Dyspepsia
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Epigastric pain or discomfort following meals, often accompanied by bloating, sensation of fullness and nausea.
Dyspepsia is most commonly functional, linked with stress and not linked to the quantity of gastric acid (antacids and antiulcer drugs are ineffective).
Resolution is usually spontaneous.
Endoscopy is warranted in all patients age 60 years or older often and selected younger patients with alarm features.
In all other patients, testing for Helicobacter pylori is recommended; if positive, antibacterial treatment is given.
Patients who have no significant findings on endoscopy as well as patients under age 60 who do not respond to H pylori eradication or empiric proton pump inhibitor therapy are presumed to have functional dyspepsia. They should be prescribed a trial of empiric proton pump inhibitor therapy.
Patients with refractory symptoms should be offered a trial of tricyclic antidepressant, a prokinetic agent, or psychological therapy.
Management
General measures: Most patients have mild, intermittent symptoms that respond to reassurance and lifestyle changes.
Alcohol and caffeine should be reduced or discontinued.
Patients with postprandial symptoms should be instructed to consume small, low - fat meals.
Pharmacological treatment:
Cap - Risek (omeprazole) 40mg PO x OD, or 20mg PO x BD (or any other PPI) before meal for 4 weeks
If there is no response, add low dose anti - depressants & look for the cause of dyspepsia.
Tab- Librax (Chlordiazepoxide + Clidinium) 1 Tab PO x TDS ' OR ' Tab- Buspar (Buspirone) 10mg, 1 tablet PO x TDS 15 minutes before meals ' OR ' Tab - Sensival (Nortriptyline) 25-50mg, 1 tablet PO x at night
Tab- Metomide (metoclopramide) 5-10mg, 1 tablet PO x TDS OR Tab- Motilium (domperidone) 10mg, 1 tablet PO x TDS
Psychotherapy and hypnotherapy may be of benefit in selected motivated patients with functional dyspepsia.