MANAGEMENT GUIDELINES FOR UNINVESTIGATED AND FUNCTIONAL DYSPEPSIA IN THE ASIA-PACIFIC REGION - FIRST ASIAN-PACIFIC WORKING PARTY ON FUNCTIONAL DYSPEPSIA

Dyspepsia is most optimally defined as pain or discomfort centred in t he upper abdomen. The symptom complex may be caused by peptic ulcer di sease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is t he method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia-Pacific region where health services are limited. A detailed treatment algori thm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm fea-tures. In patients without alarm features, tr eatment for 2-4 weeks with an empirical anti-secretory or prokinetic a gent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establi sh the efficacy and cost-effectiveness of the approaches recommended.