MORE OPTIONS FOR CHALLENGING CASES
Managing FD is challenging when both initial acid suppression therapy and H pylori eradication fail. Unproven but low-risk treatments include modification of eating habits (eg, eating slower, not gulping food), reducing stress, discontinuing medications that may be related to symptoms, avoiding foods that seem to exacerbate symptoms, and cutting down or eliminating tobacco, caffeine, alcohol, and carbonated beverages.8 Bismuth salts have been shown to be superior to placebo for the treatment of dyspepsia.25 Small studies have also demonstrated a favorable risk–benefit ratio for peppermint oil and caraway oil for the treatment of FD.47 Prokinetics have shown efficacy compared with placebo, although a Cochrane review questioned their efficacy based on publication bias.26
There is no good evidence of efficacy for OTC antacids or for GI “cocktails” (antacid, antispasmodic, and lidocaine), sucralfate, psychologic interventions (eg, cognitive behavioral therapy, relaxation therapy, or hypnosis), or antidepressants.48,49 Several recent randomized controlled trials have shown the efficacy of acupuncture for the treatment of dyspepsia.49,50 Ginger may also be helpful; it has been found to help with nausea in other GI conditions, but it’s uncertain whether it can help patients with dyspepsia.51
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