Dyspepsia (Indigestion) and GORD

🔍 When to Suspect

A complex of upper gastrointestinal symptoms for ≥4 weeks, including epigastric pain/discomfort, heartburn, acid reflux, bloating, or nausea

From the full topic in The Ocean Library: Dyspepsia (Indigestion) and GORD

🧭 When to suspect

Dyspepsia is a symptom complex, not a diagnosis – a cluster of upper gastrointestinal symptoms usually present for 4 weeks or more.

• Symptoms include epigastric pain or discomfort, heartburn, acid reflux, bloating, early satiety (feeling full quickly), belching or nausea.

• Dyspepsia is extremely common and, in most people, entirely benign.

• Symptoms are often related to eating, stress, alcohol or smoking, or to drugs – particularly NSAIDs.

First, separate the worried-but-well from the sinister:

• Identify alarm features that warrant a suspected cancer pathway referral or admission.

• 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 tricyclic antidepressant (TCA)
GORD	Endoscopic oesophagitis or endoscopy-negative reflux disease	Full-dose PPI to heal, then step down to lowest effective dose or 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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