Dyspepsia

Dyspepsia Management in Primary Healthcare

Step 1: Assess for alarm signs that require urgent referral & endoscopy:

• Age ≥50 years with new-onset dyspepsia
• Unintended weight loss, Anorexia or early satiety.
• progressive dysphagia or odynophagia, persistent vomiting.
• Gastrointestinal bleeding, anemia, family history of upper GI cancer.

Step 2: Test-and-Treat for H. pylori (Preferred)

• In KSA, H. pylori is relatively common, and antibiotic resistance is high
• Test for H. pylori using stool antigen or urea breath test.
  • If positive → Treat H.pylori using an evidence-based regimen.
  • If negative → proceed to next Step (see step 3)

Step 3: Empirical PPI Therapy

• For patients without alarm signs who tested negative for H. pylori:
  • Initiate PPI (e.g., omeprazole) once daily, typically for 4–8 weeks.
  • Use lowest effective dose, and continue only if symptoms improve

Step 4: Counsel On Long-term Lifestyle and Dietary Modifications

• Avoid NSAIDs & trigger foods (coffee, fatty or spicy meals, caffeine)
• Manage weight, control stress, stop smoking
• Smaller, more frequent meals and upright posture after eating

Step 5: Reassessment at 4–8 Weeks

• Improved? → Gradually taper PPI; consider PRN dosing for maintenance
• Still symptomatic?
  • If H. pylori negative & symptoms persist → Assess adherence & correct use, consider extending PPI to 12 weeks if partially improved, or assess for routine referral if no response is noted.
  • Consider trial of Prokinetic agents (e.g. metoclopramide or domperidone) specially if motility disorders are suspected (e.g. Gastroparesis in longstanding/uncontrolled DM).
• Routine referral if:
  • Persistent and bothersome symptoms despite ≥3 months of optimized management in PHC.
  • Possible structural disease not ruled out or unclear diagnosis.

Author: Dr. Fahad Saad Almutairi

Reviewer: Dr. Bader Thuwaini Alanazi