The Clinical Approach to Dyspepsia

Dyspepsia is a common complaint encountered in clinical practice. It is defined as chronic or recurrent pain or discomfort centered in the upper abdomen. In addition, symptoms may include early satiety, bloating, upper abdominal fullness, or nausea. Patients with dyspepsia who are over the age of 55 or who have alarm signs or symptoms should undergo prompt upper endoscopy. For all other patients, two treatment strategies are proposed, including: (1) “test and treat” for Helicobacter pylori, and (2) empirical trial of anti-secretory therapy with a proton pump inhibitor. Further investigation, such as upper endoscopy, should be considered on a case-by-case basis. This chapter reviews the most current guidelines regarding the definition of dyspepsia and functional dyspepsia, the role of endoscopy as part of the initial evaluation, the role of H. pylori, and potential treatment strategies.