Review article: managing the dyspeptic patient - an interactive discussion

Dyspepsia, a common disorder, can present some difficult clinical dilemmas. Physicians should explore some of the more challenging cases of dyspepsia in a setting that fosters interactive dialogue among colleagues, as was the case at the interactive discussion reported below. A panel of experts pres ented and discussed three case histories. The audience was able to choose f rom among several options for diagnosis or treatment and recorded their vot es by means of an electronic handset. The first case concerned the relation ship between continued non-steroidal antiinflammatory drug (NSAID) use and recurrent upper gastrointestinal (Gl) symptoms without ulcer or Helicobacte r pylori infection. The second was a woman with complex upper GI symptoms i ncluding heartburn. The last featured a young man with dyspepsia and no ala rm symptoms. The first case showed that a standard dose of proton pump inhi bitor (PPI) is the best treatment for patients with gastritis who continue to use NSAIDs. The second case revealed that 24-h pH monitoring can be used to establish a relationship between symptoms and reflux episodes. The thir d case demonstrated that it can be difficult to make a definitive diagnosis based on clinical symptoms. and that patients with endoscopy-negative refl ux disease usually respond well to PPI therapy.