Management of uncomplicated PUD

In patients with uncomplicated dyspepsia and no red flag features, the initial approach is to offer lifestyle advice:

• Stop NSAIDs
• Decrease or stop smoking
• Reduce or stop alcohol and illicit drug use
• Weight reduction
• Healthy eating advice

If this fails to resolve symptoms, the patient should be offered a four week trial of a proton pump inhibitor (PPI), or a H. pylori “Test and Treat” strategy as per NICE guidelines [20]. A trial of a H2-receptor antagonist (HRA) can be offered if there is inadequate response to a PPI.

“Test and Treat” involves a non-invasive H. pylori test, eradication of infection in those who test positive, and 4-8 weeks of PPI or HRA for those who test negative. The non-invasive “Test and Treat” strategy is as effective as endoscopy in the management of patients with uncomplicated dyspepsia who are less than 55 years old [20].

Endoscopy is indicated in patients whose symptoms do not resolve following 4-8 weeks of PPI or HRA or eradication therapy.

If symptoms subsequently return, NICE recommend continuing PPI therapy at the  lowest dose required to control symptoms [20].

Learning Bite

Patients who present with uncomplicated dyspepsia, should be given lifestyle advice and advised to attend their GP for further investigation. If symptoms are severe, a PPI or HRA may be prescribed in the interim, although this could delay H. Pylori testing.