Evaluation and Management of Nonulcer Dyspepsia - American Family Physician

Volume 70, Number 1 www.aafp.org/afp American Family Physician 107 F amily physicians frequently encounter patients with dyspepsia. An organic cause, such as duodenal ulcer, is found in only about 40 percent of these patients.1 Hence, dyspepsia is considered to be functional, or idiopathic, in as many as 60 percent of patients (Table 1).2-4 The Rome II criteria provide an updated definition of nonulcer dyspepsia (Table 2).5 Symptoms usually are categorized as ulcer-like (i.e., burning sensation, relief with antacids and histamineH2 blockers or proton pump inhibitors), dysmotility-like (i.e., nausea, bloating, early satiety, anorexia), or unspecified.5 Many patients seek medical help for an ulcer-like pain syndrome that cannot be explained easily. Notably, symptoms and physical findings are unreliable in distinguishing between ulcer and nonulcer dyspepsia. Furthermore, treatment of patients with nonulcer dyspepsia can be challenging because of the need to balance medical management strategies (e.g., eradication of Helicobacter pylori) with treatments for psychologic or functional disease. Not surprisingly, nonulcer dyspepsia is responsible for substantial costs to the U.S. health care system (direct medical costs) and to society (e.g., lost time from work, diminished work productivity).6 A better understanding of this condition and its management can improve patient care and decrease unnecessary medical expenditures.