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.
| PPI | Full/Standard Dose |
| Esomeprazole | 20mg once a day |
| Lansoprazole | 30mg once a day |
| Omeprazole | 20mg once a day |
| Pantoprazole | 40mg once a day |
| Rabeprazole | 20mg once a day |
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.