Treatment of Functional Dyspepsia in the Absence of Helicobacter pylori Infection
Patients presenting with functional dyspepsia who have confirmed absence of Helicobacter pylori infection require a specific, evidence-guided management approach distinct from H. pylori-positive cases.
Clinical Scenario
This protocol is indicated for patients with functional dyspepsia in whom Helicobacter pylori infection has been excluded. Current evidence strongly recommends offering empirical acid suppression therapy to this population.
Treatment Approach
Where symptoms persist despite initial management, the protocol directs referral for specialist evaluation. At that stage, specific pharmacological options — selected from several distinct drug classes based on the patient's symptom profile — are considered. The complete treatment algorithm and agent selection criteria are available in the full 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).
- Antipsychotics, such as sulpiride 100 mg four times a day or levosulpiride 25 mg three times a day, may be efficacious as a second-line treatment for FD.
- Pregabalin 75 mg once daily may be an efficacious second-line treatment for FD but further randomised controlled trials (RCTs) are needed and given its controlled drug status we advise this drug is only used in specialist settings.
- Tandospirone 10 mg three times a day may be an efficacious second-line treatment for FD, but there is no evidence that other 5-hydroxytryptamine-1A agonists, including buspirone 10 mg three times a day, are efficacious.
- Mirtazapine 15 mg once daily may be an efficacious second-line treatment for patients with FD with early satiation and weight loss, but further RCTs are needed.
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