Treatment of Functional Dyspepsia in Helicobacter pylori Infection
This protocol addresses functional dyspepsia (FD) in patients with concurrent Helicobacter pylori infection — a specific clinical situation that shapes both the diagnostic workup and the treatment pathway.
Clinical Scenario
In patients with functional dyspepsia who test positive for Helicobacter pylori, the presence of this infection is a central consideration. Eradication therapy is an established and efficacious treatment in this H. pylori-positive population and forms part of the clinical approach.
Specialist Treatment Approach
Where specialist referral is indicated, the protocol defines a targeted pharmacological pathway. Certain neuromodulatory agents — including antipsychotic medications and other specialist-only options — may be considered for appropriate patients. The full selection criteria, sequencing, and complete regimen are available in the structured protocol.
References
DOI: 10.1136/gutjnl-2022-327737
- Eradication therapy is an efficacious treatment for H. pylori-positive patients with FD.
- 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.
View source ↗