31 August 2026Chapter 3: Gastrointestinal disordersPDF page 124Source update: December 2020
Dyspepsia
Full paraphrased clinical guide to dyspepsia symptoms, functional dyspepsia, organic causes, H. pylori, and treatment.
This guide supports clinical education and care navigation. It does not replace bedside judgement, emergency care, specialist advice, or local treatment protocol.
Seek urgent care
- Vomiting blood, black stool, weight loss, difficulty swallowing, persistent vomiting, severe abdominal pain, or anaemia signs.
- New dyspepsia in an older adult or symptoms that persist despite appropriate treatment.
- Chest pain or breathlessness that could be cardiac rather than digestive.
Definition and usual pattern
Dyspepsia is epigastric pain or discomfort after meals, often with bloating, fullness, and nausea.
It is often functional, but organic causes must be considered before settling on that diagnosis.
Functional dyspepsia is a clinical diagnosis after organic disease has been reasonably excluded.
Assessment
- Rule out gastro-oesophageal reflux, gastric or duodenal ulcer, medicine-induced symptoms, gastric cancer, and other organic disease.
- If available, test for Helicobacter pylori.
- Consider intestinal parasites and amoebiasis when the context and symptoms fit.
- Ask about NSAIDs, aspirin, alcohol, tobacco, pregnancy, weight loss, vomiting, dysphagia, melaena, haematemesis, anaemia symptoms, chest pain, age at onset, recurrence, diet triggers, stressors, and previous treatment.
- Examine for pallor, weight loss, dehydration, abdominal tenderness or mass, hepatomegaly, jaundice, and signs that pain may be cardiac rather than digestive.
Treatment
- Address tobacco, alcohol, NSAID or aspirin use, diet triggers, stressors, and medicine causes.
- Do not repeat acid suppression indefinitely without reassessing alarm features and alternative diagnoses.
- Refer for investigation when alarm features are present or symptoms persist despite appropriate care.
| Situation | Treatment direction |
|---|---|
| H. pylori positive | Use the gastric/duodenal ulcer eradication pathway, following local resistance guidance when available. |
| H. pylori negative adult without alarm features | Omeprazole PO 10 mg once daily for 4 weeks may help. |
| Possible intestinal parasites | Investigate or treat according to intestinal protozoa, cestode, nematode, or amoebiasis pathways. |
Complications, prevention, and follow-up
- Complications depend on the underlying cause and include missed ulcer bleeding/perforation, malignancy, medication injury, anaemia, poor intake, and persistent functional impairment.
- Prevention focuses on avoiding unnecessary NSAIDs, reducing alcohol and tobacco, food safety where parasites are a concern, and treating H. pylori when indicated.
- Follow up after treatment to confirm symptom resolution. Reassess earlier for bleeding, dysphagia, weight loss, severe pain, persistent vomiting, anaemia signs, or chest-pain features.
- Handover should include symptom timing, alarm features, H. pylori testing, NSAID/aspirin exposure, alcohol/tobacco use, parasite risk, treatment given, response, and referral plan.
Medicines in this guide
Omeprazole oralShort-course acid suppression option in selected adult dyspepsia.Aluminium hydroxide/Magnesium hydroxide oralUseful when symptoms overlap with reflux and for symptomatic relief according to local protocol.Clarithromycin oralPart of H. pylori eradication regimen when indicated through the ulcer pathway.Amoxicillin oralPart of H. pylori eradication regimen when indicated and no penicillin allergy.Metronidazole oralSubstitute for amoxicillin in penicillin allergy and also relevant when parasites/amoebiasis are considered.
Source
MSF Clinical guidelines - Diagnosis and treatment manual (December 2024)
This page is a paraphrased clinician-oriented guide derived from the source topic on PDF page 124. Medicine-specific details should be checked against local protocol and the linked drug-information pages.