What is normally done if you develop dyspepsia? cont

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Test for H. pylori infection and treat if it is present

A test to detect H. pylori is commonly done if you have frequent bouts of dyspepsia. As mentioned, it is the underlying cause of most duodenal and stomach ulcers, and some cases of gastritis, duodenitis and functional dyspepsia.

A common test for H. pylori is the 'stool antigen test'. In this test you give a pea-sized sample of your faeces (stools) which is tested for H. pylori. An alternative test is a 'breath test'. (A sample of your breath is analysed to detect the H. pylori bacterium after you take a special drink.)

If you are found to be infected with H. pylori then treatment may cure the symptoms. Briefly, to clear H. pylori infection it involves a short course of two antibiotics plus an acid suppressing medicine. (Another leaflet deals with the treatment of H. pylori in more detail.) It is important to take the full course exactly as prescribed for the best chance of clearing H. pylori from the gut.

If symptoms go after treating for H. pylori, then that is the end of the matter. (As no other tests are done if symptoms go, you will not know exactly what caused the symptoms - that is if you had an ulcer, or gastritis, or functional dyspepsia. But it does not matter if symptoms go as whatever was causing the symptoms will have gone!)

Trial of acid suppressing medication

A one month trial of full dose medication which reduces stomach acid may be considered. In particular, if:

Symptoms are more suggestive of acid reflux or oesophagitis. H. pylori does not cause these problems.
If infection with H. pylori has been ruled out.
If H. pylori has been treated but symptoms persist.

There are two groups of medicines which reduce stomach acid - 'proton pump inhibitors' and 'H2 antagonists'. They work in different ways to block the cells in the stomach lining from making acid. There are several brands in each group. A proton pump inhibitor (such as omeprazole, lansoprazole, pantoprazole, rabeprazole, or esomeprazole) tends to be tried first.

Reducing acid in the stomach can help in many cases of dyspepsia, whatever the underlying cause. If medication helps, then further courses may be advised if symptoms persist. Some people take acid suppressing medication 'on-demand' (that is, waiting for symptoms to develop before taking treatment). Some people take them regularly if symptoms occur each day.