American Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia

doi:10.1053/j.gastro.2005.09.019

Gastroenterology

Volume 129, Issue 5, November 2005, Pages 1753-1755

https://doi.org/10.1053/j.gastro.2005.09.019 Get rights and content

This document presents the official recommendations of the American Gastroenterological Association (AGA) on Evaluation of Dyspepsia. It was approved by the Clinical Practice and Economics Committee on April 22, 2005, and by the AGA Governing Board on October 6, 2005.

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

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Cited by (154)

Up-Front Endoscopy Maximizes Cost-Effectiveness and Cost-Satisfaction in Uninvestigated Dyspepsia
2023, Clinical Gastroenterology and Hepatology
Practice guidelines promote a routine noninvasive, non-endoscopic initial approach to investigating dyspepsia without alarm features in young patients, yet many patients undergo prompt upper endoscopy. We aimed to assess tradeoffs among costs, patient satisfaction, and clinical outcomes to inform discrepancy between guidelines and practice.
We constructed a decision-analytic model and performed cost-effectiveness/cost-satisfaction analysis over a 1-year time horizon on patients with uninvestigated dyspepsia without alarm features referred to gastroenterology. A RAND/UCLA expert panel informed model design. Four competing diagnostic/management strategies were evaluated: prompt endoscopy, testing for Helicobacter pylori and eradicating if present (test-and-treat), testing for H pylori and performing endoscopy if present (test-and-scope), and empiric acid suppression. Outcomes were derived from systematic reviews of clinical trials. Costs were informed by prospective observational cohort studies and national commercial/federal cost databases. Health gains were represented using quality-adjusted life years.
From the patient perspective, costs and outcomes were similar for all strategies (maximum out-of-pocket difference of $30 and <0.01 quality-adjusted life years gained/year regardless of strategy). Prompt endoscopy maximized cost-satisfaction and health system reimbursement. Test-and-scope maximized cost-effectiveness from insurer and patient perspectives. Results remained robust on multiple one-way sensitivity analyses on model inputs and across most willingness-to-pay thresholds.
Noninvasive management strategies appear to result in inferior cost-effectiveness and patient satisfaction outcomes compared with strategies promoting up-front endoscopy. Therefore, additional studies are needed to evaluate the drivers of patient satisfaction to facilitate inclusion in value-based healthcare transformation efforts.
Proton Pump Inhibitors Increase the Risk of Early Biliary Infection After Placement of Percutaneous Transhepatic Biliary Stents
2021, Journal of Vascular and Interventional Radiology
To investigate the association between the use of proton pump inhibitors (PPIs) and the risk of early biliary infection (EBI) after the placement of percutaneous transhepatic biliary stents (PTBS) in patients with unresectable malignant biliary obstruction (MBO).
A total of 136 patients with unresectable MBO (82 males and 54 females) treated with PTBS were included in this multicenter retrospective study. PPIs were prescribed to MBO patients with dyspepsia. The risk factors for EBI were identified by univariate and multivariate analyses. The association between the use of PPIs and EBI was assessed by logistic analyses.
A total of 72 (53%) patients were regular users of PPIs, and 33 (24%) patients developed EBI after PTBS. Univariate and multivariate analyses revealed that diabetes (hazard ratio [HR], 20.3; 95% confidence interval [CI], 5.6–72.9; P <.001), biliary stones (HR, 20.3; 95% CI, 5.6–72.9; P <.001) and PPIs (HR, 4.0; 95% CI, 1.2–12.8; P =.020) were risk factors for EBI. Further analyses of the correlation between the duration of PPIs use and EBI demonstrated that a prolonged use of PPIs significantly increased the risk of EBI (PPIs for <15 days vs 15–30 days: HR, 10.2; 95% CI, 3.1–33.3; P <.001; and PPIs <15 days vs ≥30 days; HR, 20.4; 95% CI, 2.2–192.3; P <.001).
The use of PPIs increased the risk of EBI after PTBS in patients with unresectable MBO. Furthermore, the risk of EBI increased with a prolonged duration of PPIs use.
Gastric cancer: an update
2020, Medicine (Spain)
El cáncer gástrico constituye un problema sociosanitario grave, ya que, a pesar de que se ha registrado un descenso en su incidencia, continúa siendo la tercera causa de muerte por cáncer en el mundo. Existen varios tipos de cáncer gástrico, siendo el más frecuente el adenocarcinoma. Su desarrollo se ha visto relacionado con factores ambientales, entre los que destaca la infección por Helicobacter pylori. Suele cursar de manera asintomática hasta estadios localmente avanzados, cuando puede dar lugar a gran variedad de síntomas. La endoscopia digestiva alta con toma de biopsias constituye el método diagnóstico de elección, empleándose otras técnicas como la ecoendoscopia o la tomografía computarizada para la estadificación. La resección quirúrgica es el eje central del tratamiento en ausencia de enfermedad diseminada, siendo objeto de controversia, hoy en día, la extensión de la linfadenectomía. Las técnicas de resección endoscópica como la mucosectomía o la disección submucosa deben valorarse en casos de cáncer gástrico precoz.
Although incidence of gastric cancer has fallen dramatically, remains being a severe public health problem, and it is the third cause of death worldwide. There are several types of stomach tumors; adenocarcinoma is the most common. Environmental factors are involved in its development, standing out Helicobacter pylori infection. Many gastric cancers are asymptomatic, appearing a wide range of symptoms in advanced stages. Diagnostic technique of choice is upper digestive endoscopy plus biopsy. Other diagnostic procedures, used for cancer staging, are ultrasound endoscopy or computed tomography. In absence of disseminated disease, the basis of the treatment is surgical resection. Nowadays, extended lymphadenectomy is controversial. In early gastric cancer, endoscopic mucosectomy or submucosal dissection have to be evaluated.
Response to Yu and Fuhler et al
2024, Journal for ImmunoTherapy of Cancer
Research Progress of Probiotics Regulating Intestinal Flora to Improve Functional Dyspepsia
2023, Journal of Chinese Institute of Food Science and Technology
Functional dyspepsia in pediatrics
2023, Pediatrie pro Praxi

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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.

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American Gastroenterological AssociationAmerican Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia

Section snippets

Differential Diagnosis of Dyspepsia

Management Options for New-Onset Dyspepsia

Management Recommendations

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Am J Gastroenterol

Gastroenterology

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

The prevalence and risk factors of functional dyspepsia in a multiethnic population in the United States

Am J Gastroenterol

American Gastroenterological Association
American Gastroenterological Association Medical Position Statement: Evaluation of Dyspepsia