Monitoring
Functional dyspepsia is a remitting and relapsing disease with symptom-free intervals interspersed with flare-ups, and continuous medication is not necessary after eradication of symptoms unless there is an underlying condition requiring treatment. PPIs or H2RA treatment may be tapered to the lowest effective dose and eventually discontinued after a favorable response to the initial treatment. Consider treatment with antacids or alginates when necessary. Check the compliance to therapy and for any drug-related adverse effects. Advise the patient to continue to avoid known precipitants of dyspepsia including smoking, alcohol, coffee, chocolate, fatty foods and being overweight, and to adhere to lifestyle modifications.
Monitor for the appearance of alarm signs and symptoms. Specialized
investigations specific to presenting symptoms may be performed in patients
unresponsive to treatment; treat underlying disease accordingly. In patients
with persistent PDS symptoms, gastric emptying should be measured, and if
severely delayed, a diagnosis of idiopathic gastroparesis (with predominant nausea or recurrent vomiting) should
be made, with consideration given to treatment using prokinetic agents. Consider
a referral to a dietitian to address dietary concerns or a mental health
professional if stress or mental health issues are contributing to the
condition. Involvement of a dietitian early in the management of patients with
severe or refractory functional dyspepsia helps avoid an overly restrictive
diet.
Specialist Referral
Dyspepsia_Follow UpImmediate or urgent referral is necessary for patients with alarm features, while early endoscopy or specialist investigation is indicated for patients ≥60 years old (or younger in areas with high prevalence of gastric cancer/high-risk geography). Routine referral is appropriate for patients who have persistent symptoms despite H pylori test-and-treat plus 4-8 weeks of empiric therapy, require diagnostic confirmation or need further evaluation for an alternative diagnosis. Consider expert referral for a specialty opinion and alternative treatment if unresponsive to empiric therapy.