Evaluation and management of dyspepsia - current perspectives
o Spend time taking a good history and performing a physical examination even though the majority of patients have“functional” symptoms. Exclude “non-dyspepsia” conditions and be careful in excluding a “surgical” abdomen.
o Consider gastroscopy or an ultrasound or CT scan of the abdomen, if alarm symptoms are present. The thresholdto investigate should be lower with older male patients as there is a higher chance of organic disease.
o When patients’ symptoms are unclear, a close follow-up and review is useful. Symptoms persisting over manymonths or years are unlikely to have an organic basis.
o Explore, understand and address patients’ concerns including psychological problems. Patients need to be reassured.
o Sensible advice on food/meal and lifestyle modifications is useful. Antacids often give immediate relief to acutedyspeptic symptoms. Gastroesophageal reflux symptoms may be atypical − a trial of PPI therapy may be useful.Patients with wind, bloating and discomfort often benefit from a course of prokinetic agents.
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