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NICE updates guidance to help the NHS care for adults with indigestion (dyspepsia) and other common but potentially serious digestive disorders.

The National Institute for Health and Care Excellence (NICE) has updated its guidance to help the NHS care for adults with indigestion (dyspepsia)[1] and other common but potentially serious digestive disorders.

For the first time, the NICE guidance applies to hospitals and specialist NHS services. This comes after concerns that a lack of national guidance meant some patients may not be receiving the most effective care or treatment.

It’s thought that nearly half of all UK adults will experience dyspepsia (as defined by the British Society of Gastroenterology) every year.

Professor Mark Baker, clinical practice director at NICE, said: “Dyspepsia is most commonly known as indigestion and is normally not serious. However, it can also be a sign of an underlying health problem like stomach ulcers and gastro-oesophageal reflux disease (GORD)[2], a condition which can lead to Barrett’s oesophagus[3] – a risk factor for cancer.

“Our original guidance in 2004 was aimed solely at supporting GPs and community pharmacists to treat dyspepsia and its related conditions. However, as time went on it became clear that hospitals would benefit from comprehensive national guidance about how best to manage conditions like GORD, particularly when drug treatments fail.

Professor Baker continued: “New evidence has also come to light about the cost and most effective use of treatments and diagnostic equipment for dyspepsia and its related conditions. By updating our guidance to cover these key areas, it will support healthcare professionals across primary and secondary care to offer consistent and high-quality care to patients throughout England and Wales.”

The updated guideline includes new recommendations on the best way to eradicate H. pylori – a bacteria which causes stomach ulcers[4] - in people who have tested positive for it, and when a referral to more specialist services should be considered.

The guideline also includes new recommendations to help doctors treat patients with GORD, such as:

• Offering people a full-dose proton pump inhibitor (PPI)[5] for 8 weeks to heal severe oesophagitis[6], a condition commonly caused by GORD. This should take into account the person’s preference and clinical circumstances (for example, any underlying health conditions and possible interactions with other drugs).

• Not routinely offering endoscopy to diagnose Barrett’s oesophagus, but should consider this procedure if the person has GORD.

The updated NICE guidance on the diagnosis and care of dyspepsia and GORD is now available to download the NICE website.

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

Explanation of terms

1. The British Society of Gastroenterology defines dyspepsia as a group of symptoms that alert doctors to consider disease of the upper gastrointestinal (GI) tract, and states that dyspepsia itself is not a diagnosis. These symptoms, which typically are present for 4 weeks or more, include upper abdominal pain or discomfort, heartburn, gastric reflux, nausea, or vomiting. It is estimated that about 40% of UK adults will experience dyspepsia each year.
   Most cases of dyspepsia have no known cause. However, it can be caused by peptic ulcers of the stomach or duodenum (stomach ulcers), acid reflux, gastro-oesophageal reflux disease (GORD), Barrett’s Oesophagus and infection with H. pylori.
2. GORD is a relatively common condition where acid leaks out of the stomach and into the oesophagus. Symptoms include heartburn, an unpleasant sour taste in the mouth and difficulty swallowing. It can be severe or frequent enough to damage the oesophagus.
3. Barrett’s oesophagus is a condition that affects the lower part of the throat. The cells that line the affected area change and become ‘abnormal’. These abnormal cells are not themselves cancerous, but they are much more likely to develop into cancer than normal cells. It is thought that long-term acid reflux can cause this condition and that about 1 in 20 people who have recurring acid reflux eventually develop Barrett's oesophagus.
4. H. pylori is bacteria that can infect the lining of the stomach and duodenum (first part of the small intestine). It is one of the most common infections in the UK and is the most common cause of stomach ulcers.
5. Proton pump inhibitors (PPIs) are a group of drugs designed to reduce the amount of acid made by the stomach. They are widely used as a treatment for dyspepsia and its related conditions (stomach ulcers, GORD etc.).
6. Oesophagitis is caused by inflammation of the lining of the throat and gullet (oesophagus). It is a common complication of GORD because stomach acid can irritate and inflame the lining of the oesophagus.

About the guidance 

1. The updated guideline is available on the NICE website.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.