Wellness encompasses a healthy body and a sound mind where, a healthy digestive system is a foundation to both. Disorders of gut-brain interaction are one of the commonest disorders in GI clinical practice [1,2].  Functional dyspepsia (FD) is one of the commonest DGBI, with prevalence in the general population of approximately 10% - 40% [3]. [4]

FD is characterized by one or more of the following symptoms: postprandial fullness, early satiation, epigastric pain, or epigastric burning, which are unexplained after routine clinical evaluation. Subcategories of FD are postprandial distress syndrome (PDS), characterized by meal-induced dyspeptic symptoms, and epigastric pain syndrome (EPS), which does not occur exclusively postprandially.

Various mechanisms implicated in pathophysiology of FD include gastro-duodenal motor and sensory dysfunction, impaired mucosal integrity, low-grade immune activation, intestinal dysbiosis, dysregulation of the gut brain axis, visceral hypersensitivity, and so forth.1,2,5  Of these, visceral hypersensitivity is proposed to be the main underlying mechanism in the EPS subgroup, while disturbed GI motility, including impaired gastric accommodation to a meal and delayed gastric emptying, are thought to play a role in the PDS subgroup.[8] In addition, dysfunction of the gut-brain axis is considered to be an important determinant of symptom intensity perception in both subgroups and the available data also shows that psychological co-morbidities such as anxiety [9], depression and/or life distress play a key role in the development of the disease.[10,11,12,13,14] As measured by rating scales in various studies, Generalized anxiety disorder (GAD) and Major depressive episodes (MDE) along with poorer psychological wellbeing are often found to be related to dyspepsia [15] but, their relevance to how specific comorbid psychological disorders contribute to the clinical and societal burden of dyspeptic symptoms, still remains unclear.[16]

Although FD is not a life-threatening disease, but it impairs quality of life, put a notable negative impact on work productivity of a patient, and increases health care costs for both the patients and society.[17] Our group validated both Hindi and English version of Short Form Nepean Dyspepsia Index (SFNDI) in Functional Dyspepsia patient. 

Generally, treatment of FD should be based on the etiology of the condition but due to the complexity of the disease, the current strategy for pharmacological treatments is empirical.[18] As per ACG guidelines, H. pylori eradication treatment, is recommended as the first line treatment therapy for the treatment of FD, while acid inhibitory drugs, such as proton pump inhibitors (PPIs) and prokinetics like acotiamide, following the use of psychotropic agents like tricyclic antidepressants has been suggested as second line therapy.[19]  However, most of these pharmacological treatments have only modest effectiveness, and are associated with side effects on long-term use, and none has been proven to alter the long-term natural history of FD.2,6 

Therefore, the interest of patients in non-conventional treatment options is rising over the last decade.[21,22] Even the practitioners have also started to incline towards the complementary and alternative medicines (CAM). This incorporates a wide variety of approaches, including acupuncture, moxibustion, herbal medicine, dietary interventions, homeopathy, osteopathy, microbial therapy using probiotics, meditation, chiropractic, cupping, massage, yoga, Qigong etc. [23,24]

At present, yoga is being adapted by many patients worldwide in an attempt to reduce stress and improve overall health. As mood and digestive system health are closely linked via the gut-brain connection, [25] therefore, the rational management of the digestive disorders involves consideration of the  entire  psychosomatic  factors. This makes mind and body therapies the potential areas of interest in the management of DGBIs. [26,27] Rebalancing of the autonomic nervous system is essential for mental and emotional stability; which can be contributed by regular practice of yoga.[28] Any disharmony between body and mind has the potential to cause an adverse health effect and yoga is the science that focuses on bringing that harmony between the two. Therefore, the goal of yoga is to strengthen the muscles and the nervous system, with the goal of reaching a balance of the body and mind.[29] Yoga has been practiced for thousands of years and is an integral part of traditional Indian medicine[30] adapted for use in complementary medicine, especially with regard to preventing and treating the disease.[31]  Traditionally, yoga consists of body postures (Sanskrit: Asana), breathing exercises (Pranayama) and meditation (Dhyana); a practice to “still the mind”[32,33] while the modern practice of yoga, especially within Western cultures, has evolved and is primarily associated with a variety of poses involving stretching and breathing exercises, often performed in combination with meditation.[34] Yoga helps to strengthen the muscles of digestive system, ultimately improving the circulation of nutrients, is considered safe, economical and a natural panacea for pathologies related to digestive system.[35]

It is hypothesized that yoga practice corrects stress-induced underactivity of the parasympathetic nervous system and has been shown to reduce stress and psychological distress [36,37], factors that are known to play a prime role in the onset and persistence of DGBIs. Evidence for the benefit of yoga and their effects on various outcomes, including gastrointestinal symptoms, quality of life, anxiety and mood is available in few review studies.[38] The available data depicting the efficacy of yoga, solitary focuses mostly on bowel disorders like IBS and CC [39,40,41]. To date, no studies have yet explored the efficacy of Yoga in FD patients. This study aims to evaluate the effect of Yoga on symptoms and psychological parameters in patients with functional dyspepsia.