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, 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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