Stepwise diagnosis and treatment from uninvestigated dyspepsia to functional dyspepsia in clinical practice in Japan: proposal of a 4-step algorithm.

BACKGROUND/AIM Management of dyspepsia may differ between countries. In Japan, Helicobacter pylori infection should be considered because of the high prevalence of the infection and the related diseases. I tried to propose an algorithm for stepwise diagnosis and treatment from uninvestigated dyspepsia to functional dyspepsia in clinical practice in Japan. METHODS A proposal was made from my personal review of published studies. RESULTS A 4-step algorithm was proposed. In the first step, organic, systemic or metabolic diseases are excluded and nonulcer dyspepsia (NUD) is diagnosed. The second step is to test and treat H. pylori infection for NUD patients. In the third step, proton pump inhibitor (PPI)-responsive NUD is discriminated by PPI. Nonresponsive patients in the third step are diagnosed as having PPI-resistant NUD. In the fourth step, functional dyspepsia is diagnosed with the Rome III questionnaire. In this algorithm, it is not necessary to do special function tests for functional gastrointestinal disorders. Treatment options are automatically restricted in each step. CONCLUSIONS The proposed 4-step algorithm may be useful in clinical practice for the diagnosis from uninvestigated dyspepsia to functional dyspepsia in Japan. With this stepwise algorithm, treatment options are restricted in each step and the management of dyspepsia may be easier.