Dyspepsia (Non-Ulcer or Functional)
Addendum July 2012
Symptomatic management of non-ulcer dyspepsia is challenging and is often unsuccessful. Reconsider diagnosis in patients with resistant symptoms. Empiric treatment with a PPI or H2RA for 4–8 weeks is reasonable. The majority of patients with non-ulcer dyspepsia do not derive symptomatic benefit from H. pylori eradication.
Prokinetic agents such as metoclopramide and domperidone may be more likely to produce symptomatic improvement compared with placebo. Tricyclic antidepressants (e.g., amitriptyline, desipramine, nortriptyline) may offer some symptomatic benefit but convincing evidence is lacking.
Prokinetic agents under "Second Line Drugs" should be given to patients experiencing burning or pain.
H-2 antagonists listed under "For Pregnant Women" should be given to patients experiencing bloating, fullness or heaviness, and not specifically pregnant women.
-In up to 60% of patients, considerable improvement of symptoms occurs during placebo treatment.
-Randomized trials have not demonstrated a benefit from antacids compared with placebo.
-Although patients are typically divided into subgroups based on predominant symptoms, there are no convincing data indicating that this strategy identifies responders to a particular type of treatment.
-Although dyspepsia is a chronic condition often persisting for years, there are no long-term trials of any treatment regimen.
-There is not enough evidence of a causal relation between Helicobacter pylori and nonulcer dyspepsia to recommend triple therapy in this group of patients.
-Consider referral for additional investigation of nonresponders or if warning symptoms are present (weight loss, bleeding, vomiting).