Treatment of Functional Dyspepsia in the Absence of Helicobacter pylori Infection
This protocol applies to patients with functional dyspepsia (FD) who have tested negative for Helicobacter pylori — a sub-population for whom a distinct management pathway is indicated.
Clinical scenario
In patients without confirmed H. pylori infection, guidelines support offering empirical acid suppression therapy as part of the management approach.
Treatment approach (partial overview)
The protocol includes a tricyclic antidepressant used as a gut-brain neuromodulator. The full regimen — including agent selection, titration guidance, and treatment duration — is contained in the complete structured protocol.
References
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).
- 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.
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