Evidence To Practice

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Korean Medicine Clinical Practice Guideline for Functional Dyspepsia

1. Background and Purpose

Functional dyspepsia (FD) refers to a group of diseases with persistent dyspepsia lasting for longer than 6 months without any organic lesions. the pathophysiology is complicated and diverse, and due to the limitations of conventional therapies, interest in Korean medicine is increasing. However, to date, there are no guidelines for Korean medicine treatment; therefore, the treatment methods used by local Korean medicine doctors are not consistent, and it is dificult to evaluate the relevant results accurately.
the Korean Medicine Clinical Practice Guideline (KM-CPG) for FD introduced various evaluation tools and pattern identification questionnaires that can evaluate and classify symptoms. In addition to herbal medicine, acupuncture, and moxibustion treatment, recommendations for various therapies such as Chuna therapy, Qi-Gong, and meditation were included in consideration of the characteristics of the disease. this KM-CPG introduced a standard diagnostic method for FD and reected the clinical field by suggesting the need for a combination treatment with Korean and Western medicine and referral to other medical systems. the development of effective and standardized clinical guidelines for FD can be helpful in making clinical decisions by presenting desirable treatment directions to Korean medicine doctors. In addition, the KM-CPG provides balanced information to the general public and patients, thereby helping to improve symptoms and quality of life and reducing unnecessary socioeconomic burden. this clinical guideline was developed on the basis of evidence-based medicine through analysis and synthesis of the evidence data.

2. Overview of disease

FD refers to a group of diseases characterized by chronic and repetitive gastrointestinal symptoms localized predominantly to the upper gastrointestinal tract without evidence of any organic lesions. Representative diagnostic criteria were first established in 1992 as the ROME criteria, and the ROME IV criteria were made public in 2016 after several revisions. In this guideline, only adult patients with FD corresponding to the ROME diagnostic criteria were targeted.
the mechanisms of FD are complex and include intrinsic hypersensitivity, delayed gastric emptying, electrical rhythm change, and impaired accommodation of the gastric fundus, and are associated with diverse causes. therefore, a therapeutic approach based on the available evidence is dificult. Western medical treatment includes prokinetics, proton pump inhibitors, histamine receptor antagonists, and antidepressants. However, they are regarded as symptomatic treatments. Consequently, there is a growing interest in Korean medicine as well as complementary and alternative medicine.
In Korean medicine, FD corresponds to stuffiness and fullness (痞滿), belching (噯氣), acid regurgitation (呑酸), gastric upset (嘈雜), and stomach duct pain (胃脘痛). the classication of these clinical symptoms allows for pattern diagnoses. these patterns include excess pattern (實證), caused by food accumulation (食積); qi depression (氣鬱); phlegm-uid retention (痰飮); and deciency pattern (虛證), caused by decreased intestinal motility. An accurate diagnosis is followed by a decision on the best course of treatment, such as herbal medicine, acupuncture, Chuna, and diet modication.


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