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Health condition · Clinically reviewed

Dyspepsia, red flags first, then a NICE-aligned ladder.

Indigestion is common and usually manageable. The trick is spotting the small minority that needs urgent endoscopy, then treating the rest properly.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG184, NG12 and peer-reviewed gastroenterology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including H. pylori test-and-treat, PPI stewardship and 2WW referral criteria.

Key facts

Dyspepsia at a glance.

The essentials, in plain English. What it is, the types, and how it is worked up in UK practice today.

  • What it is

    A symptom complex of upper abdominal pain, burning, fullness, early satiety, belching, nausea and bloating.

  • How common

    Very common. Up to 40 per cent of UK adults report dyspepsia symptoms each year, though only a fraction consult.

  • Types (Rome IV)

    Functional (no structural cause), organic (ulcer, GORD, gastritis, cancer) and undifferentiated.

  • Key driver

    Helicobacter pylori infection remains the single most important treatable cause worldwide.

  • First line

    Lifestyle review, medication review, H. pylori test-and-treat, then empirical PPI for four weeks.

  • Red flags matter

    ALARM features or new-onset symptoms over age 55 trigger a two-week-wait upper GI cancer referral.

Why this guide matters

A stepped plan, not a lifetime of antacids.

Dyspepsia has a well-defined pathway. The three points below shape everything else on this page.

  • Red flags come first

    ALARM features and new-onset symptoms over 55 trigger a two-week-wait upper GI referral before any empirical treatment.

  • H. pylori is often the answer

    A non-invasive test-and-treat approach cures a large share of dyspepsia and prevents ulcers and gastric cancer.

  • PPIs are not for life

    A four-week empirical course, then step down to the lowest effective dose. Long-term open-ended prescribing is discouraged.

How the diagnosis is made

From first symptoms to a clear plan.

The steps a UK GP or gastroenterologist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and red-flag screen

    Duration, character, triggers, medications and ALARM features per NICE NG12. Any red flag changes the pathway immediately.

  2. 02

    Assessing

    Medication and lifestyle review

    NSAIDs, aspirin, bisphosphonates, iron, calcium channel blockers and nitrates all provoke dyspepsia. So do alcohol, smoking and late meals.

  3. 03

    Assessing

    Basic bloods

    FBC, U&Es and LFTs to look for anaemia, renal or hepatic causes and to guide safe prescribing.

  4. 04

    Confirming

    H. pylori testing

    Urea breath test or stool antigen. PPI stopped for two weeks and antibiotics for four weeks before testing to avoid false negatives.

  5. 05

    Confirming

    Endoscopy (OGD) if warranted

    Two-week-wait for red flags. Also considered for age over 55 with persistent or refractory symptoms and for treatment failure.

  6. 06

    Refining

    Further physiology if refractory

    Ambulatory pH-impedance, high-resolution manometry, gastric emptying studies or CT for functional and refractory cases.

  7. 07

    Refining

    MDT and dietitian input

    Gastroenterology, primary care and dietetics work together on refractory, functional and overlap syndromes.

Typical timeline: a first GP visit to a settled plan in a few weeks, sooner if red flags are present.

Symptoms

What dyspepsia actually feels like.

The classic mix of upper abdominal pain, fullness, early satiety, belching and nausea. Plus the features that mean it is time to escalate.

  • Epigastric pain or burning

    The classic upper-central abdominal ache or burning, often after meals. The core symptom of epigastric pain syndrome.

  • Postprandial fullness

    Feeling uncomfortably full after a normal-sized meal. A hallmark of postprandial distress syndrome.

  • Early satiety

    Feeling full early into a meal so you cannot finish a usual portion.

  • Belching and bloating

    Upper abdominal bloating and excess belching, often worse with fizzy drinks or fatty meals.

  • Nausea

    Nausea without vomiting is common. Persistent vomiting is a red flag and needs review.

  • Overlap with reflux

    Heartburn and acid regurgitation often coexist. See our guide to gastro-oesophageal reflux disease.

  • Trigger-related pattern

    Spicy, fatty or acidic foods, alcohol, caffeine, large meals and late-night eating are the usual culprits.

  • Red flag - ALARM features

    Anaemia, weight loss, anorexia, recent onset, melaena or haematemesis, dysphagia or a palpable mass need urgent referral.

Treatment

How dyspepsia is treated in the UK.

Lifestyle and medication review first, H. pylori test-and-treat next, then empirical PPI. Prokinetics and neuromodulators for functional and refractory cases.

  • Lifestyle and diet

    Weight loss, stop smoking, cut alcohol, avoid trigger foods, eat smaller meals earlier, elevate the head of the bed and avoid tight clothing.

  • Medication review

    Stop or substitute NSAIDs, aspirin, bisphosphonates and other culprits where possible. Add PPI cover where the drug must continue.

  • H. pylori test-and-treat

    First-line triple therapy for seven days: PPI plus amoxicillin plus clarithromycin or metronidazole. Confirm eradication after treatment.

  • Empirical PPI

    A four-week course of full-dose omeprazole, lansoprazole, pantoprazole or esomeprazole, then step down to the lowest effective dose.

  • H2 antagonist

    Famotidine as an alternative or second-line acid suppressant when PPIs are unsuitable or partially effective.

  • Antacids and alginates

    Gaviscon and simple antacids give useful symptom relief on demand, particularly for reflux-overlap dyspepsia.

  • Prokinetics

    Domperidone, metoclopramide or prucalopride for functional postprandial distress and gastroparesis. MHRA cardiac warnings apply.

  • Neuromodulators

    Low-dose amitriptyline or an SSRI such as citalopram for refractory functional dyspepsia and visceral hypersensitivity.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gastroenterologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184).

  • NICE. Suspected cancer: recognition and referral (NG12) - upper GI two-week-wait criteria.

  • British Society of Gastroenterology. Guidelines on Helicobacter pylori and functional dyspepsia.

  • MHRA. Domperidone and metoclopramide - cardiac and neurological safety updates.

Red flags

When dyspepsia needs urgent attention.

Most dyspepsia is manageable in primary care. These are the situations that are not, and where a specialist opinion is needed quickly.

  • Haematemesis or melaena

    Vomiting blood or black tarry stools is an upper GI bleed until proven otherwise. Go to A&E.

  • Dysphagia

    Difficulty or pain on swallowing is a two-week-wait criterion. See our guide to dysphagia.

  • Unintentional weight loss

    Any unexplained weight loss with dyspepsia warrants urgent upper GI referral, whatever the age.

  • New onset over age 55

    New dyspepsia in anyone over 55, particularly if persistent, prompts an urgent endoscopy under NG12.

  • Iron-deficiency anaemia

    Iron-deficiency anaemia with upper GI symptoms needs urgent OGD and, usually, colonoscopy too.

  • Palpable epigastric mass

    A palpable upper-abdominal mass with dyspepsia is a two-week-wait upper GI cancer criterion.

  • Progressive or refractory symptoms

    Symptoms that progress despite standard therapy deserve endoscopy and specialist review.

  • Persistent vomiting

    Vomiting that does not settle, particularly with dehydration, points to obstruction or gastroparesis.

  • Family history of upper GI cancer

    A first-degree relative with gastric or oesophageal cancer lowers the threshold for endoscopy.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day. Smaller earlier meals, knowing your triggers, reviewing your medicines and staying alert for red flags.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for weeks do more than a heroic Sunday-night purge that does not last.

  1. 01 Habits

    Small, earlier meals

    Smaller portions eaten earlier in the evening beat large late meals. Give your stomach three hours before lying down.

  2. 02 Triggers

    Learn your own pattern

    Spicy, fatty, acidic, caffeine, alcohol and fizzy drinks are common. A two-week symptom diary usually reveals the culprits.

  3. 03 Meds

    Review the medicine cabinet

    NSAIDs, aspirin, iron and bisphosphonates all provoke dyspepsia. Ask whether any can be stopped, swapped or protected.

  4. 04 Escalate

    Do not accept red flags

    Weight loss, swallowing trouble, vomiting blood, black stools or new symptoms over 55 always deserve urgent review.

Frequently asked

Everything we get asked about dyspepsia.

Quick answers on H. pylori, PPIs, endoscopy and functional dyspepsia.

  • What is dyspepsia?

    Dyspepsia is a symptom complex, not a single disease. It covers upper abdominal pain or burning, fullness after meals, early satiety, belching, nausea and bloating. Rome IV divides it into functional dyspepsia (no structural cause) and organic dyspepsia driven by conditions such as peptic ulcer, gastritis, GORD or, rarely, gastric cancer.

  • Do I need an endoscopy?

    Not always. NICE CG184 supports lifestyle advice, medication review, H. pylori test-and-treat and empirical PPI first. Endoscopy is reserved for red flags (ALARM features), new-onset dyspepsia over age 55 and persistent or refractory symptoms.

  • How is H. pylori tested and treated?

    The two accurate non-invasive tests are the urea breath test and the stool antigen test. Stop PPIs for two weeks and antibiotics for four weeks before testing to avoid a false negative. First-line eradication is a seven-day triple therapy of PPI plus amoxicillin plus clarithromycin or metronidazole, with confirmation of cure afterwards.

  • How long should I stay on a PPI?

    Empirical PPI treatment is typically four weeks at full dose, then step down to the lowest effective dose or on-demand use. Long-term high-dose PPI without a clear indication is discouraged. If symptoms return every time you stop, you deserve a proper diagnostic pathway rather than open-ended prescribing.

  • What is functional dyspepsia?

    Functional dyspepsia is dyspepsia without a structural cause on endoscopy. It has two subtypes: postprandial distress syndrome (fullness and early satiety after meals) and epigastric pain syndrome (upper abdominal pain or burning). Treatment layers lifestyle change, PPI or H2 blocker, prokinetics, low-dose neuromodulators and gut-directed psychological therapy.

  • When is dyspepsia serious?

    The ALARM features - Anaemia, Loss of weight, Anorexia, Recent onset, Melaena or haematemesis, Swallowing difficulty and a palpable Mass - are red flags for upper GI cancer. New dyspepsia over age 55 also triggers a two-week-wait referral. Any of these features should be reviewed the same week, not waited out.

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