GPAtlas🧭 When to suspect
Dyspepsia is a symptom complex, not a diagnosis – a cluster of upper gastrointestinal symptoms usually present for 4 weeks or more, including epigastric pain or discomfort, heartburn, acid reflux, bloating, early satiety (feeling full quickly), belching or nausea. It is extremely common and, in most people, entirely benign. Symptoms are often related to eating, stress, alcohol or smoking, or to drugs – particularly NSAIDs.
The single most important task in primary care is to separate the worried-but-well from the sinister: identify alarm features that warrant urgent endoscopy or admission, and for everyone else, manage pragmatically with a medication and lifestyle review, then either empirical acid suppression or H. pylori ‘test and treat’. A secondary skill is prescribing discipline – avoiding open-ended, unreviewed proton pump inhibitor (PPI) use.
It helps to hold four overlapping clinical pictures in mind:
| Clinical picture | What it means | Primary-care relevance |
|---|---|---|
| Uninvestigated dyspepsia | Dyspeptic symptoms, no alarm features, no endoscopy (yet) | Manage empirically – full-dose PPI or H. pylori test and treat |
| Functional (non-ulcer) dyspepsia | Persistent dyspepsia with a normal endoscopy | Commonest cause; reassure, eradicate H. pylori, low-dose PPI/H2RA, consider low-dose TCA |
| GORD | Endoscopic oesophagitis or endoscopy-negative reflux disease | Full-dose PPI to heal, then step down to lowest effective dose / on-demand |
| Peptic ulcer disease | Gastric or duodenal ulcer, usually H. pylori- or NSAID-related | Eradicate H. pylori, stop NSAID, heal with PPI; re-scope gastric ulcers |
Source: NICE CG184 · NICE NG12
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