title: Review article: managing the dyspeptic patient--an interactive discussion.
abstract: Dyspepsia, a common disorder, can present some difficult clinical dilemmas. Physicians should explore some of the more challenging cases of dyspepsia in a setting that fosters interactive dialogue among colleagues, as was the case at the interactive discussion reported below. A panel of experts presented and discussed three case histories. The audience was able to choose from among several options for diagnosis or treatment and recorded their votes by means of an electronic handset. The first case concerned the relationship between continued non-steroidal anti-inflammatory drug (NSAID) use and recurrent upper gastrointestinal (GI) symptoms without ulcer or Helicobacter pylori infection. The second was a woman with complex upper GI symptoms including heartburn. The last featured a young man with dyspepsia and no alarm symptoms. The first case showed that a standard dose of proton pump inhibitor (PPI) is the best treatment for patients with gastritis who continue to use NSAIDs. The second case revealed that 24-h pH monitoring can be used to establish a relationship between symptoms and reflux episodes. The third case demonstrated that it can be difficult to make a definitive diagnosis based on clinical symptoms, and that patients with endoscopy-negative reflux disease usually respond well to PPI therapy.
authors.affiliation: Department of Gastroenterology, Hepatology, and Infectious Diseases, University of Magdeburg, Leipziger Strasse 44, Haus 39, 39120 Magdeburg, Germany. peter.malfertheiner@medizin.uni-magdeburg.de
authors.forename: P
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: V
authors.initials: V
authors.lastname: Stanghellini
authors.forename: J P
authors.initials: JP
authors.lastname: Galmiche
authors.forename: R H
authors.initials: RH
authors.lastname: Jones
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004415:Dyspepsia / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005773:Gastroscopy; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D054328:Proton Pump Inhibitors
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole