Practice BMJ Masterclass for GPs

Dyspepsia and Helicobacter pylori

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39014.468900.BE (Published 04 January 2007) Cite this as: BMJ 2007;334:41
  1. Rupal Shah, GP principal
  1. 1Battersea, London
  1. roo_tindall{at}hotmail.com

    Practical tips

    • Dyspepsia is common, and most patients with dyspepsia do not need referral. Of those referred for endoscopy, some 30% are normal, and only 2% show malignancy. Mortality from endoscopy is 0.0001–0.0005%

    • For dyspepsia without alarm symptoms, to “test and treat” for Helicobacter pylori or to give a proton pump inhibitor empirically is more economical than referral for endoscopy

    • Review patients who have been taking acid suppression treatment for more than six weeks, to step down or stop treatment if feasible

    • Gastric ulcers found during endoscopy usually need at least 4 weeks' treatment with a full dose proton pump inhibitor as well as H pylori eradication. Patients should then have a repeat endoscopy because of the small (2%) risk of cancer

    • For patients at high risk of peptic ulcer disease (elderly, with a history of ulcers, or taking drugs that can cause ulcers) who test positive for H pylori, consider giving eradication treatment before starting regular treatment with non-steroidal anti-inflammatory drugs

    Dyspepsia is common; up to 40% of adults in the United Kingdom have the condition. A general practitioner will see on average 210 patients with dyspepsia each year (around 4% of all consultations) and will refer about one in 10 of these patients for more investigations. Around 10-20% of people who use non-steroidal anti-inflammatory drugs will develop peptic ulcer disease that can be detected with endoscopy. The annual cost of drugs that inhibit acid secretion in the UK is about £500m.

    What should I already know about this condition?

    Dyspepsia is not a diagnosis. It is a term used to describe a range of symptoms, from upper abdominal pain to heartburn, nausea, bloating, and retrosternal pain. Most dyspepsia is “functional,” which means no abnormalities are found on endoscopy. The National Institute for Health and Clinical Excellence (NICE) has produced clear guidelines on when you should refer patients …

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