Synopsis
Distinguish uncomplicated dyspepsia from cardiac, biliary, pancreatic, ulcer and malignant disease, use Helicobacter pylori testing correctly, and sequence treatment, endoscopy and review safely.
- Dyspepsia includes epigastric pain or burning, postprandial fullness and early satiation; retrosternal heartburn and regurgitation can overlap but point more towards reflux.
- Ask about exertion, breathlessness, diaphoresis and cardiovascular risk because inferior cardiac ischaemia can present as epigastric discomfort, especially in older adults and people with diabetes.
- Dysphagia, weight loss, anaemia, haematemesis, persistent vomiting, an upper abdominal mass and age-linked new symptoms trigger the current endoscopy or suspected-cancer pathway.
Key red flags
Progressive dysphagia, unexplained weight loss with upper abdominal symptoms, iron-deficiency anaemia, persistent vomiting, haematemesis or an epigastric mass moves assessment to the current urgent endoscopy or suspected-cancer pathway.
Investigation priorities
Exclude acute coronary syndrome when epigastric discomfort has exertional, autonomic or cardiovascular-risk features.
Management branches
A patient presents with new or worsening epigastric pain or dyspepsia.
- Check haemodynamics and look for bleeding, peritonism, cardiac ischaemia, jaundice with sepsis and severe dehydration, sending unstable patients to acute care.
- Elicit dysphagia, weight loss, anaemia, persistent vomiting, mass, family history and age-linked onset, then apply the current NG12 and endoscopy pathway.
Stable uninvestigated dyspepsia has no urgent endoscopy indication.
Key medicines
Proton-pump inhibitorUse a full-dose four-week course for uninvestigated dyspepsia under NICE, then step down to the lowest effective or intermittent approach after response review.
Helicobacter pylori eradication therapyGive the current locally recommended one-week combination regimen selected for penicillin allergy, previous antibiotic exposure and regional resistance, then support full adherence.