The deal on treating dyspepsia
ALVIN NEWMAN, MD, of Toronto, ON, asks, "How do you treat dyspepsia in a young patient?"
Dyspepsia in a young patient -- assuming, of course, there are no alarm features such as weight loss, anemia, etc. -- is best managed with a short trial of a proton pump inhibitor (PPI). Response to therapy indicates an acid-peptic disease. In that case, I would be inclined to test and treat for H. pylori
. Other considerations would include gastroesophageal reflux disease. If that's the situation, the response to PPIs is excellent and corresponds to symptom control. I feel that lack of response to PPIs indicates the possibility of functional dyspepsia. Endoscopy isn't generally necessary in this sort of patient and is only reserved for refractory cases. AS