A recent review (P Koduru et al. Clin Gastroenterol Hepatol 2018; 16: 467-79) provides a good review of dyspepsia and in addition provides some literary perspective.
In their introduction, the authors quote James Joyce in Ulysses: “Tom Rochford split powder from a twisted paper into the water set before him –That cursed dyspepsia, he said before drinking. –Breadsoda is very good Davy.”
After reviewing the definition and the pathophysiology, the authors provide a suggested algorithm (Figure 2).
- In areas with high H pylori, there is an option of “test and treat” and relying on endoscopy in those who fail to respond
- Empiric PPI therapy which works best if reflux-type symptoms are present and relying on endoscopy in those who fail to respond
- Endoscopy without empiric treatment
In those with a negative endoscopy –>functional dyspepsia treatment is driven by symptoms:
- If pain, the first line option recommended is a tricyclic antidepressant (pain modulator)
- If nausea, the first line option recommended is an antiemetic
- If early satiety, the first line option recommended is buspirone
For those with resistant and disabling symptoms, “consider nonpharmacologic approaches, such as psychotherapy or acupuncture.”
- Dreaded Nausea (2017)
- Dreaded Nausea
- Brave New World: Psychotropic Manipulation & Pediatric …
- Understanding Idiopathic Nausea | gutsandgrowth
- NEJM: Functional Dyspepsia | gutsandgrowth
- Does buspirone help functional dyspepsia? | gutsandgrowth
- A 6-Year Study of Amitriptyline, Escitalopram, and Functional
- Anxiety and Functional Abdominal Pain | gutsandgrowth
- Cognitive Behavioral Therapy for Childhood Abdominal Pain
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