PT - JOURNAL ARTICLE AU - Sander J.O. Veldhuyzen van Zanten AU - Nigel Flook AU - Naoki Chiba AU - David Armstrong AU - Alan Barkun AU - Marc Bradette AU - Alan Thomson AU - Ford Bursey AU - Patricia Blackshaw AU - Dawn Frail AU - Paul Sinclair AU - for the Canadian Dyspepsia Working Group TI - An evidence-based approach to the management of uninvestigated dyspepsia in the era of <em>Helicobacter pylori</em> DP - 2000 Jun 13 TA - Canadian Medical Association Journal PG - S3--S23 VI - 162 IP - 12 suppl 4099 - http://www.cmaj.ca/content/162/12_suppl/S3.short 4100 - http://www.cmaj.ca/content/162/12_suppl/S3.full SO - CMAJ2000 Jun 13; 162 AB - Objectives: To provide Canadian primary care physicians with an evidence-based clinical management tool, including diagnostic and treatment recommendations, for patients who present with uninvestigated dyspepsia. Recommendations: The management tool has 5 key decision steps addressing the following: (1) evidence that symptoms originate in the upper gastrointestinal tract, (2) presence of alarm features, (3) use of nonsteroidal anti-inflammatory drugs (NSAIDs), (4) dominant reflux symptoms and (5) evidence of Helicobacter pylori infection. All patients over 50 years of age who present with new-onset dyspepsia and patients who present with alarm features should receive prompt investigation, preferably by endoscopy. The management options for patients with uninvestigated dyspepsia who use NSAIDs regularly are: (1) to stop NSAID therapy and assess symptomatic response, (2) to treat with NSAID prophylaxis if NSAID therapy cannot be stopped or (3) to refer for investigation. Gastroesophageal reflux disease can be diagnosed clinically if the patient's dominant symptoms are heartburn or acid regurgitation, or both; these patients should be treated with acid suppressive therapy. The remaining patients should be tested for H. pylori infection, and those with a positive result should be treated with H. pylori-eradication therapy. Those with a negative result should have their symptoms treated with optimal antisecretory therapy or a prokinetic agent. Validation and evidence: Evidence for resolution of the dyspepsia symptoms was the main outcome measure. Supporting evidence for the 5 steps in the management tool and the recommendations for treatment were graded according to the strength of the evidence and were endorsed by consensus of committee members. If no randomized controlled clinical trials were available, the recommendations were based on the best available evidence. Literature review: Evidence was obtained from MEDLINE searches for pertinent articles published from 1966 to October 1999. The searches focused on dyspepsia, diagnosis and treatment. Additional articles were retrieved through a manual search of bibliographies and abstracts from international gastroenterology conferences. Sponsors: Supported by unrestricted educational grants from AstraZeneca Canada Inc., Isotechnika Inc. and Integrated Healthcare Communications Inc.