From the Guidelines
Dyspepsia management should start with a "test and treat" strategy for Helicobacter pylori infection, as this approach has been shown to be effective in reducing symptoms and is recommended by the British Society of Gastroenterology guidelines 1, 2, 3.
Key Components of Dyspepsia Management
- Test and treat strategy: All patients with dyspepsia should be offered a stool test or breath test to look for H. pylori infection, and if positive, receive a short course of antibiotic treatment 1, 3.
- Empirical acid suppression: Patients who test negative for H. pylori or whose symptoms persist after antibiotic treatment should be offered empirical acid suppression therapy, using the lowest dose that improves their symptoms 3.
- Lifestyle modifications: Regular exercise and lifestyle changes, such as avoiding certain foods that may trigger symptoms, can be helpful for some patients 1.
- Psychological and behavioral therapies: There is some evidence to suggest that psychological or behavioral therapies may be beneficial for treating symptoms in functional dyspepsia, and work is needed to improve the availability of these treatments for patients 1.
Diagnostic Considerations
- Endoscopy: Urgent endoscopy is only warranted in patients aged ≥55 years with dyspepsia and weight loss, or those aged >40 years from an area at increased risk of gastric cancer or with a family history of gastro-oesophageal cancer 2, 3.
- Abdominal CT scanning: Urgent CT scanning should be considered in patients aged ≥60 years with abdominal pain and weight loss to exclude pancreatic cancer 3.
Important Considerations
- Doctor-patient communication: Establishing an effective and empathic doctor-patient relationship and a shared understanding is key to the management of functional dyspepsia 2.
- Patient education: Patients should be educated about the diagnosis, underlying pathophysiology, and natural history of functional dyspepsia, including common symptom triggers and the role of diet, stress, and cognitive, behavioral, and emotional responses to symptoms 2.
From the Research
Management of Dyspepsia
The management of dyspepsia can be divided into several categories, including:
- General measures
- Acid-suppressive drugs
- Eradication of H. pylori
- Prokinetic agents
- Fundus-relaxing drugs
- Antidepressants
- Psychological interventions 4
Treatment Options
Treatment options for functional dyspepsia may include:
- Histamine H2 blockers
- Proton pump inhibitors
- Prokinetic agents 5
- Tricyclic antidepressant therapy 6
- Acotiamide, a new prokinetic 6
- Buspirone, a drug that promotes gastric accommodation 6
Diagnostic Evaluation
Diagnostic evaluation of dyspepsia includes:
- Upper gastrointestinal endoscopy
- Abdominal ultrasonography
- Gastric emptying testing
- Gastric accommodation evaluation 4
- Antroduodenal manometry
- Sensory function evaluation with the barostat, tensostat, and satiety test 4
Initial Management
The initial management of dyspepsia is well established and may include:
- Test-and-treat strategy to identify and eradicate Helicobacter pylori infection 5, 7
- Empiric treatment with acid-suppressive drugs 5, 7
- Upper gastrointestinal endoscopy to exclude gastroesophageal malignancy in individuals presenting for the first time with uninvestigated dyspepsia, age greater than 50 years, or alarm features 7