Dyspepsia

Last updated: December 2020

Clinical features

Epigastric pain or discomfort following meals, often accompanied by bloating, sensation of fullness and nausea. Dyspepsia is most commonly functional. The diagnosis of functional dyspepsia is based on clinical assessment after ruling out organic causes (Gastro-oesophageal reflux, Gastric and duodenal ulcers, drug-induced symptoms, gastric cancer). If possible, test for Helicobacter pylori.

Treatment

In adults:

• In case of patients who test positive for H. pylori, see Eradication of Helicobacter pylori [1] Citation 1. Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020 Nov 21;396(10263):1689-1702. .
• Omeprazole PO (10 mg once daily) for 4 weeks may help even in H. pylori-negative patients [2] Citation 2. Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.
  http://www.cag-acg.org/images/publications/CAG_CPG_Dyspepsia_AJG_Aug2017.pdf [Accessed 24 November 2020] [3] Citation 3. National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. Sept 2014.  
  https://www.nice.org.uk/guidance/CG184/chapter/1-Recommendations#interventions-for-functional-dyspepsia [Accessed 24 November 2020] .

Note: consider and treat possible intestinal parasites (see Intestinal protozoan infections, Cestodes, Nematode infections, Chapter 6; Amoebiasis, Chapter 3).