Non-ulcer dyspepsia and gastritis--clinical aspects

Although patients with non-ulcer dyspepsia (NUD) and peptic ulcer disease present similar symptoms, the two diseases are pathophysiologically completely different and should be treated accordingly. The diagnosis of NUD is still based on negative criteria, i.e., organic diseases must be excluded. The majority of the patients with NUD have a functional disorder possibly as a consequence of psychological stress which, by activating processes within the central nervous system, may evoke a sequence of reactions; By suppressing the vagal tone, fundic adaptation to ingested food may be impaired and the gastric antrum abnormally filled. The latter may contribute to largely unrecognized cause of epigastric discomfort. Increased responsiveness or hypersensitivity to visceral (gastric distention) and psychological (mental stress) stimuli may constitute important factors contributing to perception of discomfort, possibly as abnormal perception of normal events. The treatment of such a complex condition is difficult and may not be solved by medical intervention solely. Patients presenting with dyspepsia of unknown origin, should primarily be treated with antacids. Treatment with prokinetics (cisapride) is rational and worth trying. Antacids and H2-receptor antagonists may help in NUD patients with acid reflux. In patients with Helicobacter pylori-induced gastritis Al-Mg-antacids suppress, but alone do not eradicate the bacteria. Antacids in combination with oxytetracycline and metronidazole eradicate H. pylori in about one half of the infected patients.