Tests and Treatment
A variety of tests may be undertaken to try to determine the cause of dyspepsia. In some cases however, the doctor may choose to treat patients on the basis of his/her clinical assessment of symptoms before ordering tests.
Certain symptoms such as bleeding, weight loss, trouble swallowing, persistent vomiting or new symptoms in older patients will usually indicate a need for tests.
Barium X-ray (upper GI series):
This is an X-ray test that outlines the esophagus, the stomach and the duodenum. For many years this was one of the only tests available to investigate these types of symptoms and is still used as a screening test. However, in the majority of cases more accurate tests are now used.
Helicobacter pylori tests:
for the bacteria can sometimes be done in the doctor’s office. These would include blood tests that determine previous exposure to the bacteria but do not determine the actual presence of the bacteria. For the most part these tests have been replaced by the urea breath test (UBT). This test can be done in the doctor’s office or at the hospital. The patient drinks a chemical and if the bacteria are present in the stomach, this chemical is broken apart by the bacteria. The by-products are released in the patient’s breath which are collected and tested. A positive test indicates that the bacteria are actually present at that time. This test can be done to confirm that the bacteria are present, or that they have been eliminated after treatment.
A second group of tests for this bacteria can be done at the time of endoscopy with biopsies (tissue samples). Small pieces of stomach can be subjected to the same chemical reaction as noted above for the breath test or the tissue can be examined under a microscope to look for the bacteria.
Gastroscopy (upper GI endoscopy):
This test is commonly done for patients with dyspepsia as it is a very accurate way of finding or ruling out the presence of injury to the lining in the upper GI tract. A tube through which the stomach can be seen is passed through the mouth.
This test can be done in the doctor’s office in some cases, but is usually done in the hospital.
24-Hour pH study:
While endoscopy is able to determine the presence of injury to the lining of the gut from reflux, many patients may have reflux without such visible injury. The 24-hour pH test is done to try and correlate the patient’s symptoms with the actual presence of acid in the esophagus. This test involves passing a thin tube through the nose into the esophagus. The tube is left in place and continuously records the acid level in the esophagus for a period of 24 hours. A computer program then correlates the patient’s symptoms with the presence of acid in the esophagus.
Medications are listed below in general order of potency but the order does not necessarily reflect the order in which the doctor may choose to begin treatment.
are useful as short-term therapy but are usually used for infrequent or “breakthrough” symptoms that may occur when the patient experiences symptoms while on other medications. In general, antacids would not be used as a regular form of therapy.
H2-receptor antagonists (H2-RAs)
This class of drugs has been available for over 25 years and was the first truly effective form of acid-reducing medicine. These pills provide a moderate decrease in acid produced by the stomach and are helpful for milder cases of reflux. They are effective in healing ulcers, although at a somewhat slower rate than the proton pump inhibitor class of drugs (see below). These drugs are very safe. Rare side effects may include skin rash, diarrhea, liver test abnormalities, and kidney problems. These medicines are accepted as safe for long-term therapy if necessary
Proton Pump Inhibitors (PPIs)
This class of drugs has been available for over 10 years and provides the most effective acid suppression currently available. These are the most effective pills for more severe reflux symptoms and are effective at healing ulcers somewhat more rapidly than H2-RAs. In general, the best medicine is the one that adequately controls symptoms. These pills are also considered safe for longterm treatment
if necessary. Use of this type of drug is often combined with antibiotics to treat Helicobacter pylori. Side effects with this class of medication are also infrequent and may include skin rash, diarrhea and a variety of other minor side effects. Rarely, interference with other drugs has to be considered by the doctor.
Helicobacter pylori Therapy
The most common type of therapy used now includes two antibiotics plus a PPI drug. It is important that all the pills be taken as scheduled in order to obtain the greatest chance of eliminating the bacteria.