Management of Dyspepsia
Official guideline from the American College of Gastroenterology.
summary by Colleen Parker, MD
Diagnosis
Endoscopy is suggested for patients ≥60 years of age.
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.
Non-invasive testing (and treatment if positive) for H. pylori is recommended for patients <60 years of age.
Routine motility testing is not recommended.
When gastroparesis is strongly suspected (i.e., severe nausea and daily/intractable vomiting unresponsive to empiric therapy), motility testing is suggested.
Management
In those <60 years of age and H. pylori negative or symptomatic after H. pylori eradication, empiric PPI is recommended.
In those <60 years of age who do not respond to PPI, prokinetic therapy should be offered.
In those <60 years of age who do not respond to PPI therapy, tricyclic antidepressant therapy should be offered.
If H. pylori positive, treatment should be given.
In those who are H. pylori negative or symptomatic after H. pylori eradication, PPI is recommended.
In those who do not respond to PPI, tricyclic antidepressant therapy should be offered.
In those who do not respond to tricyclic antidepressant therapy, prokinetic therapy should be offered.
In those who do not respond to drug therapy, psychological therapies should be offered.
Routine use of complementary and alternative medicines is not recommended.
How strong is the ACG's recommendation?
