FOLLOW UP

• Dyspepsia is a remitting and relapsing disease, with symptoms recurring annually in about half of patients. Offer patients requiring long-term management of dyspepsia symptoms an annual review of their condition, encouraging them to try stepping down or stopping treatment [18]
• Post-treatment testing for H Pylori is not generally recommended. This testing may however be indicated in selected patients with complicated ulcer disease, low-grade gastric mucosa associated lymphoid tissue (MALT) lymphoma and following resection of early gastric cancer [1].
• If the patient had an H. pylori infection previously then testing for eradication with either a stool antigen test or a breath test would be reasonable [1].
• If previous dyspepsia symptoms recur 1 to 6 months after cessation of treatment, reevaluate person for alarm signals, taking into account timing of relapse and severity of symptoms [14].
• If previous dyspepsia symptoms recur after 6 months with no alarm signals, repeat empiric therapy [14]

SURVEILLANCE
• All patients should be told about alarm symptoms if they are not present initially.
• Because of the high incidence of gastric cancer in the East and in certain other countries, Japan, Chile and Venezuela alarm symptoms should be sought more carefully and at every yearly visit to detect gastric malignancy earlier though dyspepsia itself doesn’t confer increased risk of gastric malignancy
PROGNOSIS
• Dyspepsia is a remitting and relapsing disease, with symptoms recurring annually in about half of patients [18]
• Functional dyspepsia is generally a non-life-threatening disorder that is not associated with a need for surgery or a reduction in survival [24, 25].
• The majority of patients with uninvestigated dyspepsia will fall into the functional dyspepsia category, but the exact prognosis of this group remains variable and unexplained. No information is currently available on the periodicity of individual dyspeptic symptoms over time; understanding the cycling pattern of symptoms could have important management implications [25]
• Patients don’t have difference in prognosis whether they are H Pylori positive or negative
COUNCELLING
• Stop smoking
• Avoid NSAIDS, or if needed take with meal/H2 blocker. Paracetamol is a better choice. Or else COX II inhibitors can be used
• Lose weight
• Eat small meals
• Reduce consumption of caffeine, chocolate, fatty foods, alcohol, onions, peppermint and spearmint
• Elevate head end of bed by 6 to 9 inches
• Avoid tight fitting garments
If Patient has dyspepsia, advise to visit the doctor if:
• Over 50 years of age
• Recently lost weight without trying to
• Has trouble swallowing
• Has severe vomiting
• Has black, tarry bowel movements (this means blood in your stools)
• Can feel a mass in your stomach area
• Discomfort unrelated to eating
• Indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm

REFRENCES
1. Institute for Clinical Systems Improvement (ICSI). Initial management of dyspepsia and GERD. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jul. 53 p.
2. Tack, J, Talley, NJ, Camilleri, M, et al. Functional gastroduodenal disorders. Gastroenterology 2006; 130:1466.
3. Noya Horowitz , Menachem Moshkowitz , Moshe Leshno , Joseph Ribak , Shlomo Bierkenfeld , Gabi Kenneth , Zamir Halpern . Symptom evaluation as an efficient diagnostic tool for upper abdominal diseases. Harefuah. 2006 Nov ;145 (11):807-10, 862 17183951
4. Talley, NJ, Zinmeister, AR, Schleck, CD, Melton, LJ III. Dyspepsia and dyspepsia subgroups: A population-based study. Gastroenterology 1992; 102:1259.
5. Kurata, JH, Nogawa, AN, Everhart, JE. A prospective study of dyspepsia in primary care. Dig Dis Sci 2002; 47:797.
6. SL Grainger, HJ Klass, MO Rake and JG Williams. Prevalence of dyspepsia: the epidemiology of overlapping symptoms. Postgraduate Medical Journal, 1994, Vol 70, 154-161
7. Talley NJ, Vakil NB, Moayyedi P. American Gastroenterological Association technical review (evaluation of dyspepsia). Gastroenterology. 2005;129:1756–1780.
8. Lin Chang, MD From Rome to Los Angeles -- The Rome III Criteria for the Functional GI Disorders. Digestive Week 2006.
9. Arents NL et al: Approach to treatment of dyspepsia in primary care: a randomized trial comparing "test and treat" with prompt endoscopy. Arch Intern Med 2003;163:1606.
10. Talley NJ: Dyspepsia. Gastroenterology 2003;125:1219
11. George F. Longstreth, M.D.Functional Dyspepsia — Managing the Conundrum. N Engl J Med 2006 February 23; 354(8):791-793
12. Talley NJ, Silverstein MD, Agreus L, et al, Gastroenterology 1998;114:582
13. Fisher RS, Parkman, HP, N Engl J Med 1998;339:1376.
14. Management of dyspepsia and heartburn. Wellington (NZ): New Zealand Guidelines Group (NZGG); 2004 Jun.
15. Howden CW, Hunt RH. Guidelines for the management of Helicobacter pylori infection. Am J Gastroenterol 1998;93:2330-2338
16. . Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002 Oct 10;347(15):1175-86.
17. Drumm B, Koletzko S, Oderda G. Helicobacter pylori infection in children: a consensus statement. J Pediatr Gastroenterol Nutr 2000;30:207-213
18. Management of dyspepsia in adults in primary care. Clinical Guidelines. June 2005. Developed by the Newcastle Guideline Development and Research Unit

19. Longstreth G.F. Functional Dyspepsia — Managing the Conundrum. N Engl J Med Feb; 2006; 354 (8):791-793

20. Delaney B, Quine M, Moayyedi P. H pylori eradication versus empirical acid suppression in uninvestigated H pylori positive dyspepsia. Gastroenterology. 2005;130:A-38.
21. Barenys M, Rota R, Garcia-Altes A, et al. Score and scope versus test and treat strategies for the management of Dyspepsia: a randomized controlled trial. Gastroenterology. 2005;130:A-38.
22. Vakil N, Veldhuyzen van Zanten S, Flook N, et al. High prevalence of abnormal endoscopic findings in patients with non-GERD dyspepsia. Gastroenterology. 2005;130:A-157.
23. New Zealand Guidelines Group (NZGG). Management of dyspepsia and heartburn. Wellington (NZ): New Zealand Guidelines Group (NZGG); 2004 Jun.
24. Werdmuller B.F.M.; van der Putten A.B.M.M.; Veenendaal R.A.; Lamers C.B.H.W.; Balk A.G.; Loffeld R.J.L.F. Functional dyspepsia has a good prognosis irrespective of H. pylori status - Long-term follow-up of symptoms after anti H. pylori treatment.The Netherlands Journal of Medicine, Volume 55, Number 2, August 1999, pp. 64-70(7)
25. H.B. El-Serag; N.J. TalleyThe Prevalence and Clinical Course of Functional DyspepsiaAliment Pharmacol Ther 19(6):643-654, 2004
26.