Algorithm for “Cursed” Dyspepsia

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).

Initial options:

  • 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.”

Related posts:

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

2 thoughts on “Algorithm for “Cursed” Dyspepsia

  1. 1. Non-pharmacologic therapies should be higher on the algorithm…..data continues to shows these areas to be effective and we should discuss them sooner and with more persuasion.

    2. Historically, endoscopy has not been promoted as an initial option for pediatric population? Maybe we should lower our threshold, maybe it provides reassurance that patients/families need?

    • Both good points. With regard to reassurance, this was discussed in a previous post (March 11,2013): “Does negative testing reassure patients?”
      Key points:
      1. “Probably not according to a recent study (JAMA Intern Med, published online Feb 25, 2013, dpi:10.1001/jamainternmed.2013.2762).” 2. “While this current study suggests that there is a lack of long-term benefit when testing is done primarily for reassurance, convincing families that their child does not need testing is often difficult.”
      It is worth considering that how reassuring parents may be different than reassuring patients themselves.

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