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Last Updated: 5/20/2013  

Dyspepsia

Diagnosis
  • Characterize the symptoms and distinguish between the symptoms of dyspepsia and other GI disease processes, considering both organic and functional disorders.

  • Upper endoscopy should be performed in patients who are older than 50 years and those with alarm features which include:

    • Age over 50 years, with new onset symptoms

    • GI bleeding or iron deficiency anemia

    • Dysphagia

    • Unintended weight loss

    • Odynophagia

    • Persistent vomiting

    • Family history of upper GI malignancy

    • Palpable mass or lymphadenopathy

    • Jaundice

Therapy
  • Consider either initial non-endoscopic H. pylori testing and treatment if positive, or empiric treatment with a PPI for patients younger than 50 years with dyspepsia without alarm features.

  • To determine the presence of active H. pylori infection use a urea breath or stool antigen test.

  • Consider endoscopy for patients with persistent or recurrent symptoms after H. pylori testing and treatment if positive, and 4 to 8 weeks of PPI therapy.

DOI: 10.7326/d149
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
John M. Inadomi, MD received honorarium from AstraZeneca, TAP Pharmaceuticals, received grant from Janssen. A. Mark Fendrick, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Chad S. Miller, MD, FACP, FHM has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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