Guideline sources The following summarized guidelines for the evaluation and management of dyspepsia are prepared by our editorial team based on guidelines from the American College of Gastroenterology (ACG/CAG 2017). 1 Guidelines 1. Diagnostic investigations Testing for Helicobacter pylori infection: obtain a noninvasive test for H. pylori, and treat if positive in < 60 years old patients with dyspepsia. A 2. Diagnostic procedures Upper gastrointestinal endoscopy: Perform endoscopy to exclude upper gastrointestinal neoplasia in patients 60 years old with dyspepsia. B Do not perform endoscopy to investigate alarm features in patients < 60 years old with dyspepsia to exclude upper gastrointestinal neoplasia. D 3. Medical management https://web.pathway.md/diseases/rectVh3waGB61Fg37 1/2 6/29/23, 10:25 PM Dyspepsia Pathway Proton pump inhibitors: prescribe empirical PPIs in patients < 60 years old with dyspepsia if they are H. pylori-negative or who remain symptomatic after H. pylori eradication therapy. A Prokinetics: offer prokinetics for < 60 years old patients with dyspepsia not responding to PPIs or H. pylori eradication therapy. B Tricyclic antidepressants: offer TCAs for < 60 years old patients with dyspepsia not responding to PPIs or H. pylori eradication therapy. B 4. Specific circumstances Motility studies in functional dyspepsia: Do not routinely obtain motility studies for patients with functional dyspepsia. D Consider motility studies for selected patients with functional dyspepsia where gastroparesis is strongly suspected. C Management of functional dyspepsia: treat H. pylori infection in patients with functional dyspepsia that are H. pylori-positive. A Show 5 more References 1. Paul Moayyedi, Brian E Lacy, Christopher N Andrews et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol. 2017 Jul;112 7 988 1013. Open 2. Yang YX, Brill J, Krishnan P et al. American Gastroenterological Association Institute Guideline on the Role of Upper Gastrointestinal Biopsy to Evaluate Dyspepsia in the Adult Patient in the Absence of Visible Mucosal Lesions. Gastroenterology. 2015 Oct;149 4 1082 7. Open https://web.pathway.md/diseases/rectVh3waGB61Fg37 2/2