American Gastroenterological AssociationAmerican Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia
Section snippets
Differential Diagnosis of Dyspepsia
Dyspepsia refers to chronic or recurrent pain or discomfort centered in the upper abdomen.3 Patients with predominant or frequent (occurring more than once a week) heartburn or acid regurgitation are considered to have gastroesophageal reflux disease (GERD) until proven otherwise and are not part of the definition of dyspepsia (Figure 1). It is, however, recognized that there is considerable symptom overlap and it is often difficult to distinguish between dyspepsia and GERD in the
Management Options for New-Onset Dyspepsia
The main strategies for managing new-onset dyspepsia are (1) empirical H2-receptor antagonist therapy, (2) empirical proton pump inhibitor (PPI) therapy, (3) H pylori testing and treatment of positive cases (H pylori test and treat) followed by acid suppression if the patient remains symptomatic, (4) early endoscopy alone, (5) early endoscopy with biopsy for H pylori and treatment if positive, (6) acid suppression followed by endoscopy and biopsy if the patient remains symptomatic, or (7) H
Management Recommendations
Patients 55 years of age or younger without alarm features should receive H pylori test and treat followed by acid suppression if symptoms remain (Figure 2).3 H pylori testing is optimally performed by a 13C-urea breath test or stool antigen test. PPIs are the drug class of choice for acid suppression.3 Those who are H pylori negative should be prescribed an empirical trial of acid suppression with a PPI for 4–8 weeks. Empirical PPI therapy is the most cost-effective approach in populations
References (16)
- et al.
AGA technical reviewevaluation of dyspepsia
Gastroenterology
(1998) Dyspepsia
Gastroenterology
(2003)- et al.
American Gastroenterological Association technical reviewevaluation of dyspepsia
Gastroenterology
(2005) - et al.
The usefulness of the likelihood ratio in the diagnosis of dyspepsia and gastroesophageal reflux disease
Am J Gastroenterol
(1999) - et al.
An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsiaresolving the discrepancy between systematic reviews
Am J Gastroenterol
(2003) - et al.
The efficacy of proton pump inhibitors in non-ulcer dyspepsiaa systematic review and economic analysis
Gastroenterology
(2004) - et al.
The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsiathe Canadian Adult Dyspepsia Empiric treatment-prompt endoscopy (CADET-PE) study
Aliment Pharmacol Ther
(2003) - et al.
The prevalence and risk factors of functional dyspepsia in a multiethnic population in the United States
Am J Gastroenterol
(2004)
Cited by (154)
Up-Front Endoscopy Maximizes Cost-Effectiveness and Cost-Satisfaction in Uninvestigated Dyspepsia
2023, Clinical Gastroenterology and HepatologyProton Pump Inhibitors Increase the Risk of Early Biliary Infection After Placement of Percutaneous Transhepatic Biliary Stents
2021, Journal of Vascular and Interventional RadiologyGastric cancer: an update
2020, Medicine (Spain)Response to Yu and Fuhler et al
2024, Journal for ImmunoTherapy of CancerResearch Progress of Probiotics Regulating Intestinal Flora to Improve Functional Dyspepsia
2023, Journal of Chinese Institute of Food Science and TechnologyFunctional dyspepsia in pediatrics
2023, Pediatrie pro Praxi
Address requests for reprints to: Chair, Clinical Practice and Economics Committee, AGA National Office, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: (301) 654-5920
The Medical Position Statements (MPS), developed under the aegis of the American Gastroenterological Association (AGA) and its Clinical Practice and Economics Committee (CPEC), were approved by the AGA Governing Board. The data used to formulate these recommendations are derived from the data available at the time of their creation and may be supplemented and updated as new information is assimilated. These recommendations are intended for adult patients, with the intent of suggesting preferred approaches to specific medical issues or problems. They are based upon the interpretation and assimilation of scientifically valid research, derived from a comprehensive review of published literature. Ideally, the intent is to provide evidence based upon prospective, randomized placebo-controlled trials; however, when this is not possible the use of experts’ consensus may occur. The recommendations are intended to apply to healthcare providers of all specialties. It is important to stress that these recommendations should not be construed as a standard of care. The AGA stresses that the final decision regarding the care of the patient should be made by the physician with a focus on all aspects of the patient’s current medical situation.