Internal Medicine

P1: RLJ/OZN P2: PSB

0521779407-D-02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:9

Dyspepsia 511

General Measures

■stop smoking, coffee, alcohol or other offending agents

■stop NSAIDs or other agents associated with dyspepsia

■use acid lower drugs for persistent symptoms

specific therapy

Indications

■confirmed or suspected specific diagnosis

Treatment Options

■anti-Helicobacter pyloritherapy if positive (see section on H. pylori)

■anti-secretory therapy with H2-receptor antagonists or proton pump

inhibitors for 4–6 weeks for suspected or proven ulcer, GERD, non-

ulcer dyspepsia

■prokinetics for gastroparesis

■cholecystectomy for gallstones

Side Effects

■dyspepsia, nausea, vomiting, metallic taste withHelicobacter pylori

treatments (usually mild)

■side-effects rare with H2RAs or PPIs

■diarrhea, neuropyschiatric symptoms with prokinetics

Contraindications

■absolute: allergy to drug

follow-up

Routine

■complicated peptic ulcer

■suspected malignant ulcer

■worried patient

■recurrent symptoms

complications and prognosis

Complications

■peptic ulcer

➣bleeding

➣perforation

➣obstruction

➣symptomatic ulcer

■cholelithiasis

➣cholecysitis