علاج عسر الهضم الوظيفي في غياب عدوى الملوية البوابية

References

• We recommend that patients without H. pylori infection are offered empirical acid suppression therapy (recommendation: strong; quality of evidence: high).
• TCAs used as gut-brain neuromodulators are an efficacious second-line treatment for FD.
• They should be commenced at a low dose (eg, 10 mg amitriptyline once daily) and titrated slowly to a maximum of 30–50 mg once daily (recommendation: strong, quality of evidence: moderate).
• Tricyclic antidepressants should be used as a first-choice gut-brain neuromodulator. They can be initiated in primary or secondary care, starting at a dose of 10 mg at night, and titrating slowly (eg, by 10 mg per week) according to response and tolerability. Continue for at least 6–12 months if the patient reports a symptomatic benefit.