[Dyspepsia--can we follow dogmatic guidelines in a nuanced reality? Individual management of patients with dyspepsia with risk of stomach ulcer]

Abstract

A review of subject literature suggests management strategies for the treatment of dyspepsia to be characterised by marked differences. In some strategies the possibility of indirect Helicobacter pylori testing (e g, breath tests) is ignored and endoscopy recommended as the only appropriate investigation; only those with verified disease are treated, and the risk of antibiotic overuse is minimised. In other strategies, indirect H pylori testing is recommended for younger patients (< 45 years of age) without alarming symptoms, either to select patients for endoscopy or to eradicate the infection (i.e., irrespective of whether the patient has peptic ulcer disease or not, on the grounds that the risk of having or developing such disease is thus minimised. The article consists in discussion of the different strategies, and suggests a choice of investigations tailored to the needs of the individual patient to be preferable to dogmatic adoption of either approach, though endoscopy should be available without delay if required. Moreover, the accuracy of the various indirect H pylori tests needs to be considered. To be acceptable for use in primary care, it is suggested that recommendations regarding interventions for the various disorders associated with dyspepsia should be characterised by reasonably comparable risk levels. An algorithm with alternative strategies suited to available facilities and the patient's needs and wishes is also presented.