title: Dyspepsia: current understanding and management.
abstract: Dyspepsia, defined as "pain or discomfort centered in the upper abdomen" is reported by one in four adults in Western societies. The most important causes are non-ulcer (functional) dyspepsia, peptic ulcer, gastroesophageal reflux, and, rarely, gastric cancer. Persons with heartburn alone are not considered to have dyspepsia. The division of dyspepsia into symptom-based subgroups (ulcer-like, dysmotility-like, reflux-like, and unspecified dyspepsia) has proven to be of doubtful value for the clinician, as it has a low predictive value for identifying the causes of dyspepsia. Upper endoscopy remains the "gold standard" test; ultrasound and blood tests have a low yield. The role of Helicobacter pylori in peptic ulcer disease is well known, but the clinical role of the infection in non-ulcer dyspepsia remains very controversial. In uninvestigated dyspeptic patients who are H. pylori infected based on a non-invasive test, empiric anti-H. pylori therapy is a reasonable and probably cost-effective option. In documented non-ulcer dyspepsia, prokinetics are superior to placebo while antisecretory therapy is of less certain efficacy.
authors.affiliation: Department of Family Medicine, Uppsala University, Akademiska Sjukhuset, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Agréus
authors.forename: N J
authors.initials: NJ
authors.lastname: Talley
mesh_terms: D000328:Adult; D000863:Antacids / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000145:classification / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D015154:Esophageal Motility Disorders / Q000150:complications; D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000150:complications; D005773:Gastroscopy; D006356:Heartburn / Q000503:physiopathology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000150:complications / Q000382:microbiology; D010919:Placebos; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000150:complications
chemical_list: D000863:Antacids; D006635:Histamine H2 Antagonists; D010919:Placebos