ACG and CAG Clinical Guideline

Management of Dyspepsia

Paul M. Moayyedi, Brian E. Lacy, Christopher N. Andrews, Robert A. Enns, Colin Howden, Nimish Vakil

Research output: Contribution to journalReview article

64 Citations (Scopus)

Abstract

We have updated both the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. We suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal endoscopy to exclude organic pathology. This is a conditional recommendation and patients at higher risk of malignancy (such as spending their childhood in a high risk gastric cancer country or having a positive family history) could be offered an endoscopy at a younger age. Alarm features should not automatically precipitate endoscopy in younger patients but this should be considered on a case-by-case basis. We recommend patients <60 years of age have a non-invasive test Helicobacter pylori and treatment if positive. Those that are negative or do not respond to this approach should be given a trial of proton pump inhibitor (PPI) therapy. If these are ineffective tricyclic antidepressants (TCA) or prokinetic therapies can be tried. Patients that have an endoscopy where no pathology is found are defined as having functional dyspepsia (FD). H. pylori eradication should be offered in these patients if they are infected. We recommend PPI, TCA and prokinetic therapy (in that order) in those that fail therapy or are H. pylori negative. We do not recommend routine upper gastrointestinal (GI) motility testing but it may be useful in selected patients.

Original languageEnglish (US)
Pages (from-to)988-1013
Number of pages26
JournalAmerican Journal of Gastroenterology
Volume112
Issue number7
DOIs
StatePublished - Jul 1 2017

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Dyspepsia
Gastroenterology
Guidelines
Helicobacter pylori
Endoscopy
Proton Pump Inhibitors
Tricyclic Antidepressive Agents
Pathology
Therapeutics
Gastrointestinal Motility
Gastrointestinal Endoscopy
Stomach Neoplasms
Joints
Neoplasms

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Moayyedi, P. M., Lacy, B. E., Andrews, C. N., Enns, R. A., Howden, C., & Vakil, N. (2017). ACG and CAG Clinical Guideline: Management of Dyspepsia. American Journal of Gastroenterology, 112(7), 988-1013. https://doi.org/10.1038/ajg.2017.154

ACG and CAG Clinical Guideline : Management of Dyspepsia. / Moayyedi, Paul M.; Lacy, Brian E.; Andrews, Christopher N.; Enns, Robert A.; Howden, Colin; Vakil, Nimish.

In: American Journal of Gastroenterology, Vol. 112, No. 7, 01.07.2017, p. 988-1013.

Research output: Contribution to journalReview article

Moayyedi, PM, Lacy, BE, Andrews, CN, Enns, RA, Howden, C & Vakil, N 2017, 'ACG and CAG Clinical Guideline: Management of Dyspepsia', American Journal of Gastroenterology, vol. 112, no. 7, pp. 988-1013. https://doi.org/10.1038/ajg.2017.154
Moayyedi, Paul M. ; Lacy, Brian E. ; Andrews, Christopher N. ; Enns, Robert A. ; Howden, Colin ; Vakil, Nimish. / ACG and CAG Clinical Guideline : Management of Dyspepsia. In: American Journal of Gastroenterology. 2017 ; Vol. 112, No. 7. pp. 988-1013.
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