Persistent or recurrent pain/discomfort centred in upper abdomen — postprandial fullness, early satiety, epigastric pain/burning.
History taking
- • Pattern, relation to meals, relieving factors (antacids)
- • ALARM symptoms: weight loss, dysphagia, GI bleed, vomiting, anaemia, age >55
- • NSAID, alcohol, smoking, H. pylori risk
Examination
- • Epigastric tenderness; otherwise unremarkable
- • Look for anaemia, lymphadenopathy, masses
Red flags
- • Any ALARM symptom
- • New-onset dyspepsia after 55 years
- • Persistent vomiting, melaena, dysphagia
Differential diagnosis
- • Functional dyspepsia, GERD, peptic ulcer disease
- • H. pylori gastritis, gastric malignancy
- • Biliary disease, pancreatitis, cardiac (always rule out)
Recommended investigations
- • Empirical trial often appropriate if <55 and no ALARM
- • H. pylori stool antigen / urea breath test
- • CBC, LFT; upper GI endoscopy if ALARM or refractory
Diagnosis
- • Functional dyspepsia (Rome IV) after exclusion of organic disease
Initial treatment / management
- • Lifestyle: small frequent meals, weight loss, avoid late dinners, alcohol, smoking
- • PPI 4–8 weeks; test-and-treat H. pylori
- • Stop NSAIDs if possible
Prescription examples
- • Tab Pantoprazole 40 mg PO OD before breakfast x 4 weeks
- • H. pylori eradication (Triple): PPI BD + Amoxicillin 1 g BD + Clarithromycin 500 mg BD x 14 d
- • Antacid suspension PRN
Follow-up advice
- • Review at 4 weeks; if persists, endoscopy
- • Test of cure for H. pylori 4 weeks after therapy (off PPI)
Patient counselling
- • Trigger avoidance, weight loss, stress reduction
- • Long-term PPIs have side-effects (Mg, B12 deficiency, osteoporosis)
Referral criteria
- • ALARM symptoms, refractory dyspepsia, suspected malignancy
Clinical pearls
- • Always rule out cardiac cause for epigastric pain in older patients
- • H. pylori eradication cures most peptic ulcers
References
- • ACG Clinical Guideline: Dyspepsia 2017
- • Maastricht VI/Florence Consensus on H. pylori 2022
Educational outpatient guide — verify against local guidelines before clinical use.
