Clinical Question

What are the latest evidence-based guidelines for the management of functional dyspepsia?

Bottom Line

The thoughtful, evidence-based guidelines provide a helpful framework for evaluating and treating patients with dyspepsia. The guidance regarding imaging and the use of upper endoscopy may be conservative for U.S. physicians. The authors acknowledge that approximately half of the recommendations are based on low- or very low-quality evidence. (Level of Evidence = 1a)

Synopsis

The 2022 guideline, last updated in 1996, was based on a series of systematic reviews and network meta-analyses. The authors recommend urgent evaluation of patients with upper gastrointestinal alarm symptoms, such as dysphagia in all patients, weight loss with dyspepsia, upper abdominal pain, or reflux in patients 55 years and older. Urgent evaluation is recommended for patients 40 years and older who are from a region where gastric cancer is common or have a family history of gastroesophageal cancer. Other alarm symptoms warranting a less urgent evaluation include hematemesis; treatment-resistant dyspepsia; dyspepsia; upper abdominal pain with elevated platelet count, low hemoglobin, and nausea or vomiting; and nausea or vomiting with weight loss, reflux, dyspepsia, or upper abdominal pain in patients who are 55 years and older. Patients without alarm symptoms who present with at least two months of epigastric burning or pain, early satiety, or postprandial fullness should be given a diagnosis of functional dyspepsia and told that it is a disorder of gut-brain interaction. As part of the initial evaluation in patients 55 years and older, a complete blood count with platelets should be obtained and those with overlapping irritable bowel symptoms should have celiac serology. Those 60 years and older with abdominal pain and weight loss should have abdominal computed tomography to evaluate for pancreatic cancer.