylcholinesterase (AChE) inhibitors (acotiamide, a prokinetic agent), and Japanese herbal medicine (rikkunshito). The second feature is that the drug treatment options have been changed to reflect the latest evidence. While endoscopy was required to all cases for diagnosis of FD, the revised guidelines specify the necessity of endoscopy only in cases where organic disease is suspected. The first is the new position of endoscopy in the flow of FD diagnosis. These revised guidelines have two major features. Like previously, the guideline was created by the GRADE (grading of recommendations assessment, development and evaluation) system, but this time, the questions were classified to background questions (BQs, 24 already clarified issues), future research questions (FRQs, 9 issues cannot be addressed with insufficient evidence), and 7 clinical questions that are mainly associated with treatment. Following the revision policy of Japanese Society of Gastroenterology (JSGE), the first version of FD guideline was revised this time. In Japan, FD became a disease name for national insurance in 2013, and has been gradually recognized, though still not satisfactory. Functional dyspepsia (FD) is a disorder that presents with chronic dyspepsia, which is not only very common but also highly affects quality of life of the patients. ![]()
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