Non-ulcer dyspepsia (functional dyspepsia, indigestion) management

 Non-ulcer dyspepsia (functional dyspepsia, indigestion) management

Non-ulcer dyspepsia is a chronic recurrent dyspeptic disorder characterized by upper abdominal symptoms including discomfort, pain, fullness, early satiety, bloating, epigastric burning pain syndrome, and postprandial distress syndrome in the absence of any organic, systemic, or metabolic disease that explains the symptoms.

Clinical presentation

• Dyspeptic symptoms present for the last 3 months, with symptom onset at least 6 months before diagnosis.

• Bothersome abdominal discomfort.

• Postprandial fullness.

• Early satiety.

• Epigastric pain.

• Epigastric burning.

Investigations

• Absence of structural disease on upper gastrointestinal endoscopy.

Pharmacological treatment

H. pylori eradication

• Refer to the H. pylori eradication section where indicated.

Acid suppression therapy

• Omeprazole (PO) 20 mg every 24 hours for 4–8 weeks

OR

• Pantoprazole (PO) 40 mg every 24 hours for 4–8 weeks

OR

• Esomeprazole (PO) 40 mg every 24 hours for 4–8 weeks

Prokinetic therapy

• Metoclopramide (PO) 10 mg every 8 hours when required for bloating, nausea, or delayed gastric emptying

OR

• Domperidone (PO) 10 mg every 8 hours when required for bloating, nausea, or delayed gastric emptying

Refractory symptoms

• Amitriptyline (PO) 25 mg at bedtime when required for refractory cases