Treat the Patients' Main Dyspepsia Complaint, not the ROME Criteria
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This pragmatic, primary care study by Meineche-Schmidt in patients with presumed acid-related uninvestigated dyspepsia showed that a standard dose of omeprazole 20 mg daily was significantly more effective than a placebo in treating their self-worded main dyspepsia complaint. As a higher dose of omeprazole 40 mg daily was not more effective, the standard dose should be used. In this study, 9% of the patients had sole reflux-like symptoms while the rest had other accompanying symptoms and would be considered to have dyspepsia. In fact, patients had on average more than five symptoms. Patients do not know that there is a controversy about whether to call their symptoms GERD or dyspepsia; they just know that they want to feel better. As no initial investigations were made, patients could have a variety of possible diagnoses such as gastroesophageal reflux disease, ulcer disease, or functional dyspepsia. The recent CADET-PE study showed that if patients had endoscopic abnormalities, these were findings such as esophagitis that would be appropriately treated with acid suppression. That study also reconfirmed that symptoms do not predict endoscopic findings and do not make a diagnosis. Thus, the approach suggested in this study to treat patients based on their main symptom complaint is practical and effective.
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