Treatment options

There are several different options for treating dyspepsia:

• Antacids work by neutralising stomach acid and are usually fast but short-acting. Examples include calcium carbonate, magnesium salts and aluminium salts
• Alginates, such as sodium alginate, form a protective raft that sits above the stomach contents and prevents them leaking through the lower oesophageal sphincter
• H2-antagonists such as ranitidine may be tried if the above have not provided relief. These work by inhibiting the production of stomach acid and the effects last several hours, but they should not be used for longer than a few days without medical advice
• Proton pump inhibitors such as omeprazole also work by inhibiting the production of stomach acid, but can take a few days to work. They are also intended for short-term use when purchased over-the-counter (OTC).

With all the above treatment options, it is important to check the product packaging for restrictions, dosing, side effects and other considerations. All can be prescribed as well as purchased OTC, which sometimes alters how they can be used.

Helicobacter pylori eradication therapy may be appropriate. This usually involves taking a proton pump inhibitor plus two antibacterials, generally for a week. Surgery is usually required for a hiatus hernia.

When to refer

Certain dyspepsia symptoms warrant referral, including:

• Unexplained and persistent symptoms in someone aged 55 years or over who has never had them before
• Symptoms in children
• Pain that is severe or worsening, or radiating down the arms or into the back
• Vomit that has blood in it
• Difficulty swallowing or breathing, or chest tightness
• Unintended weight loss
• Symptoms that persist or do not resolve despite trying two or more OTC remedies.

Anyone on medication or with other health conditions should also be referred.