These guidelines for the workup an management of dyspepsia were developed jointly by the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG). They suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal endoscopy to exclude organic pathology. This is a conditional recommendation and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age. Alarm features should not automatically precipitate endoscopy in younger patients but this should be considered on a case-by-case basis. It is also recommended that patients <60 years of age have a non-invasive test for Helicobacter pylori and treatment if positive. Those that are negative or do not respond to this approach should be given a trial of proton pump inhibitor (PPI) therapy. If these are ineffective tricyclic antidepressants (TCA) or prokinetic therapies can be tried. Patients that have an endoscopy where no pathology is found are defined as having functional dyspepsia (FD). H. pylori eradication should be offered in these patients if they are infected. We recommend PPI, TCA and prokinetic therapy (in that order) in those that fail therapy or are H. pylori negative. Routine upper gastrointestinal (GI) motility testing is not recommended but may be useful in selected patients. This EvidenceCare Protocol is based on the American College of Gastroenterology 2017 publication “ACG and CAG Clinical Guideline: Management of Dyspepsia”.
Paul Moayyedi, MD, PhD
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