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Dyspepsia - unidentified cause - Management
How do I manage dyspepsia in a person taking an NSAID who does not have alarm features?

  • For people with dyspepsia and significant acute gastrointestinal bleeding, arrange immediate admission to hospital.
  • For people with nonsteroidal anti-inflammatory drug (NSAID)-induced dyspepsia without alarm features:
    • Do a full blood count if there are any features of anaemia.
    • Prescribe, or advise the use of, an antacid or alginate for immediate relief of dyspepsia as required.
    • Review and manage lifestyle factors known to exacerbate dyspepsia.
    • Review and manage drugs (other than NSAIDs) known to increase the risk of gastrointestinal bleeds or exacerbate dyspepsia.
    • Stop the NSAID if possible, and prescribe a proton pump inhibitor (PPI) for 1 month. Test and treat for Helicobacter pylori infection if symptoms recur.
      • Offer alternative analgesia (paracetamol and/or opioids).
    • When it is not acceptable to stop the NSAID:
      • Prescribe a full-dose PPI for 1 month, and maintain treatment at a dose appropriate to the risk of gastrointestinal bleeding.
      • Test for H. pylori and treat if present.
      • If possible, reduce the risk from NSAID use by reducing the frequency or dose of the NSAID, or substituting it for one less likely to cause gastrointestinal symptoms.
    • Refer those people whose symptoms persist despite treatment.

In depth

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