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 To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?'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 - unidentified cause - Management
How do I manage dyspepsia in a person without alarm features who is not taking an NSAID?
- For people with dyspepsia and significant acute gastrointestinal bleeding, arrange immediate admission to hospital.
- For other people with dyspepsia without alarm features who are not taking a nonsteroidal anti-inflammatory drug (NSAID):
- Do a full blood count if there are any features of anaemia.
- Review and manage drugs known to increase the risk of gastrointestinal bleeding or exacerbate dyspepsia.
- Review and manage lifestyle factors known to exacerbate dyspepsia.
- Prescribe, or advise the use of, an antacid or alginate as required for immediate relief of dyspepsia. Prescribe an alginate if symptoms of gastro-oesophageal reflux are present.
- Prescribe additional drug treatment to settle persistent symptoms:
- Refer those people not responding to all three treatment steps to secondary care for further management.
- For people with recurrent dyspepsia following successful treatment with either an acid suppressing drug or a prokinetic, restart and maintain the treatment but:
- Prescribe the lowest dose that controls symptoms.
- Advise using the treatment on an as required basis when possible.
- Review maintenance treatment at least annually.
Basis for recommendation
These recommendations conform with those made by the National Institute for Health and Clinical Excellence (NICE) [NICE, 2005].
- Basis for doing a full blood count (FBC): experts recommend checking the FBC because, in a person with dyspepsia, iron deficiency anaemia is a risk factor for cancer.
- Basis for recommending empirical treatment for dyspepsia in people who do not have alarm features: evidence from randomized controlled trials found no difference in outcomes when empirical treatment was compared to endoscopically-guided treatment. NICE considers both H. pylori eradication ('test and treat') and acid suppression to be equally valid empirical treatment options as evidence indicates both strategies to be equally cost-effective.
- H2-receptor antagonists (H2RAs) and prokinetics are less preferred for the initial treatment of dyspepsia. Comparative studies from a systematic study found proton pump inhibitors (PPIs) to be more effective than H2RAs in improving symptoms of dyspepsia. Evidence for prokinetics is sparse [NICE, 2005].
- Basis for maintenance treatment and annual review: NICE found little evidence to guide the long term management of patients who are suffering from chronic, persistent dyspepsia. The recommendations are extrapolated from short-term trials, epidemiological evidence and the consensus view of the guideline development group [North of England Dyspepsia Guideline Development Group, 2004]. Periodic medication review is recommended as good clinical practice. Although there is no evidence for the optimal period, NICE recommends the review should occur once a year as a minimum.
© NHS Institute for Innovation and Improvement