Optimal practice review: recommendation reminders detail
|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.
A 1-month course of treatment with a PPI can be used to stop the stomach from producing acid. The stomach produces acid to help break down food, but sometimes the acid can irritate the stomach and cause indigestion.
Patients with dyspepsia, whose symptoms are not managed with PPIs, are usually tested to see whether they have H. pylori in their stomachs, which is linked to stomach ulcers and dyspepsia. H. pylori is present in most people but causes no harm in the majority of individuals.
There are several ways of testing for H. pylori, including a breath test or a test on a blood or stool (faecal) sample. There are some blood tests for H. pylori that can be done in the GP’s surgery (office-based), but those currently available giveunreliable results. Therefore the NICE guideline development group have stated that office-based serological tests for H. pylori cannot be recommended because of their inadequate performance. The stool antigen tests detects H. pylori antigens in a provided stool sample and was found to be more accurate than blood tests, with a 90–100% sensitivity and specificity.
However, the NICE guideline development group have recommended that there is currently insufficient evidence to recommend the stool antigen test as a test of eradication for H. pylori, and re-testing should be performed using a carbon-13 urea breath test.
This page was last updated: 12 March 2008