Nonulcer dyspepsia: current approaches to diagnosis and management

Many patients with dyspepsia do not have peptic ulceration or other organic disease that explains their symptoms. The etiology of nonulcer dyspepsia is not established, and its treatment remains empiric. A careful clinical evaluation can usually rule out other disorders, such as gastroesophageal reflux disease and irritable bowel syndrome, and can identify patients who require immediate investigation and those who can safely receive empiric therapy with antacids or a histamine H2-receptor antagonist. If diagnostic investigation is indicated, endoscopy is the procedure of choice. The physician can then classify patients with documented nonulcer dyspepsia on the basis of symptoms, which may guide therapy. Many patients with nonulcer dyspepsia respond to reassurance, explanation, dietary modifications and avoidance of precipitating factors.