dyspepsia
DYSPEPSIA

Dyspepsia is having any one of the following: disturbing postprandial fullness, early satiation, epigastric pain and/or burning felt predominantly in the upper abdomen.

It is considered a symptom complex rather than a specific diagnosis.

Acid suppression is the recommended initial therapy.

Patient Education

  • There is no clear evidence of specific association between lifestyle factors and dyspepsia, but some individuals may be helped by these measures
  • To reduce anxiety, in cases where there are no indications of organic disease, reassurance is an important part of initial therapy
  • Provide patients with access to educational materials to support the care they receive

Lifestyle Modification

  • Advise patients to avoid known precipitants that they associate with dyspeptic symptoms eg alcohol, coffee, chocolate and fatty foods
    • Alcohol, coffee, and chocolate have pharmacological effects that may reduce the tone of the lower esophageal sphincter (LES)
    • Fatty foods delay gastric emptying time which may also predispose to GERD
  • Encourage patient to stop smoking
    • Smoking has pharmacological effects that may reduce the tone of the LES
  • Weight reduction for overweight and obese patients
    • Obesity may disrupt the LES due to mechanical pressure on the diaphragm
  • May suggest having a main meal well before going to bed (preferably 3 hours before)
  • Some patients may benefit from raising the head when sleeping
    • Lying flat may increase reflux episodes since gravity does not prevent acid regurgitation

Other Considerations

  • If there is concurrent use of NSAIDs, evaluate for risk of GI complications and consider alternative strategies if risk is a concern
    • See PUD Disease Management Chart for details
  • Patients with refractory functional dyspepsia are those who are unresponsive to either initial acid suppression therapy or H pylori eradication; have a high rate of accompanying depression and psychiatric illness
    • May consider psychological therapies, eg cognitive behavioral therapy (CBT) and psychotherapy, or antidepressants to reduce dyspeptic symptoms especially in non-ulcer dyspepsia
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