Patient Education

There is no clear evidence of specific association between lifestyle factors & dyspepsia, but some individuals may be helped by these measures
To reduce anxiety, in cases where there are no indications of organic disease, reassurance is an important part of initial therapy
Provide patients w/ access to educational materials to support the care they receive

Lifestyle Modifications

Advise patients to avoid known precipitants that they associate w/ dyspeptic symptoms eg alcohol, coffee, chocolate & fatty foods
- Alcohol, coffee, & chocolate have pharmacological effects that may reduce the tone of the lower esophageal sphincter (LES)
- Fatty foods delay gastric emptying time which may also predispose to GERD
Encourage patient to stop smoking
- Smoking has pharmacological effects that may reduce the tone of the LES
Wt reduction for overweight & obese patients
- Obesity may disrupt the LES due to mechanical pressure on the diaphragm
May suggest having a main meal well before going to bed (preferably 3 hr before)
Some patients may benefit from raising the head when sleeping
- Lying flat may increase reflux episodes since gravity does not prevent acid regurgitation

Other Considerations

If there is concurrent use of NSAIDs, evaluate for risk of GI complications & consider alternative strategies if risk is a concern
- See PUD Management Chart for details
Patients w/ refractory functional dyspepsia have a high rate of accompanying depression & psychiatric illness
- May consider psychological therapies, eg cognitive behavioral therapy (CBT) & psychotherapy, or antidepressants to reduce dyspeptic symptoms esp in non-ulcer dyspepsia