Evaluation and Management of Dyspepsia.docVIP

Evaluation and Management of Dyspepsia R. Christopher Harmon, David A. Peura Ther Adv Gastroenterol.?2010;3(2):87-98.? Abstract and Introduction Abstract Dyspepsia is a common clinical problem seen by both primary care physicians and gastroenterologists. Initial evaluation should focus on the identification and treatment of potential causes of symptoms such as gastroesophageal reflux disease (GERD), peptic ulcer disease, and medication side effects but also on recognizing those at risk for more serious conditions such as gastric cancer. This manuscript discusses the evaluation and management of dyspepsia including the role of proton-pump inhibitors, treatment of Helicobacter pylori, and endoscopy. Finally, treatment of refractory functional dyspepsia is addressed. Introduction Of all adults 30–40% experience symptoms of upper abdominal pain or discomfort but an organic cause is found in only a minority who seek medical care [El-Serag and Talley, 2004; Talley?et al.?1998b]. The remaining group is labeled as having functional dyspepsia. Individuals with functional dyspepsia suffer significant morbidity and expend significant resources through both direct and indirect costs. Despite periods of remission, patients will usually have continued intermittent symptoms long-term [Agreus?et al.?1995; Talley?et al.?1987]; with approximately 50% consulting a health care provider for their symptoms at some time in their life [Koloski?et al.?2001]. Dyspepsia is defined as having one or more symptoms of epigastric pain, burning, postprandial fullness, or early satiation [Tack?et al.?2006]. Bloating and nausea often coexist with dyspepsia but are nonspecific and are thus not included in its definition. Heartburn is also excluded from diagnostic symptom criteria for dyspepsia since it is thought to primarily arise from the esophagus and it is suggestive of gastroesophageal reflux disease (GERD) although it too may occur concomitantly [Talley?et al.?1993; Klauser?et al.?1990]. Similar