Nonulcer Dyspepsia: A Look Into the Future Michael Camilleri, M.D.  Mayo Clinic Proceedings  Volume 71, Issue 6, Pages 614-622 (June 1996) DOI: 10.4065/71.6.614 Copyright © 1996 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Venn diagram of symptom subgroups of nonulcer dyspepsia in 213 of 835 randomly selected residents of Olmsted County, Minnesota. Note “restriction” of “dysmotility-” and “reflux-like” groups to same circle as “ulcer-like” group because of necessity for pain as qualifying criterion for inclusion in this study. (Modified from Talley and associates.” By permission.) Mayo Clinic Proceedings 1996 71, 614-622DOI: (10.4065/71.6.614) Copyright © 1996 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Summary of study on role of prompt endoscopy versus use of a histamine H2 receptor antagonist (H2RA) for dyspepsia. Although the nonendoscopic strategy was reportedly more costly and authors favored prompt endoscopy in their conclusion, they did not factor in potential savings that would accrue from screening patients with dyspepsia by using a noninvasive, sensitive, and reliable urea breath test for Helicobacter pylori (H. pylori) infection. EGD = esophagogastroduodenoscopy; QoL = quality of life. (Data from Bytzer and associates.67) Mayo Clinic Proceedings 1996 71, 614-622DOI: (10.4065/71.6.614) Copyright © 1996 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Proposed algorithm for clinical evaluation and management of nonulcer dyspepsia in the future. Most patients with dyspepsia are assessed in primary-care settings, and the first step is most likely an antacid regimen or least likely a prokinetic medication. Sequentially, therapeutic trials and noninvasive investigations are indicated unless alarm symptoms (such as weight loss) or signs (such as pallor) are present or initial therapeutic trials fail, indications for need for upper gastrointestinal endoscopy. C =carbon; chern =chemistry; EGD =esophagogastroduodenoscopy; exam =examination; hem = hemoglobin; H2RA = histamine H2 receptor antagonist; IBS =irritable bowel syndrome. Mayo Clinic Proceedings 1996 71, 614-622DOI: (10.4065/71.6.614) Copyright © 1996 Mayo Foundation for Medical Education and Research Terms and Conditions