The primary step in treating patients with dyspepsia is to determine the risk for malignancy. If risk is minimal, then determine the appropriate type of therapy to use. Due to a possible association between a Helicobacter pylori (H. pylori) infection and dyspepsia (primarily due to its relationship to ulcer disease), many physicians look for this infection with a simple and noninvasive test.
This is performed in low-risk patients instead of a more involved and invasive procedure with an endoscope. If a H. pylori infection is diagnosed (this is much more common in older patients from low socioeconomic conditions or those who were immigrants to the United States), it should be treated with antibiotics.
Curing a H. pylori infection for patients with dyspepsia not related to an ulcer, however, generally does not appear to improve symptoms. Young patients at low risk for serious organic disease, who are H. pylori negative should be treated with trials of therapy.
The three types of medications that are used to treat dyspepsia are therapies that reduce secretions (H2 antagonists or proton pump inhibitors), prokinetics (agents such as cisapride, which improve stomach motility) and anti-cholinergics (medications such as hyoscyamine that decrease contractions in the gastrointestinal tract). These types of medications only should be used for four to six weeks if there is not improvement.
Patients who fail to respond to one type of therapy or whose symptoms develop after such therapy is discontinued, should either be switched to an alternative type of medication or undergo an evaluation with an endoscope.
In some individuals, endoscopy of the upper gastrointestinal tract may relieve concern, which in itself may make patients feel better. It is also important in identifying structural diseases. If an ulcer is found, H. pylori should be looked for and treated; its cure in the presence of ulcer disease prevents recurrence. Gastroesophageal reflux disease (GERD) can be treated with maintenance antisecretory therapy to control symptoms. Cancer, if discovered, requires definitive management with surgery and chemotherapy.