Dyspepsia: a group of symptoms arising from the upper GI tract

• Dyspepsia is not a diagnosis
• Possible symptoms include: upper abdominal pain / discomfort, heartburn, nausea, vomiting, reflux

There are 2 main types of dyspepsia:

• Uninvestigated dyspepsia - patients with dyspepsia but have NOT had an endoscopy
• Functional dyspepsia - also known as non-ulcer dyspepsia, patients with dyspepsia but normal findings on endoscopy (no ulcer, no malignancy, no oesophagitis)

Offer urgent upper gastrointestinal endoscopy (to be performed within 2 weeks) if:

• Dysphagia alone, or
• ≥55 y/o with weight loss and any of the following:
  • Upper abdominal pain
  • Reflux
  • Dyspepsia

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer.

Consider non-urgent direct access upper gastrointestinal endoscopy in people with haematemesis.

Consider non-urgent direct access upper gastrointestinal endoscopy in ≥55 y/o with:

• Treatment-resistant dyspepsia, or
• Upper abdominal pain with low haemoglobin levels, or
• Raised platelet count with any of the following:
  • Nausea,
  • Vomiting,
  • Weight loss,
  • Reflux,
  • Dyspepsia,
  • Upper abdominal pain, or
• Nausea or vomiting with any of the following:
  • Weight loss.
  • Reflux.
  • Dyspepsia.
  • Upper abdominal pain.

Offer the following to ALL patients:

• Medication review

• Lifestyle advice
  • Healthy eating
  • Weight reduction
  • Smoking cessation
  • Reduce alcohol consumption

 

• Avoid known precipitants associated with their dyspepsia (e.g. smoking, alcohol, coffee, chocolate, fatty food)
• Raising the head of the bed
• Eat smaller meals and eat their evening meal 3–4 hours before going to bed

 

NICE guideline Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
NICE CKS Dyspepsia - unidentified cause
NICE CKS Dyspepsia - proven functional

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