Gastroenterology and hepatology
Indigestion (dyspepsia)
Who needs gastroscopy, testing for and eradicating H. pylori, functional dyspepsia under Rome IV and Rome V, the stepwise PPI, tricyclic and prokinetic ladder, and deprescribing PPIs.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Dyspepsia is predominant epigastric pain or burning, postprandial fullness or early satiety, for at least a month. Predominant heartburn or regurgitation is GORD and is managed differently.
- About 3 in 4 investigated patients have functional dyspepsia. Peptic ulcer, oesophagitis and drugs make up most of the rest. Upper GI cancer is under 1%.
- Under 60 without alarm features: test and treat H. pylori, then a PPI. 60 or over, or alarm features: gastroscopy.
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Sources
- Therapeutic Goods Administration. Metoclopramide and neurological adverse events. Medicines Safety Update 2015;6(1)AU/NZTherapeutic Goods Administration, 2015
- Therapeutic Guidelines: Gastrointestinal (eTG complete), dyspepsia and Helicobacter pyloriAU/NZTherapeutic Guidelines Limited
- Moayyedi PM et al. ACG and CAG Clinical Guideline: Management of Dyspepsia. Am J Gastroenterol 2017;112:988-1013American College of Gastroenterology and Canadian Association of Gastroenterology, 2017
- Chey WD et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 2024;119:1730-53American College of Gastroenterology, 2024
- Malfertheiner P et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut 2022European Helicobacter and Microbiota Study Group (Gut), 2022
- Black CJ et al. British Society of Gastroenterology guidelines on the management of functional dyspepsia. Gut 2022;71:1697-723British Society of Gastroenterology, 2022
- Rome V criteria for disorders of gut-brain interaction (Gastroenterology, 2026)Rome Foundation, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy