Diagnostic and Management of Dyspepsia
Diagnostic Evaluation
- The American Gastroenterological Association recommends an upper endoscopy to exclude structural pathology in patients with persistent gastrointestinal symptoms despite treatment, with a prevalence of non-ulcerative peptic disease increasing 3
- The European Society of Gastrointestinal Endoscopy suggests that upper endoscopy can identify structural pathology such as gastric cancer or severe esophagitis, and confirm a diagnosis of functional dyspepsia by exclusion 6, 4, 7
Pharmacological Treatment
- The American College of Gastroenterology recommends omeprazole 20 mg once daily for 4-8 weeks as first-line treatment for dyspepsia, with proton pump inhibitors being superior to anti-H2 agents and placebo 1, 2
- The Gut journal suggests that omeprazole is particularly effective for ulcer-like symptoms, with improvement in quality of life persisting 3 months after treatment cessation in responders 3, 8, 1
Escalation of Treatment
- The Praxis Medical Insights guideline recommends increasing omeprazole to 20 mg twice daily if symptoms persist after 4 weeks, and adding a prokinetic if symptoms of dysmotility are present 5, 2, 3
Adjuvant Therapies
- The Praxis Medical Insights guideline suggests using antacids for rapid relief of intercurrent symptoms, and alginates to form a protective physical barrier in addition to proton pump inhibitors 5
Lifestyle Modifications
- The Praxis Medical Insights guideline recommends specific dietary restrictions, including limiting fat intake, avoiding carbonated drinks, chocolate, mint, citrus, and tomatoes, and managing weight if overweight 5