Dyspepsia

one or more of the following symptoms Postprandial fullness, early satiation, epigastric pain, or burning

Alarm features in dyspepsia Age older than 55 years with new-onset dyspepsia Family history of upper gastrointestinal cancer Unintended weight loss Gastrointestinal bleeding Progressive dysphagia Odynophagia Unexplained iron deficiency anemia Persistent vomiting Palpable mass or lymphadenopathy Jaundice

Patients with GERD and NSAID-induced dyspepsia should be treated with an empiric trial of proton pump inhibitors (PPI) for eight weeks and NSAIDs should be discontinued

Patients ≤55 years of age without alarm features should be tested and treated for H. pylori if the prevalence of H. pylori is high (>20 percent). Patients who test positive for an infection with H. pylori should undergo treatment with eradication therapy.

We suggest empiric treatment with a PPI in areas of low H. pylori prevalence (<5 percent)

Either strategy (test and treat H. pylori or empiric PPI therapy) may be employed in areas of intermediate H. pylori prevalence (5 to 20 percent).

Testing for H. pylori should be performed with a urea breath test or stool antigen assay