Abstract
Nonulcer dyspepsia is a common condition in clinical practice. It is a heterogeneous disorder, and no single therapeutic agent is effective in all patients. The treatment of nonulcer dyspepsia is still dissatisfactory. Eradication of Helicobacter pylori organisms has a limited role and little effect. Antisecretory therapy has a modest effect in alleviating symptoms. Prokinetic agents may be effective, but selection bias in the trials performed to date may exaggerate their benefit. Partial 5-HT4 agonists stimulate gastric emptying and may also affect gastric accommodation. They are promising but need further study. Data are limited on 5-HT3 antagonists and hypnotherapy. New treatment approaches are necessary for this common and often chronic condition.
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Talley NJ, Stanghellii V, Heading RC, et al.: Functional gastroduodenal disorders. Gut 1999, 45(Suppl II):1137–1142.
Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ: Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology 1992, 102:1259–1268.
Jones R, Lydeard S: Prevalence of symptoms of dyspepsia in the community. BMJ 1989, 298:30–32.
Marsland DW, Wood M, Mayo F: Content of family practice. Part I. Rank order of diagnoses by frequency. Part II. Diagnosis by disease category and age/sex distribution. J Fam Pract 1976, 3:37–68.
Kagevi I, Lofstedt S, Persson L-G: Endoscopic findings and diagnoses in unselected dyspeptic patients at a primary health care center. Scand J Gastroenterol 1989, 24:145–150.
Gear MWL, Barnes RJ: Endoscopic studies of dyspepsia in general practice. BMJ 1980, 1:1136–1137.
Health and Policy Committee of the American College of Physicians: Endoscopy in the evaluation of dyspepsia. Ann Intern Med 1985, 102:266–269.
Bytzer P, Hansen J, de Muckadell O: Empirical H2 blocker therapy or prompt endoscopy in management of dyspepsia. Lancet 1994, 343:811–815.
Silverstein M, Petterson T, Talley N: Initial endoscopy or empirical therapy with or without testing for H. Pylori for dyspepsia: a decision analysis. Gastroenterology 1996, 110:72–83.
Spiegel BM, Vakil NB, Ofman JJ: Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology 2002, 122:1270–1285. A PPI trial interposed between test and treat and endoscopy saves costs.
Blum AL, Talley NJ, O’Morain C, et al.: Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 1998, 339:1875–1881. H. pylori eradication does not cure nonulcer dyspepsia.
Talley NJ, Jenssens J, Lauritsen K, et al.: Eradication of Helicobacter pylori in functional dyspepsia-randomized double blind placebo controlled trial with 12 months follow up. BMJ 1999, 318:833–837. H. pylori eradication does not cure nonulcer dyspepsia in European study.
Talley NJ, Vakil N, Ballard ED, Fennerty B: Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999, 341:1106–1111. H. pylori eradication does not cure nonulcer dyspepsia in US patients.
McColl K, Murray L, El-Omar E, et al.: Symptomatic benefit from eradicating H. pylori in patients with nonulcer dyspepsia. N Engl J Med 1998, 339:1869–1874. Only study to show therapeutic efficacy for H. pylori eradication in nonulcer dyspepsia.
Greenberg P, Cello J: Lack of effect of treatment for Helicobacter pylori on symptoms of non-ulcer dyspepsia. Arch Intern Med 1999, 159:2283–2288.
Malfertheiner P, Fischbach W, Layer P, et al.: ELAN study proves symptomatic benefit of Helicobacter pylori eradication in functional dyspepsia [abstract]. Gastroenterology 2000, 118:A440.
Moayyedi P, Soo S, Deeks J, et al.: Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. BMJ 2000, 321:659–664. Meta-analysis suggesting a modest benefit for H. pylori eradication in nonulcer dyspepsia.
Laine L, Schoenfeld P, Fennerty MB: H pylori therapy is not effective for treatment of non-ulcer dyspepsia: meta-analysis of randomized controlled trials. Ann Intern Med 2001, 134:361–369. Meta-analysis suggesting no benefit for H. pylori eradication in nonulcer dyspepsia.
Finney JS, Kinnersley N, Hughes M, et al.: Meta-analysis of anti-secretory and gastrokinetic compounds in functional dyspepsia. J Clin Gastroenterol 1998, 26:312–320.
Soo S: Pharmacological interventions for non-ulcer dyspepsia [review]. Cochrane Database Syst Rev 2000, 2:CD001960.
Talley N, Meineche-Schmidt V, Pare P, et al.: Effect of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the BOND and OPERA studies). Aliment Pharmacol Ther 1998, 12:1055–1065. PPIs have modest efficacy in functional dyspepsia.
Peura D, Kovacs T, Metz D, et al.: Low-dose Lansoprazole: effective for non-ulcer dyspepsia (NUD) [abstract]. Gastroenterology 2000, 118:A439.
Tack J, Vos R, Janssens J, et al.: Influence of tegaserod on proximal gastric sensory and motor function in man [abstract]. Gastroenterology 2002, 122:A20. Early results on tegaserod, a 5-HT4 partial agonist in dyspepsia.
Tack J, Delia T, Ligozio G, et al.: A phase II placebo controlled randomized trial with tegaserod in functional dyspepsia patients with normal gastric emptying [abstract]. Gastroenterology 2002, 122:A453.
Kuo B, Camilleri M, Burton D, et al.: 5-HT3 antagonism of upper gastrointestinal symptoms after a dyspepsia inducing meal. Gastroenterology 2001, 120:A134.
Chiarioni G, Benini L, Bonfante F, et al.: Prokinetic effect of a single session of gut oriented hypnotherapy on gastric emptying in normal subjects and dyspeptic patients [abstract]. Gastroenterology 2001, 120:A133.
Holtmann G: Randomized double-blind comparison of simethicone with cisapride in functional dyspepsia. Aliment Pharmacol Ther 1999, 13:1459–1465.
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Vakil, N. Nonulcer dyspepsia. Curr Gastroenterol Rep 4, 455–458 (2002). https://doi.org/10.1007/s11894-002-0020-4
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DOI: https://doi.org/10.1007/s11894-002-0020-4