• Dyspepsia is upper abdominal discomfort or pain which may be described as a burning sensation, a heaviness, or an ache. It is often related to eating and may be accompanied by other symptoms such as nausea, fullness in the upper abdomen, or belching.
• Alarm features include one or more of the following:
• Chronic gastrointestinal bleeding.
• Progressive unintentional weight loss.
• Progressive difficulty swallowing.
• Persistent vomiting.
• Iron deficiency anaemia.
• Epigastric mass.
• Suspicion of gastric cancer after investigation with a barium meal.
• Age 55 years or more, presenting with unexplained and persistent recent-onset dyspepsia.

• For people with dyspepsia and significant acute gastrointestinal bleeding arrange immediate admission to hospital.
• For all other people with dyspepsia and alarm features:
• Arrange endoscopy within 14 days and do a full blood count.
• Suspend nonsteroidal anti-inflammatory drugs while awaiting referral. Offer alternative analgesics (e.g. paracetamol and/or opioids).
• The management of other drugs will depend on clinical judgement of the benefits and risks of continued treatment. When there is uncertainty seek specialist advice. Management options include:
• Stopping the drug.
• Reducing the frequency or dose of the drug.
• Substituting the drug for one less likely to cause bleeding or dyspepsia.
• Review and manage lifestyle factors known to exacerbate dyspepsia.
• Prescribe either an alginate or an antacid to relieve dyspepsia whilst awaiting endoscopy. Ensure that proton pump inhibitors or H₂-receptor antagonists (including those obtained over-the-counter) are not used, for a minimum of 2 weeks, before endoscopy.
• Advise those people who deteriorate significantly to seek medical attention.

In depth

• Advise people with dyspepsia that symptoms may improve if they lose weight (if they are overweight), stop or reduce smoking (if they are a smoker), stop or reduce alcohol consumption, and reduce intake of any food or drink associated with worsening symptoms.
• Advise people with reflux symptoms when lying down to avoid having meals within 3–4 hours of going to bed, and to raise the height of the head of the bed by a few inches.

In depth