Nonprescription Self-Management of Functional Dyspepsia

Recently, there’s been an uptick in studies and articles about functional dyspepsia (FD). The reason is probably that FD is quite common (10% to 15% of the US population has it), and many clinicians fail to differentiate FD from other gastrointestinal disturbances.

For Americans who have FD, its chronicity reduces quality of life and creates 2 million outpatient visits annually. A 2013 study documented higher indirect costs ($8281) due to sick leave and disability among FD patients than among others ($3009).

Lifestyle changes may help, although no evidence indicates that specific foods cause or aggravate FD. Advising patients to limit or avoid foods that precipitate symptoms is reasonable. Milk, alcohol, caffeine, fatty or fried foods, mint, tomatoes, citrus fruits, and some spices seem to trigger symptoms in individual patients. Smoking is a proven aggravator, and smoking cessation is essential. Eating smaller, more frequent meals may normalize upper gut motility. Patients should stay upright (sitting or standing) for at least 2 hours after eating. Losing weight may also help.

Patients who have no “red flags” (weight loss, recurrent vomiting, dysphagia, melena, or anorexia) can self-treat successfully with medications found in the OTC aisle. And in fact, the majority of patients with functional GI conditions self-treat. Inappropriate drug selection can be a problem, with approximately 30% of unassisted patients selecting products that won't help and may hurt. Poor OTC choices can delay appropriate treatment, increase risk for adverse drug reactions, and most important, delay relief.

Acid neutralizers include the antacids (Maalox, Tums, Pepto-Bismol, or Gaviscon) provide quick or partial relief, but usually don't provide complete relief.

The histamine-2 receptor antagonists (H₂RAs) and proton pump inhibitors (PPIs) can provide more lasting relief. PPIs are now considered the most effective therapy for relieving FD's symptoms and improving quality of life. They can also promote esophageal healing if heartburn and acid have caused erosions. Note that medication adherence is inversely related to perceptions about medication harm, so pharmacists should counsel patients thoroughly about OTC product safety.

In addition to recommending appropriate OTC therapy, pharmacists should inquire about patients' complete medication regimens. Several drugs can cause or contribute to dyspepsia, with NSAIDs most likely to cause GI symptoms. Co-treatment with PPIs added to NSAIDs can reduce this adverse effect significantly. Other drugs associated with dyspepsia include antibiotics, alendronate, cisapride, codeine, corticosteroids, iron, metformin, and potassium.

Patients whose dyspepsia is unresponsive to OTC therapies need referral to a physician or prescribing healthcare professional.