1Assess for alarm signs that require urgent referral & endoscopy
- Age ≥50 years with new-onset dyspepsia.
- Unintended weight loss, anorexia, or early satiety.
- Progressive dysphagia or odynophagia, persistent vomiting.
- GI bleeding, anemia, or family history of upper GI cancer.
2Test-and-Treat for H. pylori (Preferred)
- In KSA, H. pylori is relatively common and antibiotic resistance is high.
- Test using stool antigen or urea breath test.
- Positive → treat with an evidence-based regimen.
- Negative → proceed to Step 3.
3Empirical PPI Therapy
- For patients without alarm signs who tested negative for H. pylori:
- Initiate PPI (e.g., omeprazole) once daily for 4–8 weeks.
- Use the lowest effective dose and continue only if symptoms improve.
4Counsel on long-term lifestyle and dietary modifications
- Avoid NSAIDs and trigger foods (coffee, fatty or spicy meals, caffeine).
- Manage weight, control stress, stop smoking.
- Smaller, more frequent meals; upright posture after eating.
5Reassessment at 4–8 weeks
- Improved → gradually taper PPI; consider PRN dosing for maintenance.
- Still symptomatic:
- If H. pylori negative & symptoms persist → assess adherence, consider extending PPI to 12 weeks, or routine referral if no response.
- Consider prokinetic (metoclopramide, domperidone) if motility disorders suspected (e.g., gastroparesis in long-standing/uncontrolled DM).
- Routine referral if:
- Persistent bothersome symptoms despite ≥3 months of optimized management.
- Possible structural disease not ruled out or unclear diagnosis.