ABSTRACT
CLINICAL FEATURES Heartburn (retrosternal/epigastric burning). ➤ Postprandial epigastric pain. ➤ Nocturnal symptoms may be associated with poor sleep and respiratory problems ➤ secondary to aspiration. Alarm features indicating the need for specialist referral for consideration of ➤ endoscopy include:1
dysphagia/odynophagia — persistent vomiting — unexplained weight loss — iron defi ciency anaemia — epigastric mass — aged 55 or older with unexplained and persistent recent-onset dyspepsia alone. —
LONG-TERM CONSEQUENCES Barrett’s oesophagus and oesophageal cancer. ➤ Oesophageal stricture/ulceration. ➤ Chronic cough. ➤
DIAGNOSIS May be complicated by: ➤
atypical symptoms — comorbidity, e.g. ischaemic heart disease. —
TREATMENT General advice: ➤
avoid large meals — avoid lying down aft er eating — lose weight if overweight — stop smoking — reduce alcohol intake — elevate head of bed. —
Discontinue contributing medication if possible (otherwise continue with PPI ➤ prophylaxis). PPIs are the treatment of choice. ➤ NICE guidelines for PPI use in dyspepsia: ➤
i mild dyspepsia: antacids, alginates or H2 receptor antagonists before PPI.•
ii severe dyspepsia: healing dose PPI until symptoms controlled then lowest dose to maintain • control restart at higher dose if recurrent symptoms.•
