What is the optimum strategy for managing dyspepsia?

The demand for upper gastrointestinal endoscopy is increasing. The main impetus has been to detect gastric cancer at a treatable stage. Gastric cancer is rare in the young, but endoscopy is still performed in this age group. The rationale is to detect significant pathology such as peptic ulcer disease. Endoscopy is expensive and resources are limited, so alternative strategies to investigate young dyspeptics is desirable. This paper reviews the strategies available for investigating young patients with dyspepsia. These include symptom questionnaires, empirical anti-secretory therapy, screening for Helicobacter pylori and endoscoping those that are positive, screening for H. pylori, and treating those that are positive or prescribing empirical H. pylori eradication therapy. We have found screening for H. pylori and treating those infected has reduced endoscopy in the young by 34% in our unit and may be the most cost-effective method of managing dyspepsia in those at low risk of underlying upper gastrointestinal malignancy.