CanadiEM - By Colin Siu - January 10, 2017
..."While not the sexiest of topics, this post underscores the importance of looking up the literature on the basics. Patients with dyspepsia are not uncommon and, while we must always diligently rule out more dangerous causes (depending on the patient’s age and the particulars of their presentation, things like Acute Coronary Syndrome, Pulmonary Embolism, Pneumothorax, Pericarditis, Pancreatitis, Cholecystitis, and more may be on your list of things to ‘rule out’!), sometimes it is the diagnosis that is most likely at the end (and beginning!) of the work-up. You would think that we have a great evidence-based approach to its management, but as this post shows the treatments that we provide are more often steeped in dogma and tradition than they are evidence...
The Bottom Line
Most of the evidence points towards initial management of acute dyspepsia with an oral antacid. There does not seem to be additional benefits to using a GI cocktail or Pink Lady over antacids alone. If symptom relief is not achieved with an antacid, a trial of intravenous or oral H2-receptor antagonists may be considered. In patients that have not responded to antacids or H2-receptor antagonists in previous dyspeptic episodes, a trial of IV proton-pump inhibitors may be considered. However, intravenous proton-pump inhibitors are not recommended for concurrent use with antacids, given the former is an acid-activated pro-drug."