ACG and CAG Clinical Guideline: Management of Dyspepsia

INTRODUCTION Descriptions of upper gastrointestinal symptoms date back thousands of years ( 1 ). “Stomach disorders” became an obsession of developed countries in the eighteenth century ( 2 ) when the term dyspepsia was fi rst coined ( 3 ). A systematic review ( 4 ) reported that ~20% of the population has symptoms of dyspepsia globally. Dyspepsia is more common in women, smokers, and those taking non-steroidal anti-infl ammatory drugs ( 4 ). Patients with dyspepsia have a normal life expectancy ( 5 ), however, symptoms negatively impact on quality of life ( 6,7 ) and there is a signifi cant economic impact to the health service and society ( 8 ). Dyspepsia is estimated to cost the US health care service over $18 billion per annum ( 8 ) and societal costs are likely to be double this ( 9 ) with 2–5% ( refs 7,9 ) having time off work because of symptoms. Cost-eff ective management of dyspepsia can reduce its health and economic burdens, but it is over 10 years since either the American College of Gastroenterology (ACG) ( 10 ) or Canadian Association of Gastroenterology (CAG) ( 11 ) published guidelines on dyspepsia. We have therefore updated previous systematic review data ( 12 ) for a joint ACG and CAG guideline on dyspepsia management.