Evidence-Based Recommendations for Short- and Long-Term Management of Uninvestigated Dyspepsia in Primary Care: An Update of the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool

Hindawi Limited - Tập 19 Số 5 - Trang 285-303 - 2005
S. J. O. Veldhuyzen van Zanten1, Marc Bradette2, Naoki Chiba3, David Armstrong4, Alan Barkun5, Nigel Flook6, Alan B.R. Thomson7, Ford Bursey8
1Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
2Department of Medicine, Université Laval, and the Department of Gastroenterology, Centre hospitalier universitaire de Québec, Pavillon Hôtel-Dieu de Québec, Quebec, Quebec, Canada
3Division of Gastroenterology, McMaster University, Hamilton, and the Surrey Gl Clinic∕Research, Guelph, Ontario, Canada
4Department of Medicine, McMaster University, and the Division of Gastroenterology, Hamilton Health Sciences Corporation, McMaster Site, Hamilton, Ontario, Canada
5Department of Medicine, McGill University, and the Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
6Department of Family Medicine, University of Alberta, and the Misericordia Community Health Centre, Canada
7Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
8Health Sciences Centre, Department of Medicine, Memorial University of Newfoundland, St John’s, Newfoundland, Canada

Tóm tắt

The present paper is an update to and extension of the previous systematic review on the primary care management of patients with uninvestigated dyspepsia (UD). The original publication of the clinical management tool focused on the initial four- to eight-week assessment of UD. This update is based on new data from systematic reviews and clinical trials relevant to UD. There is now direct clinical evidence supporting a test-and-treat approach in patients with nondominant heartburn dyspepsia symptoms, and head-to-head comparisons show that use of a proton pump inhibitor is superior to the use of H2-receptor antagonists (H2RAs) in the initial treatment of Helicobacter pylori-negative dyspepsia patients. Cisapride is no longer available as a treatment option and evidence for other prokinetic agents is lacking. In patients with long-standing heartburn-dominant (ie, gastroesophageal reflux disease) and nonheartburn-dominant dyspepsia, a once-in-a-lifetime endoscopy is recommended. Endoscopy should also be considered in patients with new-onset dyspepsia that develops after the age of 50 years. Conventional nonsteroidal anti-inflammatory drugs, acetylsalicylic acid and cyclooxygenase-2-selective inhibitors can all cause dyspepsia. If their use cannot be discontinued, cotherapy with either a proton pump inhibitor, misoprostol or high-dose H2RAs is recommended, although the evidence is based on ulcer data and not dyspepsia data. In patients with nonheartburn-dominant dyspepsia, noninvasive testing for H pylori should be performed and treatment given if positive. When starting nonsteroidal anti-inflammatory drugs for a prolonged course, testing and treatment with H2RAs are advised if patients have a history of previous ulcers or ulcer bleeding.

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Hindawi Limited

Tập 19 Số 5

285-303

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