Management of Dyspepsia

Publication Date: July 1, 2017

Recommendations

1. We suggest dyspepsia patients aged 60 or over have an endoscopy to exclude upper gastrointestinal neoplasia. (Conditional (weak)  “We suggest”, Very low)
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2. We do not suggest endoscopy to investigate alarm features for dyspepsia patients under the age of 60 to exclude upper GI neoplasia. (Conditional (weak)  “We suggest”, Moderate)
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3. We recommend dyspepsia patients under the age of 60 should have a non-invasive test for H. pylori and therapy for H. pylori infection if positive. (Strong  “We recommend”, High)
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4. We recommend dyspepsia patients under the age of 60 should have empirical proton pump inhibitor ( PPI) therapy if they are H. pylori-negative or who remain symptomatic after H. pylori eradication therapy. (Strong  “We recommend”, High)
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5. We suggest dyspepsia patients under the age of 60 not responding to PPI or H. pylori eradication therapy should be offered prokinetic therapy. (Conditional (weak)  “We suggest”, Very low)
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6. We suggest dyspepsia patients under the age of 60 not responding to PPI or H. pylori eradication therapy should be offered tricyclic antidepressant (TCA) therapy. (Conditional (weak)  “We suggest”, Low)
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7. We recommend functional dyspepsia (FD) patients that are H. pylori positive should be prescribed therapy to treat the infection. (Strong  “We recommend”, High)
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8. We recommend FD patients who are H. pylori-negative or who remain symptomatic despite eradication of the infection should be treated with PPI therapy. (Strong  “We recommend”, Moderate)
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9. We recommend FD patients not responding to PPI or H. pylori eradication therapy (if appropriate) should be offered TCA therapy. (Conditional (weak)  “We suggest”, Moderate)
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10. We suggest FD patients not responding to PPI, H. pylori eradication therapy or tricyclic antidepressant therapy should be offered prokinetic therapy. (Conditional (weak)  “We suggest”, Very low)
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11. We suggest FD patients not responding to drug therapy should be offered psychological therapies. (Conditional (weak)  “We suggest”, Very low)
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12. We do not recommend the routine use of complementary and alternative medicines for FD. (Conditional (weak)  “We suggest”, Very low)
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13. We recommend against routine motility studies for patients with FD. (Conditional (weak)  “We suggest”, Very low)
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14. We suggest motility studies for selected patients with FD where gastroparesis is strongly suspected. (Conditional (weak)  “We suggest”, Very low)
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Recommendation Grading

Disclaimer

Overview

Title

Management of Dyspepsia

Authoring Organization

Publication Month/Year

July 1, 2017

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This guideline focuses on initial investigations for dyspepsia such as Helicobacter pylori (H. pylori) testing and endoscopy as well as pharmacological therapies such as H. pylori treatment, PPIs, and prokinetic therapy.

Target Patient Population

Patients with dyspepsia

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D004415 - Dyspepsia, D005764 - Gastroesophageal Reflux, D004724 - Endoscopy, D020776 - Endoscopes, Gastrointestinal, D054328 - Proton Pump Inhibitors, D016480 - Helicobacter pylori

Keywords

dyspepsia, gastroesophogeal reflux, H.pylori

Source Citation

Moayyedi, Paul M MB, ChB, PhD, MPH, FACG; Lacy, Brian E MD, PhD, FACG; Andrews, Christopher N MD; Enns, Robert A MD; Howden, Colin W MD, FACG; Vakil, Nimish MD, FACG. ACG and CAG Clinical Guideline: Management of Dyspepsia, American Journal of Gastroenterology: July 2017 - Volume 112 - Issue 7 - p 988-1013 doi: 10.1038/ajg.2017.154

Supplemental Methodology Resources

Data Supplement