Exploring Mindfulness: A Comprehensive Review of Its Potential Impact on Functional Dyspepsia Management

Introduction: This review examines the potential benefits of mindfulness-based interventions for individuals with functional dyspepsia by exploring how mindfulness practices—such as mindfulness-based cognitive therapy (MBCT), yoga, and dialectical behavior therapy (DBT)—may improve symptom relief, psychological well-being, and overall quality of life in patients suffering from this condition. By analyzing existing literature, this review highlights the promising role of mindfulness in offering a holistic approach to managing functional dyspepsia. Methods: A comprehensive literature search of related articles written in English was conducted using PubMed and Google Scholar databases, with keywords including “Mindfulness”, “Meditation”, “Yoga”, and “Functional Dyspepsia”. Results: Studies have revealed that mindfulness-based cognitive therapy (MBCT), yoga, and dialectical behavioral therapy (DBT) may reduce symptoms of functional dyspepsia and improve quality of life in patients with functional dyspepsia. Conclusion: Despite the promising findings of the initial studies, further rigorous research is needed to fully understand and confirm the effectiveness of mindfulness techniques in managing functional dyspepsia.

Introduction

As a common disorder of gut-brain interaction, functional dyspepsia affects about 7% of individuals in the general community, the majority of whom are managed in primary care[1]. The concept of functional dyspepsia has evolved over the last 35 years, shifting from a broad definition to one that only covers cardinal symptoms such as epigastric pain or burning, postprandial fullness, or early satiation. Diagnosis is also made after the patient shows no evidence of structural abnormality. The Rome IV Criteria[2], which are among the most current and widely used diagnostic criteria for functional dyspepsia, divide this condition into two categories: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Both subtypes are frequently encountered in both primary-care and specialty-care settings. About 10-30% of people around the world have functional dyspepsia. Studies in North America, for example, have reported a prevalence of 10% with the application of the Rome IV Criteria. However, the percentage of patients assessed only represents a small portion of the overall population affected by this disorder. Approximately 40% of patients only consult primary-care physicians, typically after their symptoms have gotten worse and more frequent. Less than 20% of patients are referred to specialists for further evaluation. In Indonesia, dyspepsia remains the fifth and sixth most common disorder in inpatient and outpatient settings[3]. Although dyspepsia may be caused by gastritis or ulcers, which have noticeable symptoms, the burden of functional dyspepsia remains high.

Current treatments and management for functional dyspepsia involve peripheral-acting agents (i.e., H. pylori test-and-treat strategy, acid suppression therapy, and prokinetic medications) and central-acting agents (e.g., antidepressants). Both antibiotics and probiotics may be used in some cases of functional dyspepsia[2].

Multiple stress-influenced, interconnected pathways, such as the central and peripheral stress systems, connect the gut and the brain and overlap with the pathways of the gut-brain axis. Meanwhile, the gastrointestinal tract with the enteric nervous system (ENS) is innervated by the autonomic nervous system (ANS), providing pathways for stress-induced modulation of gastrointestinal sensorimotor functions[4]. This theory also correlates with interoception, namely the ability of the brain to sense and process information regarding the internal physiological state of the body, which can also be affected by gut microbiomes and their metabolites. Additionally, interoception affects homeostatic reflexes, which also occur in the ENS. The autonomic nervous system modulates the enteric nervous system in regulating gastrointestinal motility, blood flow, and secretion in the physiological state. Moreover, the ANS has the ability to modulate intestinal barrier integrity, GI motility, secretory processes, and mucosal immune response. Changes in regional transit and GI motility are highly influenced by various factors, including emotional states, stress levels, and sleep. For example, acute and chronic stress can inhibit GI tract function. This interaction is bidirectional; therefore, abnormalities are suspected to cause disorders such as irritable bowel syndrome (IBS), functional dyspepsia, chronic abdominal pain, and psychiatric disorders[5].

Stress may affect the amount and composition of gut microbiota, where previous studies have reported a decrease in Lactobacillus sp. and Bifidobacterium spp, as well as an increase in E. coli.[6], for example, argued that higher production of catecholamines, adrenaline, and epinephrine can result in a rise in E. coli[6].

Mindfulness has its origin in the Buddhist spiritual tradition. Nonetheless, notable disparities exist between this understanding and the conceptualization prevalent in contemporary psychology, as outlined in numerous studies. McCaw (2019) predominantly adopted the framework of mindfulness as delineated in contemporary psychology[7], notably stemming from the seminal work of Kabat-Zinn (1982), as the most widely used framework in mindfulness-based intervention for clinical use.

Bishop proposed two main components in defining mindfulness according to this framework[8]:

• Self-Regulation of Attention: This component involves sustaining attention, switching attention, and inhibiting elaborative processing toward the present moment. In this regard, the limited capacity of attention is directed fully toward the present moment. Distractions are acknowledged as events or objects of observation without any preconceived beliefs or notions, and attention is then redirected toward the focus of attention in the present moment.
• Orientation to Experience: This component involves adopting a stance of acceptance and openness toward new experiences. In this regard, individuals approach experiences with curiosity and receptivity, thus allowing for a deeper engagement with the present moment.

In summary, mindfulness is defined as a process of regulating attention to cultivate a state of non-elaborative awareness in the present moment, along with fostering an attitude of curiosity, openness to experience, and acceptance. It involves gaining insights into one's mental processes and adopting a de-centered perspective, wherein these mental processes can be experienced in terms of their subjectivity (compared to their necessary validity), and their transient nature rather than their permanence. Furthermore, mindfulness is conceptualized as both a mode of awareness and a psychological process.

Mindfulness may help reduce stress and improve mental health through several mechanisms[9]. Mostly, individuals spend a significant portion of their time in a state of mindlessness, commonly referred to as mind-wandering. This involves thoughts that are independent of any stimulus and are unrelated to the tasks at hand or the present moment. Unhappiness and negative emotions frequently correlate with thoughts anchored in the past. Additionally, a ruminative thinking style can exacerbate low moods or negative emotions, although they are not always related. Negative mind-wandering can be characterized by decreased attention to external stimuli and the activation of the brain's

.....