period of rest before making other changes in the
patient’s diet or beginning medication therapy, may
be recommended.
Patients with FD may also benefit from discontin-
uing certain herbal remedies that produce symptoms
of dyspepsia. These include garlic, gingko, saw pal-
metto, feverfew, chaste tree berry, and willow bark.
Other treatments
Other treatments for functional dyspepsia include
complementary and alternative (CAM) therapies and
psychotherapy. CAM treatments include such herbal
remedies as peppermint, turmeric, and aloe vera gel
taken by mouth, and such non-dietary treatments as
yoga, meditation, relaxation techniques, acupuncture,
and music therapy. Psychotherapy is most likely to be
helpful for patients with a history of abuse or post-
traumatic stress as well as functional dyspepsia.
Prokinetic drugs may be prescribed for patients with
dysmotility-like FD. These medications speed up or
strengthen the contractions of the small intestine. Avail-
able medications include metoclopramide (Reglan),
cisapride (Propulsid), and domperidone (Motilium).
Domperidone is not approved for use in the United
States because its adverse effects include abnormalities
of heart rhythm. In addition to prokinetic drugs, some
doctors prescribe antidepressant medications in order to
lower the patient’s stress level and awareness of sensa-
tions coming from the stomach and intestines, but only a
minority of patients with FD benefit from either proki-
netics or antidepressants.
Medical
Medical management of FD in patients typically
begins with either testing and treating the patient for
infection withH. pylorior by prescribing medications
to lower the level of stomach acid secretions for a trial
period of 4–8 weeks. The two classes of medications
most commonly prescribed to reduce acid secretion
are H 2 -receptor blockers and proton pump inhibitors
(PPIs). The first group, which is the older of the two,
was developed in the late 1970s and early 1980s and
includes such drugs as cimetidine (Tagamet) and rani-
tidine (Zantac). The proton pump inhibitors are more
powerful than the H 2 -receptor blockers and have
fewer adverse effects. The PPIs include omeprazole
(Prilosec), lansoprazole (Prevacid), esomeprazole
(Nexium), pantoprazole (Protonix), and rabeprazole
(Rabecid). In general, trial therapy with acid-reducing
medications is considered more effective for FD than
testing for and treatingH. pyloriinfection, because
only a small minority of patients with FD report
improvement in their symptoms after treatment for
the infection.Function
The function of medical and dietary treatment of
FD is to manage or relieve the patient’s symptoms in
order to improve his or her quality of life. Therapeutic
fasting is intended to give the digestive system a brief
period of rest prior to medication therapy or antibi-
otics to eradicateH. pylori. Since the cause(s) of FD
are not yet known for certain, these treatments cannot
be considered cures.Benefits
The benefits of medical and dietary treatment of
FD are improved symptom management and better
quality of life, with less time lost from school or work.Precautions
Patients who experience dyspepsia for several
weeks or longer should consult their physician for an
evaluation to rule out more serious disorders; even if
the indigestion is intermittent rather than continuous.
Patients over age 45 who develop dyspepsia suddenly
should see their doctor immediately, particularly if the
indigestion is accompanied by black tarry stools, loss
of appetite, painful swallowing, bloody vomit, or
unintentional weight loss.
Patients who experience indigestion unrelated to
eating, or indigestion accompanied by sweating, short-
ness of breath, or pain radiating to the neck, jaw, or
arm should also see a doctor at once, as these symp-
toms may indicate a heart attack.Risks
There are no known risks associated with modify-
ing one’s diet to relieve functional dyspepsia, although
patients considering a therapeutic fast should consultQUESTIONS TO ASK YOUR
DOCTOR What are the chances that dyspepsia in a person
of my age and sex represents a serious disorder?
What is your opinion of dietary changes in
treating dyspepsia?
Would you recommend therapeutic fasting
before beginning medication treatment for
dyspepsia?Dyspepsia