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ASGE offers guidelines on endoscopic treatment of dyspepsia
Date:12/21/2007

disease.

Age and alarm features have been used in an attempt to identify those patients with dyspepsia who harbor structural disease. Alarm features include new onset of symptoms in someone over 50, family history of upper-GI malignancy, unintended weight loss, GI bleeding or iron deficiency anemia, progressive trouble swallowing, pain with swallowing, persistent vomiting, palpable mass or lymphadenopathy, and jaundice.

The guidelines recommend that patients older than 50 years of age with recent onset of dyspepsia or patients of any age with alarm features should undergo an endoscopy. An endoscopy should also be considered for patients in whom there is a clinical suspicion of malignancy even in the absence of alarm features.

Patients Without Alarm Features

Patients with dyspepsia who are younger than age 50 and without alarm features are commonly evaluated by one of three methods: noninvasive testing for Helicobacter pylori (H. pylori), with subsequent treatment if positive (the test-and-treat approach), a trial of acid suppression or an initial endoscopy.

In many patients with dyspepsia who have peptic ulcer disease, H. pylori infection will be present. Noninvasive testing options for this infection include a blood test, urea breath testing (UBT), and stool antigen. There is growing evidence that patients who are managed with the test-and-treat approach have similar outcomes when compared with those undergoing initial endoscopy. In addition, the test-and-treat approach is more cost effective. Results from a meta-analysis of five randomized studies of test-and-treat versus an initial endoscopy showed a negligible improvement of symptoms in the endoscopy group, but a savings of $389 per patient in the test-and-treat group.

Many investigators and societies advocate acid-suppressive therapy as the initial strategy for patients with dyspepsia. Proton pump inhibitors (PPI) are more effective than H2 blo
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Contact: Anne Brownsey
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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