Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Dyspepsia - pregnancy-associated - Management
When should I refer a pregnant woman with dyspepsia?

  • Refer urgently to a gastroenterologist if there are alarm features, such as: chronic gastrointestinal bleeding; progressive unintentional weight loss; progressive difficulty swallowing (dysphagia); or persistent vomiting.
  • Refer non-urgently to a gastroenterologist if:
    • Symptoms do not adequately respond to antacids, alginates, ranitidine, or omeprazole.
    • The woman is unable to eat sufficiently because of symptoms.
    • The diagnosis is in doubt (e.g. biliary colic).
    • There is a previous history of peptic ulcer disease; Barrett's oesophagus; or known dysplasia, atrophic gastritis, or intestinal metaplasia; and symptoms are inadequately controlled on usual medication.
  • Refer to an obstetrician if symptoms suggest a pregnancy-related disorder other than dyspepsia (e.g. HELLP syndrome [haemolysis, elevated liver enzymes, and low platelets], pre-eclampsia).
Clarification / Additional information
  • The classical alarm features of weight loss, an epigastric mass, or iron deficiency anaemia may be difficult to interpret in pregnancy.
  • An endoscopy can be safely undertaken in pregnancy, but is generally avoided unless symptoms are severe, there is diagnostic uncertainty, or there are alarm features suggesting gastrointestinal bleeding.
Basis for recommendation
  • CKS could find no UK guidelines on referral criteria for dyspepsia in pregnancy. These recommendations are based on expert opinion [Ali and Egan, 2007], and extrapolated from the National Institute for Health and Clinical Excellence guidance Dyspepsia: Management of dyspepsia in adults in primary care [NICE, 2005].

© NHS Institute for Innovation and Improvement