Management of Dyspepsia
Official guideline from the American College of Gastroenterology.
summary by Colleen Parker, MD
Diagnosis
Dyspepsia
Endoscopy is suggested for patients ≥60 years of age.
Conditional recommendation
Very low quality evidence
Endoscopy to investigate individual alarm features (i.e., weight loss, anemia, non-progressive dysphagia) is not suggested for patients with dyspepsia <60 years of age.
Conditional recommendation
Moderate quality evidence
Non-invasive testing (and treatment if positive) for H. pylori is recommended for patients <60 years of age.
Strong recommendation
High quality evidence
Functional Dyspepsia
Routine motility testing is not recommended.
Conditional recommendation
Very low quality evidence
When gastroparesis is strongly suspected (i.e., severe nausea and daily/intractable vomiting unresponsive to empiric therapy), motility testing is suggested.
Conditional recommendation
Very low quality evidence
Management
Dyspepsia
In those <60 years of age and H. pylori negative or symptomatic after H. pylori eradication, empiric PPI is recommended.
Strong recommendation
High quality evidence
In those <60 years of age who do not respond to PPI, prokinetic therapy should be offered.
Conditional recommendation
Very low quality evidence
In those <60 years of age who do not respond to PPI therapy, tricyclic antidepressant therapy should be offered.
Conditional recommendation
Low quality evidence
Functional Dyspepsia
If H. pylori positive, treatment should be given.
Strong recommendation
High quality evidence
In those who are H. pylori negative or symptomatic after H. pylori eradication, PPI is recommended.
Strong recommendation
Moderate quality evidence
In those who do not respond to PPI, tricyclic antidepressant therapy should be offered.
Conditional recommendation
Moderate quality evidence
In those who do not respond to tricyclic antidepressant therapy, prokinetic therapy should be offered.
Conditional recommendation
Very low quality evidence
In those who do not respond to drug therapy, psychological therapies should be offered.
Conditional recommendation
Very low quality evidence
Routine use of complementary and alternative medicines is not recommended.
Conditional recommendation
Very low quality evidence
What do the icons mean?
How strong is the ACG's recommendation?
Strong recommendation
Intervention's desirable effects clearly outweigh undesirable effects.Moderate recommendation
Further research likely to impact confidence in estimate of effect.
Conditional recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.Weak recommendation
Uncertainty in tradeoffs between desirable & undesirable effects of intervention.
High quality evidence
Further research unlikely to change guideline authors' confidence in estimate of effect.Moderate-high quality evidence
Between high and moderate levels of evidence.
Moderate quality evidence
Further research likely to impact confidence in estimate of effect.Low quality evidence
Further research expected to have important impact in confidence in estimate of effect.Very low quality evidence
Effect is very uncertain.
