Nonulcer Dyspepsia.

There is currently no effective treatment for patients with nonulcer dyspepsia. Helicobacter pylori eradication has no beneficial effect on dyspeptic symptoms. Proton pump inhibitors are superior to placebo in the subset of patients with epigastric pain as the predominant symptom. H(2 )Receptor antagonists have no effect. Patients with dysmotility-like dyspepsia should be treated first with prokinetics. Unfortunately, cisapride no longer can be used to treat patients with functional dyspepsia because of reports of serious cardiovascular side effects and subsequent withdraw from the US market. Therefore, metoclopramide (or domperidone, if available) should be given. Treatment with motilides has no use in the relief of symptoms, even in patients with delayed gastric emptying. If the initial therapy has no effect after 4 weeks, switch treatment (eg, from proton pump inhibitor to metoclopramide or vice versa). If both of these pharmacologic therapies fail, consider treatment with an antidepressant (or with buspirone, an anxiolytic agent) or psychotherapy.