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    Management of Dyspepsia (beta)

    Official guideline from the American College of Gastroenterology.

    Summary by Colleen Parker, MD
    Strength
    Strong recommendation
    Moderate recommendation
    Conditional recommendation
    Weak recommendation
    Evidence
    High quality evidence
    Moderate-high quality evidence
    Moderate quality evidence
    Low quality evidence
    Very low quality evidence

    Diagnosis

    Dyspepsia
    1. Endoscopy is suggested for patients ≥60 years of age.
    2. 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.
    3. Non-invasive testing (and treatment if positive) for H. pylori is recommended for patients <60 years of age.
    Functional Dyspepsia
    1. Routine motility testing is not recommended.
    2. When gastroparesis is strongly suspected (i.e., severe nausea and daily/intractable vomiting unresponsive to empiric therapy), motility testing is suggested.

    Management

    Dyspepsia
    1. In those <60 years of age and H. pylori negative or symptomatic after H. pylori eradication, empiric PPI is recommended.
    2. In those <60 years of age who do not respond to PPI, prokinetic therapy should be offered.
    3. In those <60 years of age who do not respond to PPI therapy, tricyclic antidepressant therapy should be offered.
    Functional Dyspepsia
    1. If H. pylori positive, treatment should be given.
    2. In those who are H. pylori negative or symptomatic after H. pylori eradication, PPI is recommended.
    3. In those who do not respond to PPI, tricyclic antidepressant therapy should be offered.
    4. In those who do not respond to tricyclic antidepressant therapy, prokinetic therapy should be offered.
    5. In those who do not respond to drug therapy, psychological therapies should be offered.
    6. Routine use of complementary and alternative medicines is not recommended.
    What do the icons mean?  
    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.