Indigestion / Dyspepsia
Please refer to the BNF or SPC for licenced indications, doses, contraindications and other
prescribing information.
--------------------------------------------------------------------------------------------------------------------------------Definition/Criteria
Indigestion/dyspepsia are terms used to describe a number of symptoms often occurring shortly
after eating or drinking. It is important to clarify exactly what the patients mean by the term
indigestion.
Symptoms: upper abdominal or epigastria pain or discomfort. Retrosternal pain.
Flatulence/belching. Heartburn. Nausea and, or vomiting. Feeling of fullness in the abdomen.
Acid taste in the mouth. Symptoms may be released or worsened by food.
--------------------------------------------------------------------------------------------------------------------------------Criteria for INCLUSION
Treat Patients who present with characteristic symptoms of indigestion/dyspepsia.
----------------------------------------------------------------------------------------------------------------------------Criteria for EXCLUSION
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Adverse drug reaction suspected
Suspected or previous history of duodenal ulcer/gastric ulcer
Pregnant and breast feeding women
Patients <18 years
Patients with anaemia
Patients taking prescribed NSAIDS
Patients with alarm symptoms:
o Patients over 55 with persistent unexplained recent onset dyspepsia.
Patients of any age with the following symptoms:
o Unintentional weight loss
o Dysphagia
o Pain on swallowing
o Persistent vomiting or vomiting with blood
o Gastrointestinal bleeding/blood in stools/jaundice
o Patients who have taken an indigestion/dyspepsia remedy for two weeks
with no relief of symptoms
---------------------------------------------------------------------------------------------------------------------------Action for excluded patients and non-complying patients
Refer to GP
--------------------------------------------------------------------------------------------------------------------------------Action for patients who are included for treatment
Advice
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Explain - diet and habitual eating patterns, caffeine, alcohol, certain medicines,
stress, smoking, weight and hiatus hernia are all precipitating factors
Advise to stop smoking, moderate alcohol intake and lose weight (where
appropriate)
Reduce caffeine intake
Eat small meals slowly and regularly, avoid or reduce foods e.g. spicy, which may
aggravate the problem
Avoid bending or stooping, wearing tight clothes/belts as these may be aggravating
factors
Avoid taking NSAIDs or other precipitating medicines where possible
Advise that regular use of indigestion remedies may mask the symptoms of
gastric cancer
Alert patient to the alarm symptoms of gastric cancer
---------------------------------------------------------------------------------------------------------Treatment choice from the formulary
Gaviscon Advance Liquid
500ml
The sodium content of some antacids may be important when a highly restricted salt diet
is required.
Supply: One treatment course in any twelve-month period
-------------------------------------------------------------------------------------------------------------------------------Routine referral to GP*
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Suspected or previous history of duodenal or gastric ulcer
Patient needs to continue NSAIDs or other medicines suspected of causing the
symptoms
Patients taking prescribed NSAIDs with or without a PPI
Symptoms that persist longer than 2 weeks
Patients <18 years
Pregnant or breastfeeding women
Patients requiring repeated courses of treatment
Referral to GP within 24 hours*
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See GP urgently if alarm signs
Patients with alarm symptoms:
o Patients over 55 with persistent unexplained recent onset dyspepsia.
Patients of any age with the following symptoms:
o Unintentional weight loss
o Dysphagia
o Pain on swallowing
o Persistent vomiting or vomiting with blood
o Gastrointestinal bleeding/blood in stools/jaundice
o Patients who have taken an indigestion/dyspepsia remedy for two weeks
with no relief of symptoms
-----------------------------------------------------------------------------------------------------------Emergency referral to A&E
Pain is sudden and radiates to the back and arms
N.B. It is not possible to list all referral criteria and this should be used as a guide.
Professional judgement must be used when considering if an emergency referral is
required
-----------------------------------------------------------------------------------------------* The pharmacist should complete a referral note for the patient to hand to the surgery
detailing why the patient was unable to be treated under the MAS.
Version 1.0 29/10/14