Dyspepsia

Dyspepsia denotes a symptom and not a disease. It is a short-term problem in the majority of patients.

Antacids.

Alginates. Please note there is a lower dosage advised for Gaviscon Advance products compared to Peptac.

Proton pump inhibitors.

Lansoprazole orodispersible tablets are for use only in patients with swallowing difficulties, or for administration via nasogastric or percutaneous endoscopic gastrostomy tube.

Prescribing Notes:

Lifestyle changes are often required, such as raising the head of the bed, weight reduction, reduction of alcohol, smoking cessation and avoidance of aggravating foods.
Compound alginic acid preparations are less powerful antacids than co-magaldrox but may be more effective for heartburn.
PPIs are most effective when taken on an empty stomach, 20-30 minutes before breakfast.
One week’s treatment may be sufficient to determine if dyspepsia will respond and whether it is self-limiting.
Antacids should be used for 10-14 days when withdrawing PPI treatment, to help with rebound symptoms. PPIs should be used with caution in the elderly. There may be an association between PPI use and Clostridioides difficile (C.diff) infection and osteoporosis. Careful consideration should be made to the risk benefit ratio.
Antacids, taken at the same time as other drugs, may impair their absorption. They may also damage enteric coatings designed to prevent irritant drugs from dissolving in the stomach.

History Notes

15/04/2026

Regional formulary chapter launched.

If NSAID-induced gastro-intestinal bleeding or ulceration occurs the NSAID should ideally be stopped, and omeprazole or lansoprazole prescribed.

Omeprazole capsules should be prescribed rather than tablets, as tablets are more expensive with no additional benefit.

Prescribing Notes:

Lansoprazole orodispersible tablets should be reserved for patients with swallowing difficulties or who require a proton pump inhibitor via nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tube. Lansoprazole orodispersible tablets are preferred to omeprazole dispersible tablets.
PPIs are most effective when taken on an empty stomach, 20-30 minutes before breakfast.
Patients receiving low dose aspirin 75mg daily, who are at risk of NSAID-associated ulcers, should be prescribed a proton pump inhibitor concomitantly instead of replacing aspirin with clopidogrel.
PPIs should be used with caution in the elderly. There may be an association between PPI use and Clostridioides difficile (C.diff) infection and osteoporosis. Careful consideration should be made to the risk benefit ratio.
Step down treatment from 20mg omeprazole daily (or equivalent), or "on demand treatment" may be appropriate when symptoms are controlled.
Stepping down treatment is NOT appropriate for the following groups:
- People with complicated oesophagitis (LA Grade C & D).
- People taking PPI for gastroprotection against NSAID.
- Those with a previous bleeding peptic ulcer, remaining H. pylori positive after at least 2 eradication attempts.
Patients should have:
- 2 weeks off PPI and 4 weeks off antibiotics prior to H. pylori faecal antigen test or breath test;
- Antacids/alginates are the preferred treatment during this period;
- Patients on PPIs are encouraged to increase their intake of dietary calcium.

History Notes

15/04/2026

Regional formulary chapter launched.

Antacids.

Alginates. Please note there is a lower dosage advised for Gaviscon Advance products compared to Peptac.

History Notes

15/04/2026

Regional formulary chapter launched.

History Notes

15/04/2026

Regional formulary chapter launched.