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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:
      • Step 1: treat with either a proton pump inhibitor (PPI) at full dose for 1 month, or test and treat for Helicobacter pylori.
      • Step 2: for people who have not responded to a PPI, test and treat for H. pylori. For people who have not responded to treatment for H. pylori, treat with a PPI for 1 month.
      • Step 3: for people responding to neither a PPI nor treatment for H. pylori, prescribe either a prokinetic (metoclopramide, domperidone) or an H2-receptor antagonist for 1 month.
    • 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.

In depth

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