Gastro-oesophageal reflux disease and dyspepsia in adults_ investigation and management _ 1-recommendations _ guidance and guidelines _ nice

The following guidance is based on the best available evidence. Chronic stomach aches in child The full guideline gives details of the methods and the evidence used to develop the guidance.

The wording used in the recommendations in this guideline (for example, words such as ‘offer’ and ‘consider’) denotes the certainty with which the recommendation is made (the strength of the recommendation).


What causes frequent stomach aches See about this guideline for details.

These recommendations apply to adults (aged 18 and over) with symptoms of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease (GORD), or both.

1.1.1 Community pharmacists should offer initial and ongoing help for people with symptoms of dyspepsia. What causes stomach cramps before bowel movement This includes advice about lifestyle changes, using over-the-counter medication, help with prescribed drugs and advice about when to consult a GP. What causes stomach aches and headaches [2004]

1.1.2 Community pharmacists should record adverse reactions to treatment and may participate in primary care medication review clinics. What causes stomach cramps in early pregnancy [2004]

1.2.1 Offer simple lifestyle advice, including advice on healthy eating, weight reduction and smoking cessation. Frequent stomach aches and diarrhea [2004]

1.2.2 Advise people to avoid known precipitants they associate with their dyspepsia where possible. What’s good for stomach cramps These include smoking, alcohol, coffee, chocolate, fatty foods and being overweight. What causes stomach aches and back pain Raising the head of the bed and having a main meal well before going to bed may help some people. Frequent stomach aches and bowel movements [2004]

1.2.3 Provide people with access to educational materials to support the care they receive. I always have stomach aches [2004]

1.2.4 Recognise that psychological therapies, such as cognitive behavioural therapy and psychotherapy, may reduce dyspeptic symptoms in the short term in individual people. What causes stomach cramps diarrhea [2004, amended 2014]

1.2.5 Encourage people who need long-term management of dyspepsia symptoms to reduce their use of prescribed medication stepwise: by using the effective lowest dose, by trying ‘as-needed’ use when appropriate, and by returning to self-treatment with antacid and/or alginate therapy (unless there is an underlying condition or comedication that needs continuing treatment). Why do i keep getting stomach aches [2004, amended 2014]

1.3.1 For people presenting with dyspepsia together with significant acute gastrointestinal bleeding, refer them immediately (on the same day) to a specialist. Why do we get stomach aches [2004] (Also see Acute upper gastrointestinal bleeding [NICE clinical guideline 141].)

1.3.2 Review medications for possible causes of dyspepsia (for example, calcium antagonists, nitrates, theophyllines, bisphosphonates, corticosteroids and non-steroidal anti-inflammatory drugs [NSAIDs]). What causes stomach cramps during pregnancy In people needing referral, suspend NSAID use. What is good for stomach cramps [2004]

1.3.3 Think about the possibility of cardiac or biliary disease as part of the differential diagnosis. How do you get rid of stomach aches [2004, amended 2014]

1.3.4 If people have had a previous endoscopy and do not have any new alarm signs [ 2], consider continuing management according to previous endoscopic findings. Stomach aches and pains [2004]

For more information about when to refer people to specialists when they present with symptoms that could be caused by cancer, see Referral for suspected cancer (NICE clinical guideline 27 [update in progress; publication expected May 2015: http://www.nice.org.uk/Guidance/InDevelopment/GID-CGWAVE0618]).

1.4.1 Be aware that dyspepsia in unselected people in primary care is defined broadly to include people with recurrent epigastric pain, heartburn or acid regurgitation, with or without bloating, nausea or vomiting. What causes stomach aches at night Also see Common elements of care. Chronic stomach aches after eating [2004, amended 2014]

1.4.2 Leave a 2?week washout period after proton pump inhibitor (PPI) use before testing for Helicobacter pylori (hereafter referred to as H pylori) with a breath test or a stool antigen test. What causes stomach discomfort after eating [2004, amended 2014]

1.4.3 Offer empirical full-dose PPI therapy (see table 1 in appendix A) for 4 weeks to people with dyspepsia . Keep getting stomach aches [2004]

1.4.4 Offer H pylori ‘test and treat’ to people with dyspepsia. Frequent stomach aches in child [2004]

1.4.5 If symptoms return after initial care strategies, step down PPI therapy to the lowest dose needed to control symptoms. What causes stomach aches and nausea Discuss using the treatment on an ‘as-needed’ basis with people to manage their own symptoms. Frequent stomach aches in the morning [2004]

1.4.6 Offer H 2 receptor antagonist (H 2RA) therapy if there is an inadequate response to a PPI. Regular stomach aches [2004, amended 2014]

1.6 Interventions for gastro-oesophageal reflux disease (GORD)

1.6.1 Manage uninvestigated ‘reflux-like’ symptoms as uninvestigated dyspepsia. What’s good for stomach ache [2004, amended 2014]

1.6.2 Offer people with GORD a full-dose PPI (see table 1 in appendix A) for 4 or 8 weeks. Frequent stomach aches after eating [2004]

1.6.3 If symptoms recur after initial treatment, offer a PPI at the lowest dose possible to control symptoms. Frequent stomach aches and gas [2004, amended 2014]

1.6.4 Discuss with people how they can manage their own symptoms by using the treatment when they need it. What is good for stomach aches [2004]

1.6.5 Offer H 2RA therapy if there is an inadequate response to a PPI. What causes stomach aches [2004, amended 2014]

1.6.6 People who have had dilatation of an oesophageal stricture should remain on long-term full-dose PPI therapy (see table 1 in appendix A). What causes stomach cramps during period [2004]

1.6.7 Offer people a full-dose PPI (see table 2 in appendix A) for 8 weeks to heal severe oesophagitis, taking into account the person’s preference and clinical circumstances (for example, underlying health conditions and possible interactions with other drugs). Chronic stomach discomfort causes [new 2014]

1.6.8 If initial treatment for healing severe oesophagitis fails, consider a high dose of the initial PPI, switching to another full-dose PPI (see table 2) or switching to another high-dose PPI (see table 2 in appendix A), taking into account the person’s preference and clinical circumstances (for example, tolerability of the initial PPI, underlying health conditions and possible interactions with other drugs). Child has frequent stomach aches [new 2014]

1.6.9 Offer a full-dose PPI (see table 2 in appendix A) long-term as maintenance treatment for people with severe oesophagitis, taking into account the person’s preference and clinical circumstances (for example, tolerability of the PPI, underlying health conditions and possible interactions with other drugs), and the acquisition cost of the PPI. Child with frequent stomach aches [new 2014]

1.6.10 If the person’s severe oesophagitis fails to respond to maintenance treatment, carry out a clinical review. What causes stomach cramps at night Consider switching to another PPI at full dose or high dose (see table 2 in appendix A), taking into account the person’s preference and clinical circumstances, and/or seeking specialist advice. Frequent stomach aches [new 2014]

1.6.11 Do not routinely offer endoscopy to diagnose Barrett’s oesophagus, but consider it if the person has GORD. What causes stomach aches in the morning Discuss the person’s preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender). What medicine helps stomach aches [new 2014]

1.7.1 Offer H pylori eradication therapy to people who have tested positive for H pylori and who have peptic ulcer disease. Things to help stomach aches Also see H pylori testing and eradication. What tea good for stomach ache [2004]

1.7.2 For people using NSAIDs with diagnosed peptic ulcer, stop the use of NSAIDs where possible. I get stomach aches every day Offer full-dose PPI (see table 1 in appendix A) or H 2RA therapy for 8 weeks and, if H pylori is present, subsequently offer eradication therapy. Is 7up good for stomach aches [2004]

1.7.3 Offer people with gastric ulcer and H pylori repeat endoscopy 6 to 8 weeks after beginning treatment, depending on the size of the lesion. What helps for stomach aches [2004, amended 2014]

1.7.4 Offer people with peptic ulcer (gastric or duodenal) and H pylori retesting for H pylori 6 to 8 weeks after beginning treatment, depending on the size of the lesion. What helps with stomach aches [2004, amended 2014]

1.7.5 Offer full-dose PPI (see table 1 in appendix A) or H 2RA therapy for 4 to 8 weeks to people who have tested negative for H pylori who are not taking NSAIDs. What causes stomach cramps in newborn babies [2004]

1.7.6 For people continuing to take NSAIDs after a peptic ulcer has healed, discuss the potential harm from NSAID treatment. What helps stomach aches and nausea Review the need for NSAID use regularly (at least every 6 months) and offer a trial of use on a limited, ‘as-needed’ basis. My stomach aches Consider reducing the dose, substituting an NSAID with paracetamol, or using an alternative analgesic or low-dose ibuprofen (1.2 g daily). What’s good for stomach aches and diarrhea [2004]

1.7.7 In people at high risk (previous ulceration) and for whom NSAID continuation is necessary, consider a COX-2 selective NSAID instead of a standard NSAID. What causes stomach aches during pregnancy In either case, prescribe with a PPI . What can help stomach aches [2004, amended 2014]

1.7.8 In people with an unhealed ulcer, exclude non-adherence, malignancy, failure to detect H pylori, inadvertent NSAID use, other ulcer?inducing medication and rare causes such as Zollinger–Ellison syndrome or Crohn’s disease. How to make stomach aches go away [2004]

1.7.9 If symptoms recur after initial treatment, offer a PPI to be taken at the lowest dose possible to control symptoms. How to help stomach aches Discuss using the treatment on an ‘as-needed’ basis with people to manage their own symptoms. What causes stomach discomfort and gas [2004, amended 2014]

1.7.10 Offer H 2RA therapy if there is an inadequate response to a PPI. What causes bad stomach aches [2004]

1.8.1 Manage endoscopically determined functional dyspepsia using initial treatment for H pylori if present, followed by symptomatic management and periodic monitoring. Frequent stomach aches and headaches [2004]

1.8.2 Offer eradication therapy to people testing positive for H pylori. What causes stomach aches and bloating [2004]

1.8.3 Do not routinely offer re-testing after eradication, although the information it provides may be valued by individual people. What causes stomach cramps during exercise [2004]

1.8.4 If H pylori has been excluded and symptoms persist, offer either a low-dose PPI (see table 1 in appendix A) or an H 2RA for 4 weeks. What causes stomach cramps when running [2004, amended 2014]

1.8.5 If symptoms continue or recur after initial treatment, offer a PPI or H 2RA to be taken at the lowest dose possible to control symptoms. What causes stomach aches and gas [2004, amended 2014]

1.8.6 Discuss using PPI treatment on an ‘as-needed’ basis with people to manage their own symptoms. Frequent stomach aches during pregnancy [2004]

1.8.7 Avoid long-term, frequent dose, continuous antacid therapy (it only relieves symptoms in the short term rather than preventing them). What causes stomach aches everyday [2004, amended 2014]

1.9.1 Test for H pylori using a carbon?13 urea breath test or a stool antigen test, or laboratory-based serology where its performance has been locally validated. What helps stomach aches go away [2004, amended 2014]

1.9.2 Perform re-testing for H pylori using a carbon?13 urea breath test. What causes stomach aches and diarrhea (There is currently insufficient evidence to recommend the stool antigen test as a test of eradication [ 3].) [2004]

1.9.3 Do not use office-based serological tests for H pylori because of their inadequate performance. What causes stomach aches and vomiting [2004, amended 2014]

Choose the treatment regimen with the lowest acquisition cost, and take into account previous exposure to clarithromycin or metronidazole. I keep getting stomach aches [new 2014]

1.9.5 Offer people who are allergic to penicillin [ 4] a 7?day, twice-daily course of treatment with:

1.9.7 Discuss treatment adherence with the person and emphasise its importance. What causes painful stomach gas For more information about supporting adherence, see Medicines adherence (NICE clinical guideline 76). Always have stomach aches [new 2014]

a confirmed diagnosis of acid reflux and adequate symptom control with acid suppression therapy, but who do not wish to continue with this therapy long term

a confirmed diagnosis of acid reflux and symptoms that are responding to a PPI, but who cannot tolerate acid suppression therapy. What causes stomach cramps after you eat [new 2014]

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