MDCalc

Management of Dyspepsia

Official guideline from the American College of Gastroenterology.

Diagnosis

Dyspepsia
Conditional recommendation
Very low quality evidence
Endoscopy is suggested for patients ≥60 years of age.
Conditional recommendation
Moderate 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.
Strong recommendation
High quality evidence
Non-invasive testing (and treatment if positive) for H. pylori is recommended for patients <60 years of age.
Functional Dyspepsia
Conditional recommendation
Very low quality evidence
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.

Management

Dyspepsia
Strong recommendation
High quality evidence
In those <60 years of age and H. pylori negative or symptomatic after H. pylori eradication, empiric PPI is recommended.
Conditional recommendation
Very low quality evidence
In those <60 years of age who do not respond to PPI, prokinetic therapy should be offered.
Conditional recommendation
Low quality evidence
In those <60 years of age who do not respond to PPI therapy, tricyclic antidepressant therapy should be offered.
Functional Dyspepsia
Strong recommendation
High quality evidence
If H. pylori positive, treatment should be given.
Strong recommendation
Moderate quality evidence
In those who are H. pylori negative or symptomatic after H. pylori eradication, PPI is recommended.
Conditional recommendation
Moderate quality evidence
In those who do not respond to PPI, tricyclic antidepressant therapy should be offered.
Conditional recommendation
Very low 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.
Literature
Original/Primary Reference
Research PaperMoayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013.