Guidelines for managing patients with dyspepsia in primary carePublished: 16th September 2020
Dyspepsia is a term that describes a collection of symptoms that affect the oesophagus (gullet), stomach or duodenum (the first part of the small intestine). It is sometimes called indigestion.
Non-ulcer dyspepsia is the diagnosis given to a patient who has symptoms of dyspepsia when no specific medical cause can be found. It is a very common problem, 6 out of 10 people who experience indigestion are diagnosed with non-ulcer dyspepsia. It is also sometimes referred to as ‘functional dyspepsia’.
Symptoms of non-ulcer dyspepsia include mild to severe upper abdominal discomfort which may be described as burning, nausea, vomiting, belching, bloating and feeling uncomfortably full after meals. Symptoms often come and go, rather than being constant and are particularly worse after eating large meals, eating too quickly and if food is eaten shortly before going to bed. The pain from the upper abdomen may spread up to the centre of the chest (behind the breastbone), into the neck or through to the back.
There is no known single cause of non-ulcer dyspepsia. It is diagnosed once other causes of indigestion such as ulcers, inflammation, reflux disease, a hiatus hernia or a bacterial infection called Helicobacter pylori, have been excluded. This may be done with tests such as endoscopy, barium x rays, CT scans or ultrasound scans.
Non-ulcer dyspepsia is diagnosed by the pattern of symptoms and when all other diagnostics tests undertaken are proved to be negative. It is important that conditions such as ulcers, gallstones and stomach cancer are excluded first and possible investigations include gastroscopy (a tube with a camera passed down the gullet), ultrasound (similar in scans during pregnancy) of the abdomen and a test for Helicobacter pylori infection. In non-ulcer dyspepsia, the lining of the gut will look normal on an endoscopy test. The test for Helicobacter pylori can be a breath test, stool test, blood test or can also be done during a gastroscopy.
The pathway shown below provides guidance on managing patients with dyspepsia in primary care.