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Optimal practice review: recommendation reminders detail

Recommendation reminder 4: Surgery cannot be recommended for the routine management of persistent GORD although individual patients whose quality of life remains significantly impaired may value this form of treatment.

Guidance:Dyspepsia
Date issued:August 2004

Indigestion is the word used to describe pain or discomfort in the chest or upper abdomen that happens, sometimes after meals. The medical word for indigestion is dyspepsia. Indigestion covers a number of symptoms, such as feeling bloated, burping, or feeling or being sick. It also covers reflux, which is where some of the stomach contents come back up towards the mouth. The person feels a burning sensation because of the acid present in the stomach.

Studies have found that each year, dyspepsia occurs in 40% of the population and 5% of the population consult their GP about it.

Initial therapeutic strategies for dyspepsia are empirical treatment with a proton pump inhibitor (PPI) or testing for and treating the bacteria Helicobacter pylori (H. pylori) in the stomach. There is currently insufficient evidence to guide which should be offered first.

Patients diagnosed with gastro-oesophageal reflux disease (GORD), should be offered a course of treatment with a PPI. The course should last for 1 or 2 months. If the PPI is not helping with symptoms, the GP should offer the patient other medicines.

The evidence reviewed by the NICE guideline development group indicated that surgery was no better than long-term medical therapy at achieving remission of symptoms.

Although surgery can help GORD, it should not be offered routinely to everyone because, like all operations, there is a small chance that it can go wrong or cause more problems. But if the patient’s life is being badly affected by their symptoms, the doctor may discuss surgery with them.

This page was last updated: 12 March 2008

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.