title: A new approach to the management of uninvestigated dyspepsia in primary care.
abstract: BACKGROUND
  The prevalence of dyspepsia in the general population worldwide is very high (20-40%). Upper abdominal complaints are one of the most common cause of patients' visits to primary care settings. Making an accurate etiological diagnosis of dyspepsia is difficult, but is an important challenge and goal for every doctor in primary care practice. Clinical guidelines have standards for gastroesophageal reflux disease, management of Helicobacter infection and indications for the use of endoscopy (empiric treatment, prompt endoscopy, "test and treat"). In spite of the application of those standards, many patients experience no improvement in their symptoms or often the recurrence of disease.
  
  
  OBJECTIVE
  This study presents a new approach to the diagnostic and therapeutic management of uninvestigated dyspepsia in primary care settings to provide long-term effective control of symptoms for family doctors.
  
  
  METHODS
  3000 unselected consecutive dyspeptic patients underwent abdominal ultrasound, and 1000 dyspeptic patients from the same group upper endoscopy.. In this approach diagnostic evaluation of dyspepsia includes: abdominal ultrasonography as a first line obligatory routine method and the exact estimation of nutritional condition.
  
  
  RESULTS
  Abdominal ultrasound, physical examination and BMI control have significant value in the diagnostic evaluation of dyspepsia. The therapeutic approach includes, besides general standards (acid suppressive drugs, eradication of H. pylori, prokinetic and antidepressant agents), life style modification and nutritional interventions as first-line treatments. In this approach the use of new drugs such as ursodeoxycholic acid (UDCA), pre and probiotics, and digestive enzymes supplements is recommended.
  
  
  CONCLUSIONS
  Throug the combination of different diagnostic procedures as first line methods, including abdominal ultrasound and nutritional condition (BMI), a family doctor can manage successfully uninvestigated dyspepsia at the primary care level.
authors.affiliation: Department of Emergency Medicine, Faculty of medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina ; Medicus A Gracanica, Gracanica, Bosnia and Herzegovina.
authors.forename: Nizama
authors.initials: N
authors.lastname: Salihefendic
authors.affiliation: Medicus A Gracanica, Gracanica, Bosnia and Herzegovina.
authors.forename: Muharem
authors.initials: M
authors.lastname: Zildzic
authors.affiliation: Polyclinic and Primary Health Care Center Doboj-jug, Matuzici, Bosnia and Herzegovina.
authors.forename: Emir
authors.initials: E
authors.lastname: Cabric
mesh_terms: D000465:Algorithms; D015992:Body Mass Index; D004415:Dyspepsia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D004724:Endoscopy; D006801:Humans; D009765:Obesity / Q000150:complications; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors; D014463:Ultrasonography
keywords: BMI; abdominal ultrasound; life-style modifications; obesity; primary care; uninvestigated dyspepsia