Managing heartburn, undifferentiated dyspepsia and functional dyspepsia in general practice
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Heartburn, undifferentiated dyspepsia and functional dyspepsia are common. Management requires an individually tailored combination of lifestyle modification and drug treatment.
Key Adviser: Professor Gil Barbezat
Dyspepsia is a range of symptoms which may indicate significant organic disease but most people with dyspepsia have no underlying pathology and do not seek medical advice
Heartburn is a burning sensation rising from the epigastrium toward the neck.
Dyspepsia is pain or discomfort located in the epigastrium. Associated symptoms may include fullness after meals, bloating, belching, early satiety, anorexia, nausea and vomiting. The symptoms of dyspepsia may be episodic, recurrent or chronic and whilst many symptoms are associated with food this is not always the case.
Undifferentiated dyspepsia is dyspepsia that has not been investigated. In a person at low risk of underlying pathology this can be managed empirically without further investigation.
Functional dyspepsia is dyspepsia, which has been investigated and no underlying pathology found.
The management of dyspepsia associated with underlying pathology, e.g peptic ulceration or use of NSAIDs is not discussed in this article.
Key Points
- Red flags are indications for oesophago-gastro-duodenoscopy (OGD)
- People with heartburn or undifferentiated or functional dyspepsia often benefit from modification of lifestyle and drug therapies
- If heartburn is part of the symptom complex, treat initially as gastro-oesophageal reflux disease (GORD) with a proton pump inhibitor (PPI) and step down therapy
- If drug treatment for undifferentiated or functional dyspepsia without heartburn is required an H2-receptor antagonist (H2RA) is the drug of choice
- In areas of moderate to high prevalence of H. pylori consider the need for a test and treat approach
- After the initial control of symptoms encourage people to step down to the lowest effective dose and/or treat symptoms intermittently ‘on-demand’
- Review your patients with chronic dyspepsia annually for the appearance of alarm signals and use of aggravating drugs
- Review all patients for on-going requirement for pharmacotherapy, especially PPIs
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