**Author details**

Jan Pen

H. Hartziekenhuis – Lier, Department of Internal Medicine, Division of gastroenterology, Belgium

#### **References**

**Type of food HIGH in FODMAP LOW in FODMAP**

Tofu Peanuts

seeds

Sugars

Glucose , sucrose Pure maple syrup Aspartame

Wine , beer Vodka , gin

<1/3 cup green peas

1-2 tablespoons almonds, pecans, pine nuts, walnuts, sunflower seeds, sesame

Chickpeas , hummus Kidney beans, baked beans

High fructose corn syrup Sorbitol, mannitol, xylitol, maltitol

Fructose-oligosaccharides

Protein-rich food Fish, chicken, turkey, eggs, meat

Functional dyspepsia is a clinical problem of considerable magnitude for the health care system due to its high prevalence and the chronic or recurrent nature of symptoms. The manifestation of FD symptoms is directly caused by physiological abnormalities: abnormal gastroduodenal motility and/or visceral hypersensitivity. The therapeutic options for a clinician are limited and far from optimal: pharmacological therapies often fail. As food ingestion commonly triggers gastrointestinal symptoms, a dietary approach would seem most effective. There is reasonable evidence to suggest that a low FODMAP diet is beneficial, while gluten sensitivity may benefit others particularly in patients with IBS features. Gastroenterologists should no

H. Hartziekenhuis – Lier, Department of Internal Medicine, Division of gastroenterology,

longer ignore specific dietary intervention for patients with functional dyspepsia.

Soy milk Lentils

Honey Agave

Inulin

Sugar alcohols Chicory root

Nuts and seeds Pistachios

106 Dyspepsia - Advances in Understanding and Management

Alcohol Rum

**Table 3.** FODMAP status of food

**8. Summary**

**Author details**

Jan Pen

Belgium

Legumes

Sweeteners

Additives


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[28] Gibson P.R., Shepherd S.J. Evidence-based dietary management of functional gastro‐ intestinal symptoms: the FODMAP approach. J. Gastroenterol Hepatol ; 2010 ; 25:

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[29] Raithel M.,Baenkler H.W., Nayel A. et al. Significance of salicylate intolerance in dis‐ eases of the lower gastrointestinal tract. J. Physiol. Pharmacol. 2005 ; 56 (Suppl 5):

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[33] Troncone R., Jabri B. Coeliac disease and gluten sensitivity. Journal of internal Medi‐

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[28] Gibson P.R., Shepherd S.J. Evidence-based dietary management of functional gastro‐ intestinal symptoms: the FODMAP approach. J. Gastroenterol Hepatol ; 2010 ; 25: 252-258.

[14] Bisschops R., Karamanolis G., Arts J., Caenepeel P, Verbeke K.,Janssens J., Tack J. Re‐ lationship between symptoms and ingestion of a meal in functional dyspepsia. Gut

[15] Carvalho R.V., Lorena S.L.,Almeida J.R., Mesquita M.A. Food intolerance, diet com‐ position and eating patterns in functional dyspepsia patients. Dig Dis Sci 2010, 55:

[16] Mullan A., Kavanagh P., O'Mahony P., Joy T., Gleeson F., Gibney M.J. Food and nu‐ trients intakes and eating patterns in functional and organic dyspepsia. Eur J Clin

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**Chapter 7**

**Biliary Dyspepsia: Functional Gallbladder and Sphincter**

Biliary-type abdominal pain is common and often presents a clinical challenge for physicians. True biliary colic consists of episodes of steady pain across the right upper quadrant and epigastric regions, lasting from 30 minutes to 6 hours [1]. Such abdominal pain, when it lasts longer than 6 hours, is likely due to complications of gallstone disease such as acute cholecys‐

Classical biliary pain that occurs in the setting of gallstones represents symptomatic choleli‐ thiasis. The symptoms associated with gallstones however are frequently confusing. In fact, only 13% of people with gallstones ever develop biliary pain when followed for 15–20 years [2], meaning that most (70-90%) patients with gallstones never experience biliary symptoms. Vague dyspeptic complaints like belching, bloating, flatulence, heartburn and nausea are not characteristic for biliary disease [3, 4]. Therefore, it is not surprising that cholecystectomy often fails to relieve such ambiguous symptoms in those with documented gallstones. In fact, cholecystectomy fails to relieve symptoms in 10-33% of patients with documented gallstones [5]. If the abdominal pain is misdiagnosed and instead due to functional gut disorders like irritable bowel syndrome, cholecystectomy would not provide a favorable outcome [4, 5, 6].

Biliary-type abdominal pain (also termed biliary colic) in the context of a structurally normal gallbladder has been referred to as "biliary dyspepsia". True biliary pain manifests as steady,

> © 2013 Mathivanan et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

titis or acute pancreatitis, or represents a non-biliary source of pain [1].

**1.1. Cholelithiasis, biliary pain and atypical dyspepsia**

**1.2. Functional gallbladder disease**

**of Oddi Disorders**

http://dx.doi.org/10.5772/56779

Eldon A. Shaffer

**1. Introduction**

Meena Mathivanan, Liisa Meddings and

Additional information is available at the end of the chapter
