Therapeutic strategies for the treatment of dyspepsia.
BACKGROUND
Dyspeptic symptoms are highly prevalent in the population and represent a major burden for healthcare systems. The ROME III criteria address and define two separate entities of functional dyspepsia: epigastric pain syndrome and postprandial distress syndrome. The etiology of dyspeptic symptoms is heterogeneous, underlying mechanisms are poorly understood and symptomatic improvement after drug therapy is often incomplete.


METHODS
This review of the literature included Medline data being published in the field of functional dyspepsia and different therapies.


RESULTS
The reader will gain a current, unbiased understanding of the pathophysiological mechanisms underlying functional dyspepsia and of the therapeutic regimens based on randomized, controlled trials and on the meta-analyses that have been published on different therapeutic agents.


CONCLUSIONS
Before starting medical treatment, a careful physical examination should exclude 'alarm symptoms'. Laboratory data, ultrasound and endoscopy are recommended in patients older than 45 - 55 years (depending on the guidelines being used). In areas with a high prevalence of Helicobacter pylori, the initial strategy includes 'test and treat' for H. pylori in addition to empiric acid suppressive therapy. Many studies have focused on the role of gastrointestinal dysmotility and hypersensitivity for dyspepsia with inconclusive results. Further therapeutic medical strategies include prokinetics, herbal preparations and psycho-/neurotopic drugs as well as additional psycho- or hypnotherapy.
Kandulski
Arne
A
Otto-von-Guericke University Magdeburg, Department of Gastroenterology, Hepatology and Infectious Diseases, Germany.
Venerito
Marino
M
Malfertheiner
Peter
P
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019468:Disease Management; D004415:Dyspepsia / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D016480:Helicobacter pylori; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011613:Psychotherapy / Q000639:trends; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D054328:Proton Pump Inhibitors