Guideline
The role of endoscopy in dyspepsia

https://doi.org/10.1016/j.gie.2015.04.003Get rights and content

Section snippets

Definition

Dyspepsia is a poorly characterized syndrome thought to originate from anatomic or functional disorders of the upper GI tract.7, 8, 9 Dyspepsia encompasses a variety of symptoms including epigastric discomfort, bloating, anorexia, early satiety, belching or regurgitation, nausea, and heartburn. Rome III criteria define dyspepsia as 1 or more of the following 3 symptoms for 3 months within the initial 6 months of symptom onset10: (1) postprandial fullness, (2) early satiety, and (3) epigastric

Patients with alarm features

Symptoms of dyspepsia do not reliably identify individuals with malignancy or other important upper GI pathology. Therefore, patient age and alarm features (Table 2)18 have been used to categorize patients with dyspepsia who may harbor true pathology that may be found with endoscopy or other examinations. Patients with new-onset dyspepsia after 4518 to 5519 years of age (average age 50 years) and those with symptoms or signs that suggest structural disease are advised to undergo initial

Patients without alarm features

Dyspeptic patients younger than 50 years of age and without alarm features are commonly evaluated by 1 of 3 methods: (1) noninvasive testing for Helicobacter pylori, with subsequent treatment if positive (the “test and treat” approach), (2) an empiric trial of acid suppression, or (3) initial endoscopy.

Recommendations

  • 1.

    We recommend initial endoscopy for new-onset dyspepsia in patients 50 years of age of older or those with alarm features. ⊕⊕⊕○

  • 2.

    We recommend that dyspeptic patients younger than 50 years of age and without alarm features undergo either an initial “test and treat” approach for H pylori or empiric therapy with a PPI, depending on the prevalence of H pylori infection in their population. For H pylori prevalence greater than 20%, “test and treat” is recommended. ⊕⊕⊕○

  • 3.

    We suggest that dyspeptic patients

Disclosures

Dr Fanelli is the owner and director of New Wave Surgical Inc, is an advisor for and receives royalties from Cook Medical, is a consultant for EndoGastric Solutions, and is an owner of Allurion Technologies Inc and Mozaic Medical Inc. Dr Khashab is a consultant for and on the advisory board of Boston Scientific, a consultant for Olympus, and has received research support from Cook Medical. Dr Muthusamy is a consultant for Boston Scientific and Covidien GI Solutions and a stockholder in

References (53)

  • U. Ladabaum et al.

    Helicobacter pylori test-and-treat intervention compared to usual care in primary care patients with suspected peptic ulcer disease in the United States

    Am J Gastroenterol

    (2002)
  • P. Moayyedi et al.

    The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis

    Gastroenterology

    (2004)
  • W.H. Wang et al.

    Effects of proton-pump inhibitors on functional dyspepsia: a meta-analysis of randomized placebo-controlled trials

    Clin Gastroenterol Hepatol

    (2007)
  • L. Rabeneck et al.

    A double blind, randomized, placebo-controlled trial of proton pump inhibitor therapy in patients with uninvestigated dyspepsia

    Am J Gastroenterol

    (2002)
  • B. Williams et al.

    Do young patients with dyspepsia need investigation?

    Lancet

    (1988)
  • P. Bytzer et al.

    Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia

    Lancet

    (1994)
  • B.C. Delaney et al.

    Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care

    Lancet

    (2000)
  • L. Rabeneck et al.

    Impact of upper endoscopy on satisfaction in patients with previously uninvestigated dyspepsia

    Gastrointest Endosc

    (2003)
  • H.B. El-Serag et al.

    Systemic review: the prevalence and clinical course of functional dyspepsia

    Aliment Pharmacol Ther

    (2004)
  • Ford AC, Marwaha A, Sood R, et al. Global prevalence of, and risk factors for, uninvestigated dyspepsia: a...
  • S. Mahadeva et al.

    Epidemiology of functional dyspepsia: a global perspective

    World J Gastroenterol

    (2006)
  • S.K. Ahlawat et al.

    Dyspepsia consulters and patterns of management: a population-based study

    Aliment Pharmacol Ther

    (2005)
  • A.P. Hungin et al.

    Management of dyspepsia across the primary-secondary healthcare interface

    Dig Dis

    (2001)
  • V. Stanghellini et al.

    Management of dyspeptic patients by general practitioners and specialists

    Gut

    (1998)
  • J. Tack et al.

    Functional dyspepsia–symptoms, definitions and validity of the Rome III criteria

    Nat Rev Gastroenterol Hepatol

    (2013)
  • N.J. Talley

    Functional (non-ulcer) dyspepsia and gastroesophageal reflux disease: one not two diseases?

    Am J Gastroenterol

    (2013)
  • Cited by (43)

    • Quality in Barrett's Esophagus: Diagnosis and Management

      2022, Techniques and Innovations in Gastrointestinal Endoscopy
      Citation Excerpt :

      Endoscopic screening is performed in those with multiple risk factors for esophageal cancer with particular attention to the male sex, family history of EAC/BE, and reflux symptoms.3,13 Other risk factors for BE and esophageal cancer include central obesity,14 age over 50 years,15 tobacco use, Caucasian race,16 first or second degree relatives with BE,17 PPI use, and dyspepsia.18–21 Our standard screening paradigm is imperfect.

    • Correlation between the symptoms of upper gastrointestinal disease and endoscopy findings: Implications for clinical practice

      2021, Journal of Taibah University Medical Sciences
      Citation Excerpt :

      Dyspeptic symptoms can be associated with different gastrointestinal diseases such as esophagitis, gastritis, peptic ulcer, and gastric cancer, which are the main causes of gastrointestinal morbidity and mortality worldwide.3 Western endoscopy societies,4,5 Asian recommendations,6 and current Brazilian7 guidelines recommend investigation of these symptoms through upper gastrointestinal endoscopy, also known as esophagogastroduodenoscopy (EGD) to detect organic diseases that cause the patient's symptoms and, more importantly, to exclude upper gastrointestinal malignancies. EGD is one of the most common endoscopic procedures used for the investigation of digestive symptoms, and it provides information for the diagnosis and treatment of gastrointestinal disorders.5,8

    • Effectiveness of Ayurveda treatment in Urdhwaga Amlapitta: A clinical evaluation

      2021, Journal of Ayurveda and Integrative Medicine
      Citation Excerpt :

      Pregnant/lactating mothers. Patient with alarm features [3] as Family history of upper GI malignancy in a first-degree relative, Unintended weight loss more than 5% of normal body weight over last 6–12 months, Occult (elicited by past history) or overt GI bleeding (recent history of past 15 days to one month) or iron deficiency anemia, Dysphagia, Odynophagia, Persistent vomiting –considered when there was more than 3 episodes of vomiting in 24 h in past 15 days to one month An elaborative case taking proforma (Annexure 1) was designed for taking a history of dosha involvement and assessing the Nidan (causative factor).

    View all citing articles on Scopus

    This document was reviewed and approved by the governing board of the American Society for Gastrointestinal Endoscopy.

    View full text