Non-ulcer Dyspepsia (Functional Dyspepsia, Indigestion)

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It is a chronic recurrent dyspeptic disorder characterized by upper abdominal symptoms, discomfort,  pain, fullness, early satiety, bloating, burning epigastric pain syndrome and post prandial distress  syndrome without any organic, systemic or metabolic disease to explain its presence. 

Clinical presentation 

  • Dyspeptic symptoms present for last 3 months and onset at least months prior to diagnosis
  • Bothersome abdominal discomfort post prandial fullness.
  • Early satiety
  • Epigastric pains
  • Epigastric

Investigations 

  • Lack of evidence of structural disease by upper endoscopic examination.

Pharmacological Treatment 

  1. H. pylori eradication (see under pylori)

A: omeprazole (PO) 20mg 24hourly for 4-8weeks 

OR 

C: pantoprazole (PO) 40mg 24hourly for 4-8weeks 

OR 

S: esomeprazole (PO) 40mg 24hourly for 4-8weeks 

AND 

C: metoclopramide (PO) 10mg 8hourly when required (bloating and nausea symptoms, delayed gastric emptying) 

OR 

D: domperidone (PO) 10mg 8hourly when required to alleviate bloating and nausea symptoms, delayed gastric emptying. 

AND 

A: amitriptyline (PO) 25mg at bedtime when required for refractory cases 

Note: Presence of alarm features (see list above under GERD) warrant OGD.