Monitoring
Functional dyspepsia is a remitting and relapsing disease with symptom-free intervals interspersed with flare-ups, and continuous medication is not necessary after eradication of symptoms unless there is an underlying condition requiring treatment. Proton pump inhibitors or H2RA treatment may be tapered to the lowest effective dose and eventually discontinued after a favorable response to the initial treatment. Consider treatment with antacids or alginates when necessary. Check the compliance to therapy and for any drug-related adverse effects. Advise the patient to continue to avoid known precipitants of dyspepsia including smoking, alcohol, coffee, chocolate, fatty foods and being overweight, and to adhere to lifestyle modifications.
Monitor for the appearance of alarm signs and symptoms. Specialized investigations specific to presenting symptoms may be performed in patients unresponsive to treatment; treat underlying disease accordingly. In patients with persistent PDS symptoms, gastric emptying should be measured, and if severely delayed, a diagnosis of idiopathic gastroparesis should be made, with consideration given to treatment using prokinetic agents. Consider a referral to a dietitian to address dietary concerns or a mental health professional if stress or mental health issues are contributing to the condition. Involvement of a dietitian early in the management of patients with severe or refractory functional dyspepsia helps avoid an overly restrictive diet.
Specialist Referral
Dyspepsia_Follow Up
Specialist investigation is necessary for patients with severe or alarm symptoms, patients ≥60 years old (younger in areas with high prevalence of gastric cancer), patients who did not respond to empiric therapy and have persistent symptoms, for diagnostic confirmation and for further evaluation of an alternative diagnosis. Consider expert referral for a specialty opinion and alternative treatment if unresponsive to empiric therapy.