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

ckers in this approach. Initiation of empiric acid suppression will not address underlying H. pylori in those patients with H. pyloriassociated peptic ulcer disease, risking recurrent symptoms when acid suppression is withdrawn. This may prompt long-term acid suppression if no further investigation is performed.

One advantage of early endoscopy is the possibility of establishing a specific diagnosis, such as peptic ulcer disease or erosive esophagitis. The risk of malignancy is quite low in young patients without alarm features. Many patients, however, with early stage malignancy do not have alarm symptoms. Another advantage of a negative endoscopy in the evaluation of patients with dyspepsia is a reduction in anxiety and an increase in patient satisfaction. Yet, there is little evidence to suggest significant improvement in outcomes by the initial endoscopy approach. Most studies demonstrate an increased cost with the initial endoscopic approach compared with the test-and-treat method.

Recommendations

  • Patients with dyspepsia who are older than 50 years of age and/or those with alarm features should undergo endoscopic evaluation
  • Patients with dyspepsia who are younger than 50 years of age and without alarm features may undergo an initial test-and-treat approach for H. pylori
  • Patients who are younger than 50 years of age and are H. pylori negative can be offered an initial endoscopy or a short trial of PPI acid suppression
  • Patients with dyspepsia who do not respond to empiric PPI therapy or have recurrent symptoms after an adequate trial should undergo endoscopy


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Contact: Anne Brownsey
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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