Uninvestigated dyspepsia

  • Uri Ladabaum
  • William D. Chey

Opinion statement

  • Dyspepsia, which is defined as pain or discomfort centered in the upper abdomen, is encountered frequently in primary care and subspecialty practice.

  • Dyspepsia is a symptom complex caused by a heterogeneous group of disorders and diseases. A large fraction of patients with dyspepsia suffer from functional dyspepsia, in which no evidence of organic disease (typically on the basis of upper endoscopy) is found to explain persistent or recurrent symptoms.

  • Initial management strategies for uninvestigated dyspepsia include empiric antisecretory therapy, the “test-and-treat” strategy for Helicobacter pylori, or prompt upper endoscopy. The cost-effectiveness of empiric therapy versus the test-andtreat strategy is dependent upon a number of variables including the prevalence of H. pylori infection, ulcer prevalence, and likelihood that an ulcer is due to H. pylori infection. As the prevalence of H. pylori infection falls and the likelihood of H. pylori negative ulcer increases, empiric antisecretory therapy will become more cost-effective.

  • Upper endoscopy should be reserved for patients older than 45 to 50 years with symptom presentation and those with warning signs. Endoscopy also should be considered in those for whom empiric therapy or an attempt at the test-andtreat strategy fails.

  • Common-sense dietary counseling can be helpful in patients with meal-related symptoms. Highly restrictive diets rarely improve symptoms and may be counterproductive if nutrition is compromised.


Omeprazole Pylorus Infection Dyspepsia Lansoprazole Esomeprazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Talley NJ, Stanghellini V, Heading RC, et al.: Functional gastroduodenal disorders. In The Functional Gastrointestinal Disorders, edn 2. Edited by Drossman DA. McLean, VA: Degnon Associates; 2000:299–350. An excellent reference reflecting the efforts of international working teams. The book includes thorough literature reviews, proposed definitions for the functional gastrointestinal disorders, and recommendations for future research.Google Scholar
  2. 2.
    Farup PG, Wetterhus S, Osnes M, et al.: Ranitidine effectively relieves symptoms in a subset of patients with functional dyspepsia. Scand J Gastroenterol 1997, 32:755–759.PubMedGoogle Scholar
  3. 3.
    Farup PG, Hovde O, Torp R, et al.: Patients with functional dyspepsia responding to omeprazole have a characteristic gastro-oesophageal reflux pattern. Scand J Gastroenterol 1999, 34:575–579.PubMedCrossRefGoogle Scholar
  4. 4.
    Bytzer P, Hansen JM, Schaffalitzky de Muckadell OB: Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia. Lancet 1994, 343:811–816.PubMedCrossRefGoogle Scholar
  5. 5.
    Lassen AT, Pedersen FM, Bytzer P, et al.: Helicobacter pylori test-and-eradicate versus prompt endoscopy for management of dyspeptic patients: a randomised trial. Lancet 2000, 356:455–460. Important randomized, controlled study of alternative strategies to manage uninvestigated dyspepsia.PubMedCrossRefGoogle Scholar
  6. 6.
    Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. European Helicobacter Pylori Study Group. Gut 1997, 41:8–13.Google Scholar
  7. 7.
    American Gastroenterological Association medical position statement: Evaluation of dyspepsia. Gastroenterology 1998, 114:579–558.Google Scholar
  8. 8.
    Veldhuyzen van Zanten SJ, Flook N, Chiba N, et al.: An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori. Canadian Dyspepsia Working Group. CMAJ 2000, 162(suppl 12):S3–23.PubMedGoogle Scholar
  9. 9.
    Peterson WL, Fendrick AM, Cave DR, et al.: Helicobacter pylori-related disease: guidelines for testing and treatment. Arch Intern Med 2000, 160:1285–1291.PubMedCrossRefGoogle Scholar
  10. 10.
    Jones R, Tait C, Sladen G, et al.: A trial of a test-andtreat strategy for Helicobacter pylori positive dyspeptic patients in general practice. Int J Clin Pract 1999, 53:413–416.PubMedGoogle Scholar
  11. 11.
    Quartero AO, Post MW, Numans ME, et al.: What makes the dyspeptic patient feel ill? A cross sectional survey of functional health status, Helicobacter pylori infection, and psychological distress in dyspeptic patients in general practice. Gut 1999, 45:15–19.PubMedCrossRefGoogle Scholar
  12. 12.
    Moayyedi P, Feltbower R, Brown J, et al.: Effect of population screening and treatment for Helicobacter pylori on dyspepsia and quality of life in the community: a randomised controlled trial. Leeds HELP Study Group. Lancet 2000, 355:1665–1669.PubMedCrossRefGoogle Scholar
  13. 13.
    Moayyedi P, Soo S, Deeks J, et al.: Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. Dyspepsia Review Group. BMJ (Clinical Research ed) 2000, 321:659–664.CrossRefGoogle Scholar
  14. 14.
    Laine L, Schoenfeld P, Fennerty MB: Therapy for Helicobacter pylori in patients with nonulcer dyspepsia. A meta-analysis of randomized, controlled trials. Ann Intern Med 2001, 134:361–369.PubMedGoogle Scholar
  15. 15.
    Delaney BC, Innes MA, Deeks J, et al.: Initial management strategies for dyspepsia. Cochrane Database Sys Rev 2000, 2:CD001961. A recent systematic review of 10 studies evaluating the effectiveness of PPIs, H2RAs, antacids, and early endoscopy in patients with uninvestigated dyspepsia.Google Scholar
  16. 16.
    Jones RH, Baxter G: Lansoprazole 30 mg daily versus ranitidine 150 b.d. in the treatment of acid-related dyspepsia in general practice 1997, 11:541–546.Google Scholar
  17. 17.
    Talley NJ, Meineche-Schmidt V, Pare P, et al.: Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies). Aliment Pharmacol Therap 1998, 12:1055–1065.CrossRefGoogle Scholar
  18. 18.
    Talley NJ, Axon A, Bytzer P, et al.: Management of uninvestigated and functional dyspepsia: a working party report for the World Congress of Gastroenterology 1998. Aliment Pharm Ther 1999, 13:1135–1148.CrossRefGoogle Scholar
  19. 19.
    Everhart JE: Recent developments in the epidemiology of Helicobacter pylori. Gastroenterol Clin N Am 2000, 29:559–578.CrossRefGoogle Scholar
  20. 20.
    Staat MA, Kruszon-Moran D, McQuillan GM, Kaslow RA: A population-based serologic survey of Helicobacter pylori infection in children and adolescents in the United States. J Infect Dis 1996, 174:1120–1123.PubMedGoogle Scholar
  21. 21.
    Munnangi S, Sonnenberg A: Time trends of physician visits and treatment patterns of peptic ulcer disease in the United States. Arch Int Med 1997, 157:1489–1494.CrossRefGoogle Scholar
  22. 22.
    el-Serag HB, Sonnenberg A: Opposing time trends of peptic ulcer and reflux disease. Gut 1998, 43:327–333.PubMedCrossRefGoogle Scholar
  23. 23.
    Borody TJ, Brandl S, Andrews P, et al.: Helicobacter pylori-negative gastric ulcer. Am J Gastroenterol 1992, 87:1403–1406.PubMedGoogle Scholar
  24. 24.
    Ciociola AA, McSorley DJ, Turner K, et al.: Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol 1999, 94:1834–1840.PubMedCrossRefGoogle Scholar
  25. 25.
    Jyotheeswaran S, Shah AN, Jin HO, et al.: Prevalence of Helicobacter pylori in peptic ulcer patients in greater Rochester, NY: is empirical triple therapy justified? Am J Gastroenterol 1998, 93:574–578.PubMedCrossRefGoogle Scholar
  26. 26.
    Chey WD, Ladabaum U, Fendrick AM, Scheiman JM: Cost-effectiveness of empiric PPI therapy vs. test and treat in uninvestigated dyspepsia: impact of decreasing H. pylori prevalence and increasing non-H. pylori ulcers. Am J Gastroenterol 2001, 96:A836.Google Scholar
  27. 27.
    Uemura N, Okamoto S, Yamamoto S, et al.: Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001, 345:784–789.PubMedCrossRefGoogle Scholar
  28. 28.
    Physicians’ Desk Reference OnLine. Medical Economics Company, Inc; 2002. URL: Accessed January 27, 2002.Google Scholar
  29. 29.
    AHFS Drug Information 2001. Besthesda, MD: American Society of Health-System Pharmacists; 2001.Google Scholar
  30. 30.
    Drug Topics Red Book. Montvale, NJ: Medical Economics Company, Inc.; 2001.Google Scholar
  31. 31.
    Chey WD: Helicbacter pylori. Curr Treat Options Gastroenterol 1999, 2:171–181.CrossRefPubMedGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Uri Ladabaum
    • 1
  • William D. Chey
    • 1
  1. 1.Division of GastroenterologyUniversity of California, San FranciscoSan FranciscoUSA

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