Management of nonulcer dyspepsia

Nonulcer dyspepsia is a common disorder with a wide array of symptoms. It is not advisable to perform extensive diagnostic tests such as esophagogastroduodenoscopy, biliary tract ultrasonography, or even abdominal computed tomography in all patients. Whether all patients who present with dyspeptic symptoms should at least undergo initial endoscopy is controversial. Empirical therapy is advisable in patients who do not have signs or symptoms of an underlying organic disorders, such as gastric ulcer or cancer. If empirical therapy is indicated without diagnostic testing, where does one begin? Which approach - prokinetic therapy, acid suppression, eradication of H. pylori, psychotropic therapy, or antinociceptive therapy - is most effective? The answer to this question will be determined by studies of the short- and long-term effects of the various therapies on symptoms and quality of life and by cost-benefit analyses.