Nonulcer Dyspepsia

Dyspepsia is a heterogeneous symptom complex with differing symptom presentations, underlying pathophysiology and available treatments. Patients older than 50 years and those who have "alarm" symptoms or signs (eg, weight loss, dysphagia, vomiting, anemia, or heme-positive stool) should undergo an initial endoscopic evaluation. Empiric treatment without diagnostic testing may be used in the initial approach to young patients without alarm symptoms. For patients presenting with uncomplicated dyspepsia, initial testing for H. pylori is appropriate. If present, H. pylori infection is generally treated and symptoms are followed. In patients who do not have H. pylori infection or do not respond to H. pylori treatment, initial treatment with an H(2) blocker or promotility agent is appropriate empiric therapy. In some patients, gastroesophageal reflux disease (GERD) presents atypically with primarily dyspeptic symptoms. In these patients, a trial of gastric acid suppressant may help implicate GERD. For patients with nonulcer dyspepsia (ie, dyspeptic symptoms with negative endoscopy), prokinetic therapy may be the most effective empiric treatment.