Digestive Diseases and Sciences

, Volume 52, Issue 4, pp 983–987 | Cite as

Proton Pump Inhibitors: Effective First-Line Treatment for Management of Dyspepsia

  • David A. PeuraEmail author
  • Jeff Gudmundson
  • Nancy Siepman
  • Betsy L. Pilmer
  • James Freston


The aim of this study was to evaluate the reasons for trial exclusion among dyspeptic patients and estimate the proportion that may have benefited from proton pump inhibitor (PPI) therapy. Stringent inclusion criteria for enrollment in two multicenter functional dyspepsia trials included dyspepsia (predominant persistent/recurrent upper abdominal discomfort [UAD] during the prior 3 months) of at least moderate intensity during ≥30% of days during the prior 2 to 3 weeks. Exclusion criteria were mild/infrequent UAD; heartburn and UAD of equal frequency; predominant heartburn with UAD; endoscopic evidence of erosive esophagitis or Barrett’s or gastric and/or duodenal erosions (>5) or ulcers; irritable bowel syndrome (IBS); other gastrointestinal diagnoses; or other “non-categorized” disorders. Of 2,588 screened patients, 1,667 were excluded. Excluded patients by category had mild/infrequent UAD (12.5%, n=324), heartburn and UAD of equal frequency (1.1%, n=29), predominant heartburn with UAD (11.6%, n=300), endoscopic evidence of erosive esophagitis or Barrett's (6.2%, n=160), gastric and/or duodenal erosions (1.4%, n=36), gastric and/or duodenal ulcers (2.0%, n=53), IBS (7%, n=180), “other” gastrointestinal diagnoses (2.8%, n=73), or other “non-categorized” disorders (19.8%, n=512). Fifty-four percent of patients (902/1,667) had symptoms/diagnoses that would be expected to improve with PPI therapy. Individuals with IBS, “other,” or “non-categorized” disorders were considered to have symptoms unlikely to respond to PPI treatment. Empiric PPI treatment would be expected to provide symptom relief to the majority of dyspepsia sufferer who present in clinical practice. PPIs represent the best currently available therapy for acid-related disorders and should be considered the first-line management approach in patients with uninvestigated dyspepsia.


Functional dyspepsia Proton pump inhibitor 



functional dyspepsia


Food and Drug Administration


gastroesophageal reflux disease


histamine-2 receptor antagonists


irritable bowel syndrome


over the counter


proton pump inhibitor


upper abdominal discomfort



Research was funded by TAP Pharmaceutical Products Inc., Lake Forest, IL.


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Copyright information

© Springer Science+Business Media, Inc. 2007

Authors and Affiliations

  • David A. Peura
    • 1
    Email author
  • Jeff Gudmundson
    • 2
  • Nancy Siepman
    • 2
  • Betsy L. Pilmer
    • 2
  • James Freston
    • 3
  1. 1.University of Virginia Health Sciences CenterCharlottesvilleUSA
  2. 2.TAP Pharmaceutical Products Inc.Lake ForestUSA
  3. 3.University of Connecticut Health CenterFarmingtonUSA

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