DYSPEPSIA UPDATE

Background: Non-Ulcer Dyspepsia (NUD) is a very common problem which has many causes. Trying to group dyspeptic patients according to symptoms has been proposed in order to improve our understanding of the problem and to aid both clinical trials and indeed practice by studying and treating homogeneous groups. Review: The literature has been reviewed to see if sub-groups of dyspepsia are standing up to scrutiny and clinically relevant. Results: Reflux-like dyspepsia may now be identified accurately in a high proportion by a combination of careful history and the use of intra-oesophageal 24-h pH monitoring. Acid suppressing therapy is often useful in this group. Dysmotility-like dyspepsia is currently an area of active investigation with growing evidence that there is abnormal gastric emptying. Response to pro-kinetic drugs looks encouraging. Ulcer-like dyspepsia: Appears to be the largest dyspeptic group. Acid secretion is normal. Helicobacter pylori does not correlate with any group of dyspepsia. Conclusion: Separating NUD into groups is becoming useful in both investigation and treatment. but more specific simple tests are needed to take this further.