When Helicobacter pylori infection has been excluded in a patient with functional dyspepsia, the clinical approach must address symptoms through other evidence-based pathways. This protocol applies to that H. pylori-negative presentation.
This protocol is indicated for patients with functional dyspepsia in whom Helicobacter pylori infection is absent. Current guidelines strongly recommend empirical pharmacological treatment for this specific sub-population.
Management in this setting involves the use of a prokinetic agent. Efficacy varies by drug class, and availability differs by region.
DOI: 10.1136/gutjnl-2022-327737
We recommend that patients without H. pylori infection are offered empirical acid suppression therapy (recommendation: strong; quality of evidence: high).
Some prokinetics may be an efficacious treatment for FD. However, efficacy varies according to drug class, and many of these drugs are unavailable outside of Asia and the USA.
In terms of other prokinetics, acotiamide, which is an acetylcholinesterase inhibitor, itopride, which is a dopamine antagonist, and mosapride and tegaserod, which are 5-HT4 receptor agonists, have all been evaluated in FD.
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