[Guideline "Dyspepsia"].
For the management of patients with dyspepsia a multidisciplinary working party has made recommendations, i.e. about indications for prompt endoscopy, the management of dyspeptic complaints of recent onset, the application of diagnostic tests and treatment of recurrent dyspepsia and the indications for long term use of acid suppressants. Endoscopy is indicated in every patient with alarm symptoms, i.e. blood loss, dysphagia, weight loss or anemia in combination with dyspepsia. Age alone is not a decisive factor in this. Given the good prognosis of recent onset dyspepsia, the application of diagnostic tests is generally not required. Treatment should be restricted to antacids or H2 receptor antagonists. Only in case of persistent or recurring complaints, diagnostic tests or another treatment (Helitobacter pylori diagnostic tests, empirical treatment or endoscopy) should be considered. Testing for H. pylori is especially effective in patients at risk for peptic ulcer disease: those with recurrent complaints, and those with a history of peptic ulcer, without typical reflux symptoms or those with a history ofpeptic ulcer. Short term empirical treatment with a proton pump inhibitor is especially effective in patients with typical reflux symptoms. Endoscopy is the only way to rule out malignancy, and should be used to solve serious diagnostic uncertainty in patient or physician. The only indication for continuous proton pump inhibitor treatment is severe oesophagitis. All other patients with less severe reflux disease should preferably be treated on either on demand or intermittent basis. Long term proton pump inhibitor treatment is not indicated for patients with peptic ulcer disease or functional dyspepsia.
de Wit
N J
NJ
Universitair Medisch Centrum Utrecht, Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, Postbus 85.060, Utrecht. n.j.dewit@umcutrecht.nl
van Barneveld
T A
TA
Festen
H P M
HP
Loffeld
R J L F
RJ
van Pinxteren
B
B
Numans
M E
ME
D000863:Antacids / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D004724:Endoscopy; D005762:Gastroenterology / Q000592:standards*; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans
D000863:Antacids