NICE guidance - management of non-ulcer dyspepsia in primary care

Management of Non-ulcer Dyspepsia (functional dyspepsia) in Primary Care

If H.pylor test is positive then (A) else (B)

Step (A) If H.pylori test is positive

1. Use H pylori eradication therapy as described in linked item. Do not re-test unless there is a strong clinical need.
   1. if no response then (B)
   2. if response then return to self-care

Step (B) if H.pylori test is negative

• low-dose PPI or H2RA for one month, followed by
• low-dose PPI or H2RA as required (offer low-dose treatment, possibly on an as-required basis) then (C)

Step (C) Review - In some patients with an inadequate response to therapy or new emergent symptoms it may become appropriate to refer to a specialist for a second opinion. Emphasise the benign nature of dyspepsia. Review longterm patient care at least annually to discuss medication and symptoms.

Notes:

• avoid long-term, frequent dose, continuous antacid therapy (it only relieves symptoms in the short term rather than preventing them)

For full details then refer to the full guideline (1).

Reference:

1. NICE (September 2014).Dyspepsia and gastro-oesophageal reflux disease - Investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both