Approach to the evaluation and management of dyspepsia in adults

H. pylori: Helicobacter pylori.
* Gastric mucosal biopsies should be obtained at the time of upper gastrointestinal endoscopy to rule out infection with H. pylori.
¶ Additional evaluation may be required based on symptoms (eg, abdominal imaging in patients with concurrent jaundice or pain suggestive of a biliary/pancreatic source).
Δ Refer to UpToDate topic reviews.
◊ Patients with continued symptoms of dyspepsia for 3 months with symptom onset at least 6 months before diagnosis and no evidence of structural disease to explain the symptoms should be diagnosed and treated as functional dyspepsia.
§ Eradication of H. pylori infection can be confirmed with a urea breath test, stool antigen testing, or upper endoscopy-based testing performed 4 weeks after completion of antibiotic therapy. The choice of test depends on the need for an upper endoscopy (eg, follow-up of bleeding peptic ulcer) and local availability. H. pylori serology should not be used to confirm eradication of H. pylori. Refer to UpToDate topic on diagnostic tests for H. pylori.
¥ Allow 8 to 12 weeks before reassessing symptomatic response.
‡ For patients with a partial clinical response to a proton pump inhibitor, a tricyclic antidepressant can be initiated as combination therapy with a proton pump inhibitor.